Meet the Other Phone. Child-safe in minutes.

Meet the Other Phone.
Child-safe in minutes.

Buy now

Please or to access all these features

AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To ask for an maternal choice elective C-section?

259 replies

Miphy · 29/07/2021 20:23

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?

OP posts:
Darkstar4855 · 29/07/2021 21:51

@Miphy “Also if I do go for VD I am going to be an absolute nightmare for whichever poor midwife gets me checking the CTG”

Hopefully you won’t need one! I only went on it at the end when progress stalled. I actually found it very reassuring though because I could hear that he was coping fine (did 3 years of O&G so have a good ear for a FH!) so it helped me to feel calm.

EarringsandLipstick · 29/07/2021 21:53

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!

Completely understand OP!

And we all have our beliefs / biases etc. I know personally I wanted, and probably expected, SVD. I have been so fortunate that I did have positive, straightforward experiences. Even reading accounts on this thread fills me with awe for women who had challenging problematic births, and do it again, and cope admirably.

I became v sick shortly after my 3rd baby & had to go back into hospital. I was only in a few days, grand then. But I remember being so shook, I had a 2 yo & 4yo at home, a desperately unsupportive H (who was to become an ex shortly after) and I remember how awful it all was. And I certainly had nothing as much as other women to deal with.

VestaTilley · 29/07/2021 21:59

I had a vaginal delivery - back-to-back baby, epidural, induced, spinal in theatre, episiotomy, forceps, 1.2 litres of blood loss, transfusions - the works.

Two years later I still have pain when I have my period or stand for too long.

But on the other hand, DH’s SIL has had three DC: quick labours, little-no tearing, quick recovery etc.

The problem is there’s no way of knowing. You may have a section which may have complications. You may have a “straightforward” vaginal delivery (still hurts like hell though I’m afraid) or you may not- but you can’t know in advance.

I think my scarring is pretty bad, so I’d be tempted to have an elective c section next time myself, and yet after all I went through last time, I’d still consider a vaginal delivery. Mad? Yes, probably.

A surgeon friend had two c-sections: an emergency one with DC1 then elective second time. She said all the obs and gynae doctors always have them Grin - how old are you too? If you’re over 35 you may end up with an emergency section anyway.

Good luck OP. Nobody can really know what to do for the best, so go with your gut.

taybert · 29/07/2021 22:00

YANBU- however….. I’m a doctor too and the closest I ever came to seeing a woman die in childbirth was with an elective section (I can still remember her name well over 10 years later, it was horrendous). The only baby I’ve ever seen cut with a scalpel was in an elective section for maternal choice.

I’m not saying that to scare you, just to remind you that as doctors our perception of risk sometimes gets distorted by the memorable and distressing things. For what it’s worth, I’ve had a section and a normal delivery, both presented their own challenges. Have a chat to a consultant.

EarringsandLipstick · 29/07/2021 22:02

I had a vaginal delivery - back-to-back baby, epidural, induced, spinal in theatre, episiotomy, forceps, 1.2 litres of blood loss, transfusions - the works.

Two years later I still have pain when I have my period or stand for too long

God Vespa that's so tough 🙁

EarringsandLipstick · 29/07/2021 22:02

Vesta even 🤦🏻‍♀️

Dragon50 · 29/07/2021 22:02

I was aiming for VD but was terrified of instrumental birth and/or damage. I know too many women with VD injuries, and this could be illogical but felt a CS would bring fewer surprises.

I discussed with my midwives, requested that if there was any chance of instruments I wanted a section (I accepted that the choice might not be mine).

In any case, I happily prepared the hypnobirthing, tens and whatnot, too high risk for a water birth otherwise would have tried that.

Laboured for 48 hrs, was exhausted so asked for a CS which was granted immediately.

Recovery was fine, much better than I thought or seen in others - I was lucky. BF 2 years.

If I was guaranteed a safe injury free birth I’d happily VD but as that’s not possible my preference is a CS.

twinguilt · 29/07/2021 22:03

I had a long gruelling 25hr labour with my first DC - vaginal delivery, episiotomy with foreceps, I lost a relatively high amount of blood and was in HDU for the first night (baby was born in evening) Was moved to normal ward the 2nd night and left the 2nd day. I was sore and I was uncomfortable and I wondered for the first couple of weeks if I'd ever feel my pelvic floor again (I was trying to do PF exercises but just couldn't feel anything working. I did however feel mostly normal after about 4 weeks, and after 6 months my body was pretty much back to normal I'd say.
When pregnant with my twins a few years later, had an elective c-section partly down to it being twins and partly down to my previous experience. While I don't regret it from the point of view of making sure my twins were safe, I must admit I do regret it for me...it was a v simple procedure from my point of view (the Canula was the most painful part of the op for me!) but I felt like I'd been hit by a bus afterwards! I wasn't expecting to feel SO weak and awful and I was in more pain. I don't know for sure if part of this might have been down to the twins thing, rather than c-section, my core was wrecked and I took SO much longer to feel vaguely normal and also vainly I absolutely hate my stomach now - the scar line itself isn't that bad, but the bulge of scar tissue above it is not nice, plus I feel like my digestive system took a bruising from it.
I'd chose the same again for my twins, but had I been pregnant with a singleton I think id chose vaginal birth with good pain relief every time.

Catchthepigeons · 29/07/2021 22:12

I opted for a section and it was the best decision I could've made for myself. It was calm and as pleasant as I imagine surgery could possibly be. It just seems a much more civilised way to have a baby, albeit the recovery time is a bit longer.

Saoirse82 · 29/07/2021 22:13

YANBU, I believe every woman should be allowed to choose. I'm 24 weeks pregnant with my first and I feel the same as you, but I have no experiences of being around births and the majority of women I know have had fairly straight forward births, but I've scared myself by reading things online in the early days. My best friend just had an ELCS for medical reasons and it went like a dream but I feel I don't have a leg to stand on requesting one just because I'm scared, it makes me feel foolish and that my fears will just be dismissed.

Crowsaregreat · 29/07/2021 22:13

You're a doctor, look at the stats!

I've had long labour ending in EMCS and also a vbac. Vbac was infinitely preferable even if the birth itself was a horror, episiotomy etc. I felt like I'd been run over by a truck first time, second time I was fine the minute the baby was out. I couldn't believe I could just get up and walk!

Mhc19 · 29/07/2021 22:21

One of my closest friends is an obs Dr and whilst she's not pregnant yet, she's hinted she'd be opting for an elective c section. I think it speaks volumes. Do what's right for you. C section recovery won't be easy, but neither is the recovery from a natural birth gone wrong. I had a natural birth but needed stitches for a 3rd degree tear. The calmer environment and the environment I felt most listened to and respected was in theatre. If I have any more, ill be heavily swaying towards a c section. Do what's right for you x

EarringsandLipstick · 29/07/2021 22:23

I feel I don't have a leg to stand on requesting one just because I'm scared, it makes me feel foolish and that my fears will just be dismissed.

I really hope you would feel you could discuss your concerns. Your feelings are completely valid 💐

Based on your UN are you in Ireland? If doing shared care, can you discuss with your GP? If private, I hope your consultant would be open to a discussion on how you feel. Good luck.

Draineddraineddrained · 29/07/2021 22:23

@FartnissEverbeans

Less than half of births have interventions. That is not the same as requiring them. Clinicians in maternity care are INCREDIBLY risk averse, to the point where carrying and delivering a child is extensively pathologised. If you look at how rates of induction and section have risen in recent decades, with no comparable parallel decrease in infant or maternal mortality, this is quite obvious. Intervention is often done for the sake of having done something, especially induction. Stillbirth after 40 weeks is still incredibly uncommon; but induction at 40-42 weeks has become standard, and the number of women induced for big baby/small baby/too much water/not enough water are enormous. Induction itself often leads to a cascade of interventions, chiefly epidural as the pain is often worse and contractions closer together, and epidural reduces your chances of delivering without assistance (forceps, ventouse, ultimately C-section for "failure to progress") because an exhausted, frightened, demoralised woman, strapped to a bunch of monitors whilst lying semi-paralysed on a bed, is not on an optimum position to deliver a baby.

To suggest the rates of intervention are any indication of the viability of natural birth is nonsense unless you really dig into what those interventions were, the reasons for them and at what stage they occurred.

OP, it is completely up to you. You know as well as anyone it is absolutely your right to choose to give birth in the way you feel happiest and safest.

Personally I had 2 x EMCS, neither "one of you is in imminent danger of dying" emergencies but both unplanned and necessary. First birth was as described above - induced for postdates, terrible long painful labour with baby back to back, eventual epidural as could no longer cope with the pain, failure to progress, terrible mismanaged C-section, trauma it took me a while to get over.

Was determined to have a VBAC for second baby, a HBAC actually. But meconium in waters put paid to the H, and after a very swiftly progress to active labour (got to 3 contractions in 10 minutes within an hour of waters breaking), baby's heart rate failing to recover between contractions soon stuffed up the V. I had the choice between an epidural to enable constant monitoring and blood gas testing of baby, as they were worried about her oxygen, or a c section, and I chose the section as I knew from experience where this was going and saw no need to drag it out.

My second section was done really sensitively and my recovery both physical and mental was good - this was entirely down to feeling empowered by knowledge and research to assert my wishes, to make decisions, and also really stellar aftercare and PROPER PAIN RELIEF AFTER THE SURGERY - expecting women who have just been cut in half to make do with fucking paracetamol is one of the cruellest jokes in maternity care IMO. Can't think of any abdominal surgery men might be subjected to where this would be expected.

Even given how it ended, I wouldn't have gone for an ELCS second time round (although that option was open to me after first section). It was important to me to go into labour and labour naturally as I'd always blamed myself for agreeing to the induction (not that I realised I could refuse, that was not made at all clear to me at the time!) for how things went afterwards. It means a lot to me that I know no what it feels like to go into labour, to contract, to progress, and to push - I'll never now know what it's like to bring my own baby into the world, which I am sad about, but it just wasn't meant to be and I'm reconciled to that now. Also, second surgeon did a bang up job on my wound and tidied up the mess the previous dickhead had made, so that was nice Grin

I'm wondering if going into labour and labouring is something you want to experience? If so, why not plan for s hospital birth and then just lean very much on the side of caution if you feel like things aren't going well/getting out of hand - you can request a section during labour and as long as it's still physically possible they should provide it.

If on the other hand you don't think you'd have any regrets about not labouring naturally, then ELCS is a perfectly legitimate option - not without risk, and statistically less risky than natural birth, but as you point out statistics become a bit irrelevant when it's your completely unique experience, baby and anatomy.

My best advice would be to research EVERYTHING, know your legal rights as a birthing person and be prepared to be difficult if you have to (sorry to say this to you as a doctor, but health professionals can be very "this is what we're going to do" to labouring women and you need to have gumption to stand up to them and remind them it is YOUR choice, always). I had so much better a second birth because I was so informed and empowered compared to birth one where I just did whatever I was told as things got worse and worse and worse.

Draineddraineddrained · 29/07/2021 22:24

Sorry @FartnissEverbeans, that first bit should say "more than half"

Hfjshdhs · 29/07/2021 22:25

I had an ELCS for the same reason you want one. It was a beautiful, calm experience. Almost like checking into a hotel to have my baby! It was on the NHS and I was lucky that the trust was very supportive. My recovery was better than friends with natural births.

YANBU.

Fefifoefum · 29/07/2021 22:26

I’m a nurse (again not gynaecology but I have some minimal experience). But I read to a point I’d got myself so bloody anxious.
I felt very similar, especially the tearing. But the stats are in your favour there. (Less than 10% have 3/4th degree) I felt that the stats related to induction were an unacceptable risk though, 2/3 end up with an emergency section or an instrumental delivery. Are women told this?
So I had a section booked for 10 days after my due date.
I did however invest time in hypobirthing techniques and calming my anxiety.
I did end up with a midwifery unit birth, just entonox, 2nd degree tear and a large pp haemorrhage (1500ml). BUT I feel happy with that. I was driving by day 3, I don’t think the hb of 80 on discharge helped…. But that could of been the same with an ELCS.

I felt I’d hit a happy middle ground. Extensive birth plan. I.e not pushing in water (midwife can’t see, this cannot help protect perineum).

SinkGirl · 29/07/2021 22:28

@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 elected for a planned caesarean with my twins. I have tokophobia which is not rational and is severe, but it’s backed up by all the very rational concerns you mention.

Almost all the medics I know opted for caesarean (except the Midwives, most of whom didn’t) and the doctors I know were very much “definitely request a caesarean”, yet the obstetricians I saw really tried to put me off, wouldn’t discuss it, were extremely patronising about my full blown phobia despite me having therapy throughout my pregnancy because I was terrified of vaginal birth.

They eventually agreed to it at about 32 weeks - only because my husband came with me, said that their putting off the discussion was making me really ill and that I needed an answer. The registrar said she would discuss it with the consultant and he would call me, but the next day I got a call to book me in.

I felt so much happier after that, but didn’t last long as I needed an emergency CS at 35+1

I wish they had agreed early on, when I told them I absolutely could not give birth vaginally, so I hadn’t spend most of my pregnancy having panic attacks about birth.

I also have a pretty awful needle phobia - once they told me they’d want me to have an epidural for vaginal birth anyway, and that there was a chance i would deliver one vaginally and then need a caesarean for a second, I was even more certain that I just wanted a calm, planned Caesarean (which is definitely not what I got).

I have to be honest - the spinal was the most horrendous thing I’ve ever been through (and I’ve had some pretty horrific medical procedures). But I know I was unlucky there, it doesn’t normally go like mine did. And an epidural would probably have been worse and if I’d had a vaginal birth I would definitely have needed an epidural to get through it.

Because of that, I can’t have any more children - sitting here right now I think if I were pregnant again I would want a water birth, but I know as soon as I got pregnant again the tokophobia would explode, and then I wouldn’t be able to face another spinal (seriously I acted like a cornered wild animal, I couldn’t physically let one happen to me again) so I’d be begging for a cs under general which obviously they wouldn’t agree to. It’s really sad that I can’t have any more kids because of this, it sounds so ridiculous to people who haven’t experienced a phobia like that, but no matter what I’ve tried it seems insurmountable.

I am not surprised that you feel scared of vaginal birth after what you’ve witnessed - as you say, you may be one of the fortunate majority (it came up in a survey at work that 40% of women say they experienced birth trauma, which means the majority don’t but not by much). But there’s really no way to know what will happen. It’s completely understandable and fine if your choice is ELCS - it’s not a cop out or the easy option, it’s major abdominal surgery.

Where I am the trusts attitude to maternal request CS has changed a lot since I had my boys nearly 5 years ago. You may need to be insistent. However, as you’re a doctor yourself I think they will take you seriously.

Madwife123 · 29/07/2021 22:30

I’m a midwife. The vast majority of births don’t go wrong, you were unlucky and saw a skewed view. You’re a medic, look at the research and stats. Look at the likelihood of adverse outcomes from vaginal birth vs ELCS. You are well aware that anecdotes don’t equal evidence.

thecognoscenti · 29/07/2021 22:30

YANBU. There's a lot of bollocks about the many horrible complications of vaginal birth being something women just have to put up with. No thanks. CS every time.

Justgettingbye · 29/07/2021 22:33

2 vaginal births here I'm 5ft 2 the first was over 9lb, it took a while and only a few stitches. Second was 9lb also no stitches just gas and air. No long term effects.

The only person I know who had a c section was my mum (emergency) and she said she didn't realise how much she used those muscles that had been cut and it was bloody painful.

Im way too squeamish to opt for surgery that could be avoidable. However on the contrary no way would I have wanted to witness a vaginal birth before hand so I get where you're coming from.

MissTrip82 · 29/07/2021 22:33

I think woman-centred care should mean you decide for yourself which risk profile is preferable.

I kind of laughed at the people who immediately chastised you for not having seen births involving midwives when you’d specifically said that’s what you’d been involved with previously. People can’t even bother to read in their rush to criticise you.

Make the best choice for you. We all tolerate risks differently based on our experiences.

SinkGirl · 29/07/2021 22:34

@Saoirse82

YANBU, I believe every woman should be allowed to choose. I'm 24 weeks pregnant with my first and I feel the same as you, but I have no experiences of being around births and the majority of women I know have had fairly straight forward births, but I've scared myself by reading things online in the early days. My best friend just had an ELCS for medical reasons and it went like a dream but I feel I don't have a leg to stand on requesting one just because I'm scared, it makes me feel foolish and that my fears will just be dismissed.
Of course you do! You are entitled to a maternal request caesarean whatever your reasons. As long as you are fully informed of the risks and benefits of your choices, then it’s your choice and should be respected. Read the NICE guidelines, ask for referral to the birth choices clinic or whatever they have in your area.

If they are difficult, remind them of all the work being done right now around the Ockenden report, and that you are entitled to all the information needed on both place and mode of birth.

Caesarean birth is not without risks so you need to understand what those risks are. But vaginal birth comes with risks too. Each woman should decide which factors matter most to her. And you should be supported in this.

SayMumOneMoreTime · 29/07/2021 22:38

Go for it! I had a failed homebirth, failed forceps, emcc and still experience flashbacks. I think I had ptsd to be honest. Planned a section for my second and it was a breeze in comparison (apart from the flashbacks from the first one which was upsetting).

I think you are really sensible to approach it this way, it's realistic to expect birth injuries. Out of my mum group there was a high number of emcc, and everyone who gave birth vaginally had an injury: from messed up stitches which had to be redone, to incontinence. Just awful.

I would recommend a planned section to anyone!

Draineddraineddrained · 29/07/2021 22:39

@Saoirse82

I feel I don't have a leg to stand on requesting one just because I'm scared, it makes me feel foolish and that my fears will just be dismissed

The leg you have to stand on is your absolute right to request a cs for maternal choice. Your right. The consultant you ask doesn't have to sign off on it if they don't want to, but if they won't then they MUST refer you to another consultant who will. Your fears may well be dismissed - ignore that bollocks. Just calmly and firmly recite the portion of the NHS advice that makes it quite clear you are entitled to a C-section for no reason other than that you want one. The end.