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?

It's a hard one, my first birth was tough epi, forceps, stitches 5 years down the line I'm fine and it's not left me with any trauma although it was rough. Second birth quick, no pain relief, less than an hour active labour honestly quite a magical experience. I did consider asking for a c section the second time but for me seeing many friends struggle in the weeks post section put me off as even after my first birth I was
Doing the food shop and driving couple days later

The thing is, the risk involved in you choosing a c section, you can plan for. You can read up on what risks you're likely to encounter. The risk in going for a vaginal birth are huge and wide ranging. You could push them out with gas and air and not a scratch. Or you could need a whole hierarchy of interventions. When i was pregnant it was likely id need an induction. Straight away that's a greatly increased risk of forceps or ventouse. That increases the risk of maternal injuries and injuries to the baby. I'm not going to but if i ever had a baby again it's straight to c section every time. You decide what risks you're most happy to take and go with that.

I've had 2 births. The first was an attempted natural birth which went very wrong and ended up with a traumatic emergency c section. The second was an elective c section due to the problems with the first.

My elective c section was calm and controlled. If I ever had a third child (unlikely), it would be another planned c section. The two experiences were like night and day.

Surgical adhesions.
Don't discount the issues with c-sect because they are very real. I've had more major abdominal surgery and likely will need more - endo / adeno caused double prolapse and bowel / bladder problems.

I had two ELCS and both were wonderful. Breastfed both babies with no issues. It’s your choice, go for what works best for you. Good luck!

Ask for one if you want one - if you're quite anxious about it having only heard awful things it makes sense. My best friend had one with no regrets.

My first labour was back to back, episiotomy and then a 3b tear anyway. As a result they advised elcs for second baby. I would rather have had my labour again. My csection went absolutely fine except I think they stitched me badly, the pain was awful and I couldn't lay down flat for a couple of weeks. On the ward they acted like I was making a huge fuss because I should be fine X amount of hours after the section. My scar now (it was four years ago) isn't neat, it's like two wobbly/broken lines and one end (where the pain was) is puckered and pinched and threads still sometimes come out. But worse than that was not being believed and staff acting like I was just whining, from the midwives and the doctors on the ward to the midwife at home. Only my health visitor was understanding much later on. Being made to feel like I was exaggerating was horrible.

With my labour I felt like an active participant even when things went a bit wrong. Csection I felt like a lump of meat on a rack having stuff done to me. I think your individual framing and perception of something makes a difference, so labour probably best for me but csection probably best for you

Just thought - I guess VD v CS also depends on how much support you expect to have afterwards.

My DH had extended pat leave and would have been doing all the graft regardless. So if I wanted to sit and eat grapes for 6 weeks after I easily could have.

As it was I was walking around central london with 2 weeks but as said I was very lucky with recovery.

I’ve also had lots of abdominal surgery (gynae investigations) while more severe CS wasn’t miles apart from keyhole so wasn’t a novel shock to me.

If I’m lucky enough to have a 2nd DC I’m going straight to a CS, purely to avoid the unknown (even though anything can happen too).

Downsides - I lost a hell of a lot of blood.
Would have needed more post natal assistance if DH didn’t stay at hosp with me (never left us for about 2 /3 weeks).

I had two planned c-sections but for medical reasons as opposed to fear of vaginal birth.

In my job I come across a lot of women post vaginal birth and to be honest, some of their stories are horrific.

From discussions I’ve had with pregnant women and doctors it is becoming more common for women to ask for c-sections and as crude as it may sound, they do it because they think it will be a much more pleasant experience and also that there is less chance of the baby coming to harm in ways they can do during a complicated vaginal birth.

Both my c-sections were fine, the wound was obviously uncomfortable and it was a good few weeks where I would consider myself ‘back to normal’ in terms of mobility - but it’s major abdominal surgery so I didn’t expect any different.

In summary - you are not unreasonable at all and I can see why a lot of women do it.

I had an ELSC and would certainly recommend it. I was terrified of giving birth and visits to the local maternity unit did nothing to reassure me. I had to be pretty insistent with the midwife but my female GP was very supportive.

I’m about to start TTC. Also a doctor. No obs experience but a lot of friends/colleagues I know who have had a vaginal deliveries have had really bad care - perhaps they are also more aware of it because they are doctors and know what is and isn’t acceptable. It seems like the system is so overstretched and therefore not safe, but also a culture where listening to the patient does not seem to be a priority - despite their medical backgrounds. Pain relief never seems prioritised in any way either. For this reason, and also concerns regarding potential pelvic floor damage, I would choose an Caesarean section. Anecdotally, friends who have chosen Caesarean are happy with their choice but not all those have chosen vaginal delivery are.

I have thought about perhaps a vaginal delivery on the private wing of a NHS unit, as this may be better staffed with better access to anaesthetists. However I would have to do more research on that as private doesn’t always equate to better.

I haven't even RTFT but YANBU to request. They may try and push you to go natural but stay strong if that's what you want. Good luck!

I wouldn't unless you have medical reason. If you are young, fit and healthy then there's no reason to.

Everyone I know who had vaginal birth complications were not in the best way to begin with. All of my active, younger friends and myself had pretty easy labours. I'm sure your psychological state makes a massive difference too though, stress does inhibit the right hormones during birth so if you think you can't do it then get a section.

I worked with a man whose wife was left permanently paralysed following her c section. All planned as she had twins. He was in pieces, 2 newborn babies and his wife left broken. Signed off for a year and then left.

I also had a girl in my ante natal whose c sections scar got horrifically infected and was still open when I saw her 9 month post partum! Still unable to lift her baby, drive or really do much at all.

Maybe the complications are rarer but to me they seem so much worse.

YANBU but.......

ANY unnecessary intervention leads to more intervention therefor more risks.

Birth outcomes are far more positive when they start spontaneously and remain intervention free, these includes epidurals, inductions etc.

Im very pro natural birth and applaud people who can make informed decisions and choices based on research and not fear mongering and "doctors orders" but on the flip side i am also pro choice.

FWIW i had 3 natural births that went beautifully and one was breech. My pregnancies were fucking horrific tho.

Thanks for the link to the paper @FartnissEverbeans

As there seem to be a lot of professionals on this thread, anyone else got links to the relevant stats? I would really like to know not only what proportion of vaginal births go to plan and heal easily, but also the relative risks of increasingly bad outcomes up the scale. (I'm asking about the probability density function in terms of adverse maternal outcome, if that is something that would be referred to in your discipline?). And of course the same for elective C section. TIA.

Maybe the complications are rarer but to me they seem so much worse.

People don't tend to talk about birth injuries (serious tears, incontinence, ptsd, infections) though. Especially if you go on about your lovely easy birth. Loads of people don't feel like you can talk about this stuff because you're fear mongering. So a lot of women are completely ignorant of how dangerous childbirth can be, and if things do go wrong you feel like it must be something you did because birth is supposed to be a lovely "experience". Ultimately it's a medical procedure and all the candles and positive thinking in the world won't make a difference if things go wrong.

YANBU and I would ask for an elective. My child is seriously disabled due to a birth injury. It was not actually giving birth related (delay) and an ECS would have made no difference, but I am in a group and some of the horrendous stories I hear, make me horrified and angry about the poor maternity services in this country. My second baby was an elective and calm lovely and a healthy child.

I know statistically c sections are not as problem free but have not examined the reasons for this, and recovery usually longer, but I advise you to take the surgery. It does limit the size of your family though with increasing risk if you have more than 2-3 babies.

@Miphy FWIW, and from my extensive research into birth injury, problems are mainly delay to CSection and not able to interpret the CTG readings.

Also the statistics re VB and CS need to be looked at carefully and only those relating the elective sections used as comparisons. I've not done this, but know that many csections are done as emergencies which may affect the statistics?

Yanbu.

I really felt I was missold my vbac! My recovery after my EMCS (after long labour) was fine. With my second, although it was my choice, the consultant and midwives were really pushing the vbac, especially from a 'low risk' and 'back on your feet right after' point of view. The forceps, tear, haemorrhage and blood transfusion meant that I couldn't walk for days and felt like I had been hit by a bus for weeks afterwards. Months later I still felt dreadful as a result of the anaemia caused by the blood loss and almost 4 years later, my scar tissue gets inflamed during my period or if I stand for too long, like a PP said. I also had a prolapse which was fun! I remember lying in bed about 3 weeks after I had the baby and feeling so confused as to why I felt so terrible and even feeling nostalgic about my super fast recovery after the major surgery that was my C section first time around. For every "horror story" someone sneezes a baby out and there is no way of knowing what will happen. I feel that this decision is very much a heart decision. I'm pregnant again and a big part of me still yearns for that wonderful, straightforward experience of vb that other women have, but it didnt happen in 2 out of 2 of my births so am going straight to CS with this one. You have to follow your instincts on this one. You are literally the only person that will have to deal with the consequences, physical or mental.

You should have whatever makes you feel best and safest. You don't have to justify your feelings. Lots of people have great c-sections and bad vaginal births, and the other way around. The main thing is that you feel respected, heard, and like you had a choice.

Nothing wrong with going for planned section. I had two very straightforward nvds and then a planned section. No problems or pain or trauma from any of them but the section inevitably took a bit longer to get over physically. My DC were not born in the era of partners taking time off work so you would need some assistance after the section ; my DM popped round to help with shopping and school run etc.

I've had two vaginal births, 2nd degree tear first, 1st degree tear with second. Everything is normal as as it should be.
My friend had two c sections and her scar hasn't healed and has a constant open wound and has done for 12 years !

I'm a section advocate for those reasons

Ive had two. They are great.

Aha: here are the detailed stats. I see NICE guidance is for doctors to go through this with us, but I for one prefer to read it in my own time in advance.

www.nice.org.uk/guidance/ng192/evidence/a-the-benefits-and-risks-of-planned-caesarean-birth-pdf-9071941646

A natural birth is the best possible outcome. After intervention with my other births I didn't think I could have one, but I did and it was exactly as the books ssaidd, my body told me what to do. Me personally wouldn't have surgery unless necessary, surely as a Dr you'd realise the possible risks of surgery?