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'm going for an ELCS next time. Failed induction first time round, the section was the least upsetting part of the whole situation. I was walking around Marksies pushing the pram (ok only inside and for like five minutes) within three days, able to drive a fortnight later. I honestly didn't feel any pain after it, maybe because DH managed my pain relief and pre-empted any discomfort.

Aside from that, I don't want to roll the dice and be treated like crap again by uncaring midwives when I'm exhausted, immobile and in intense pain. I want to be in control and to be able to assert myself, not critised in my notes for "refusing to make eye contact" well yes I was bawling my eyes out at the time. I wish I could say I was just unlucky but it's a pattern I hear about time and time again, with the exception of two friends who managed the birthing pool in the local MLU. Maybe as a HCP you're more likely to be listened to.

Aside from all that, I think our professional experience always has an impact on how we approach things in our personal lives. It's natural. I work in insurance, I see risk and potential hazards everywhere.

Your body your choice. I had 2 vaginal deliveries and 2 very different experiences.
My first I was induced 6 weeks early due to his size or told I could go up term and have a cs. 4 hours from induction, at one point they did say they would need to use forceps, but fortunately didn't have to. No tears and was hone within 12 hours.
My second I was just over an hour from my waters breaking to birth, very different experience, as I was calmer and contractions weren't forced. Again no tears and I was home 4 hours later in time to do the school run. And show the baby off!
My friend had an elcs with her first then opted for a vbac with her second due to how long she took to fully recover.
Everyone is different and you have a while to decide.

I had an ELCS over twenty years ago and I'm still really glad I did. It was the right thing for me although I would support anyone to have the type of birth they feel is best for them.
The consultant I was referred to was very supportive (the GP who grudgingly referred me very much was not- his wife, also a GP, had had a vaginal birth so that was clearly correct in their minds so I was told).
OP, you can do the research. Push for what's best for you, no pun intended. I would add that my recovery was very quick and easy (but so were DM's who had two vaginal births).

Part of the reasons so many births ‘go wrong’ is because of unnecessary interventions and lack of experienced supportive midwives. A C section is statistically more dangerous for maternal health. Hospitals are becoming increasingly unsafe places to give birth.

It's not unlikely you'll need a c section anyway so why not cut the middle man out?

Being induced and being exhausted and in pain for days due to the process contributed to my PND.

I agree with all of @Draineddraineddrained post.

I think ultimately one of the main things that is going to make your birth positive is that you understand and know your rights, you make informed choices FOR YOU and feel as in control as you can be.

If that means you want an ELCS then that is your choice and your right. If you choose that and are positive about it, it will likely be a positive experience.

I will give a word of warning that I would try and choose my hospital carefully if you can and also make an aftercare plan including what pain relief you know could be given to you if you want it as my aftercare after my EMCS last time is one of the reasons I refuse to go for a hospital birth unless it is life and death this time. I ended up taking my own paracetamol and ibuprofen I brought with me as no one bothered with pain relief unless you were screaming in the ward I was in. Or food or drink unless I got it myself which I couldn't do until the numbness wore off.

I wanted one and was talked out of it by the doctor. Ended up with a traumatic birth and ptsd which is still affecting me years later. Do what you need to do to feel comfortable and safe. You're entitled to a c section if you want one.

@AHobbyaweek

I ended up taking my own paracetamol and ibuprofen I brought with me as no one bothered with pain relief unless you were screaming in the ward I was in. Or food or drink unless I got it myself which I couldn't do until the numbness wore off

You weren't at Newham General were you??? I was begging and begging for pain relief after my first, they kept saying they'd bring some soon, it never came - I've never felt so helpless and I got no food after my section for ages, I'd been in hospital since the Sunday morning and she was born on Tuesday afternoon 😬 fuckers.

My just in case hospital bag for number 2 had loads of food and a fucking pharmacy's worth of paracetamol in it 😂 as it turned out at that hospital they prescribed me oramorph straight after surgery without my even having to ask, and dihydrocodeine regularly on recovery and discharge. It was bloody magical, the difference in my recovery was insane. Honestly the shitty pain relief often offered to women post section - post birth in general actually - is a scandal imo. It's not just the pain in the moment; proper pain relief has a huge impact on the speed of recovery.

There are some groups already mentioned where you can ask fellow doctor mums. Pm me if you want further details. I am a doctor.

Fwiw I had vaginal deliveries that were on the whole very straightforward (intact perineum, short second stage, minimal analgesia required). They were great experiences, and I really enjoyed giving birth. The recovery was great, in that I got straight up afterwards, and felt completely fine. Many women have positive vaginal birth experiences.

A caesarean section, as you know, is major surgery with known risks, including consequences for future pregnancies. I have seen many women who have very complicated recoveries from caesareans (wound infection, paralytic ileus, return to theatre etc). It should not be regarded as an 'easier' or 'safer' option.

I am a Midwife and will be having an elective section

I’m sorry that happened to you @AHobbyaweek -that is just unacceptable.

My experience was the opposite. I have had lots of surgeries and regularly take opiates at home for an ongoing condition - I had reduced massively during my pregnancy so was only on a low dose by the time I had my emcs. But the anaesthetist had a long discussion with me about it and checked in on me as my spinal was wearing off and the pain was getting bad - she immediately wrote me up for a maximum much higher dose based on my previous dose, gave me that and said that I could request up to that much every 4 hours, as needed. I did have that dose that night, then just requested half the next day, and then went home the day after that where I could manage it myself.

Of all the surgeries I’ve ever had, it was the best pain management I’ve experienced. I suspect it depends massively on who you get (I tend to find anaesthetists are very good about writing up pain relief - but other staff are not always great at following those orders).

As the OP is a doctor I expect she’ll be offered plenty of pain relief!

YANBU. I had to sit through the ordeal of a midwife whose main job was to talk people out of having an ELCS.

She tried her best, despite me saying at the beginning my mind was made up (after emergency section with DS1). Total waste of time and energy.

They did fuck up on the day as they cut through a blood vessel and I had to have a transfusion. Surgeon blamed it on the area being “very vascular”. Bit concerned this was a surprise to him tbh . Still- no regrets.

Takes a bit longer for milk to come in, but eventually managed to feed after EMCS and ELCS.

Good luck and stand your ground, although usually they won’t argue if you’re another medic.

I seriously considered an ELCS but in the end went into labour naturally but had an induction after not progressing at 1cm (because I wanted one versus going home). Pain relief was gas, air & epidural after 3 hours of only dilating a further 2cm and vaginal birth. No regrets whatsoever.

Minor tear but baby was out in 45 mins of pushing. Felt listened to and respected throughout regarding pain relief and midwives were both incredible.

No judgement for those who have a CS, mum and sister had 2 each but strangely I did feel unexpectedly proud and pleased to have got her out without it. Minimal recovery.

www.mumsnet.com/Talk/guest_posts/4302468-Guest-post-Women-are-expected-to-go-home-with-life-changing-injuries-after-giving-birth-and-just-get-on-with-it?msgid=109492990#109492990

Have a read through this. Elective C section all the way in my opinion. Natural birth has left me with life changing issues. I have already had one lot of surgery to try and rectify my problems, and will need more in the future. Why go through all that trauma and damage if you have the choice to avoid it. I will be recommending my own daughters to have c sections if they ever become pregnant

Had two births never a stitch or tear, gas and air.

Before I had ds I was very pro VB, I was induced at 36+5 due to pre eclampsia & before they started was asked if I wanted a CS, I refused & went through 60 hours of induced labour before an EMCS. Had I known then what I know now I would have snatched their hands off & taken the CS, if I had been due to give birth again I would have opted for CS.

Thank you for starting this thread! I’m in early pregnancy and veer wildly between trying to train myself as hard as possible for some kind of water birth at the MLU and just seizing up in absolute terror and pushing for an ELCS as soon as I can.

I think it’s harder if you’re slightly older (I’m late 30s) as you just end up accumulating awful VD stories from friends who’ve had theirs. What scares me is no one has ever said “actually it wasn’t as bad as I thought.”

Maybe medical professionals here can tell me if I’m wrong but it does feel very strange to me that the pain relief/general options have not really changed since my mum gave birth? And it’s very much on the mother to prepare (and fund it herself) via hypnobirthing etc…I’ve also had hypnosis for another phobia before and it did not touch the sides after five £££ sessions.

It just feels a bit sad that the two options seem to be so different and so risky. If women’s bodies are designed for it then why all the tearing/EMCS, forceps? That’s a genuine question not a rhetorical one!

YANBU! I had elective with both of mine and thankfully they were textbook

@Draineddraineddrained no Stoke Mandeville but have heard common stories in other hospitals.
I have 48 hours of labour which I was sick the whole way through with no food or drink so the lack of food after was a torture.

Unfortunately I have heard bad stories on either side of VB or CS and I think it is about knowing your rights and being aware of the options so you can at least advocate for the best care you can.

SunandSea37 I was 37 when I had ds, was admitted with in the words of my GP "very bad pre eclampsia" my BP went from 110/80 on the Monday to 197/115 on the Friday & I gained just under 2 stone in fluid in 4 days. My face looked like a moon & the protein in my urine was +++. The only thing other than pregnancy I can put it down to was I had a fall ironically at my midwife appointment, I got my trousers caught in the brake of the medical couch & fell with my hands outstretched, I broke all the fingers & my hand on one side. I was admitted virtually straight from the surgery after going with a headache & flashing lights in my eye & induced with the gel in triage before being put in a room on the Labour ward, it took 3 months before my BP started to settle & I was on BP drugs for 6 months.

spinningspaniels
Hello I agree with you fully.I have already commented on another thread about c sections not always being the calm controlled scenarios people describe them as.
I am very biased here though.Both of my now grown up children born by EMCS, in the long ago days when all were done under GA, the long vertical scar was used and if anyone requested one your sanity was questioned.
I have never had any trouble from adhesions but the GA almost killed my first son and myself and has left me with a lifelong fear of them.
I got sterilised during my second son's birth because I could not go through with it again.
I know they were both emergencies, actually what is now termed as crash sections, and if I had eenallowed to have elective ones I would not have the lasting fear I have now, still 49 years later.
All the best to you OP, I hope you get the birth you want, but as a doctor you must be fully aware of the risks of abdominal surgery.

yanbu. everyone i know who has had a natural birth described it as traumatic in one way or another. i had an elective and had a lovely peaceful experience and easy recovery. go for it!

Hmm I think you’re focusing on the labour too much, mine were straight forward V births and was back walking around straight away with soreness yes but all very manageable. Those 4 weeks with a new born and surgery…that’s tough.

It’s entirely up to you, and actually your previous experience matters. If you’re shit scared, you’re not likely to have a wonderful experience of labour and c- sections can be great.

However there’s a huge middle ground between vaginal birth at any cost and ELCS. There’s

• aim for a vaginal birth only if spontaneous labour. If needing induction, augmentation etc going for CS at that point
• booking a CS but waiting until spontaneous labour to have it, minimises risks of RDS
• electing for MLU or home birth and then ELCS if needing transfer

These ways minimise the risk of poor outcomes as most ( though not all) poor outcomes are the end result of long interventionist labours.

I had relatively straightforward vaginal births and it meant I and my new babies went out for a meal within 24 hours of birth. It honestly especially second and third times was like I’d barely given birth. However I’d had it agreed that if I called time, we went to ELCS. I wouldn’t have accepted certain interventions.

When I was pregnant with my first, I knew I wanted a CS. All the medical staff I spoke to - consultants, midwives, everyone - advised my to try for a vaginal births. But when I asked them what they'd had, they'd all had sections.

I ended up having a section for medical reasons (DS was 15 days overdue and I wasn't going into labour, despite being induced) and then could have an elective CS second time. Both were bliss.