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?

@RedHelenB

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?

The best possible outcome is whatever the mother chooses to have. No birth is without risk, but I chose an ELCS because it reduced the mystery of birth. So many people wind up with intervention and lots go on to have birth injuries. I didn’t want that. Labour frightened me, so I chose not to have it. My CS was textbook and I recovered really well and really quickly. So many people I know wound up having EMCS and then chose ELCS subsequently and say how wonderfully calm and different it was. If that’s what the mother wants, that’s her best possible outcome. You having a natural Labour was yours.

I completely agree a natural birth is the best possible outcome but it really depends on your approach to risk. Are you:
A) aiming for the best possible likely outcome; or
B) aiming to avoid the worst likely outcomes.

For me it’s B. So although I’ve got about a 50-60% chance of a natural unassisted birth at my age, what I really want to do is avoid the most likely adverse outcomes which are: emergency c section; forceps; ventouse; major tearing.

So that rules out vaginal birth for me.

Obviously what I view as a worst likely outcome is based on my personal preferences and personal risk tolerances.

I should have qualified that - “a STRAIGHTFORWARD natural birth”

If I had known that having interventions like induction & epidural increased the likelihood of ending up with an emcs I would have gone straight for a Cs but nobody ever tells you that when they tell you that you have to be induced & it is never discussed at birth classes, quite frankly they never really tell you anything about Cs as well as nothing about pnd, all you get told is you may have the baby blues for a couple of days, not that you could feel suicidal & like you are going out of your mind.

If it had been an option when I had mine I would have done it too.

It sounds like you’re really informed and have thought this through very carefully. You’re the best person to make the decision for you!

The only thing I would say is don’t underestimate c-section recovery. It took me a long time to feel fully healed, and I subsequently developed a hernia related to my c-section which will require further surgical repair. But I totally appreciate that I could have had a similarly difficult recovery from a vaginal birth.

You know your own mind, you clearly know the risks and advantages - I say do what feels right for you. Every woman should have a full suite of choices when it comes to giving birth.

If I had known that having interventions like induction & epidural increased the likelihood of ending up with an emcs I would have gone straight for a Cs but nobody ever tells you that when they tell you that you have to be induced & it is never discussed at birth classes

When I was discussing birthing options with my Consultant with my first birth we were deciding whether to go straight to c-section or be induced/have epidurals (this was in specific relation to my chronic health condition).

She told me that for the majority of women who are induced/have epidurals generally need some other form of intervention (forceps etc) which often results in a c-section anyway so I may as well just cut out the middle man and go straight for a section.

I appreciated her honesty and went straight for a section.

My friend in very similar circumstances chose the other option and after a 3 day slow labour following induction, she ended up having an emergency section due to having a very distressed baby. She was very traumatised by the whole thing.

There are risks to surgery, but there are also risks with vaginal births.

My friend said that when she thinks of the risks of vaginal birth she thinks about her baby coming to harm, whereas when she thinks about risks of a CS, the risks are to the mother whereas the baby is most likely to be born healthy and well.

She said she would rather risk her own health with a c-section than risk the health/life of her baby with a vaginal birth.

@RedHelenB

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?

What a patronising comment! I’m sure the OP understands plenty about what surgery involves. Perhaps she’d like to avoid future surgeries necessitated by birth injuries?

Do whatever you feel is right for you, OP. Nobody should be telling you what to do. Some women are comfortable with the physical and emotional risks of vaginal birth and feel it’s worth the benefits; others are not.

My personal view is that if there was any other natural human process with such high rates of physical injury and long-term impact, surgery would be a no-brainer. But too often, women’s reproductive health issues get ignored and instead we are told to just ‘get on with it.’

Like your friend I was in labour for nearly 3 days before my emcs, I'd had no sleep & then in HDU they were constantly waking me up to monitor me so I didn't have any proper sleep for over 5 nights. I was hallucinating at the end, when I got home I tried to just sleep at night but with the broken nights for feeds etc after 2 days I collapsed & my BP shot up to dangerous levels again, my lovely GP kept me at home instead of sending me back in hospital & told me to stay in bed until it settled & get as much sleep as I could, I slept for 72 hours except for being woken for food, my mum & my husband cared for me & ds in shifts until I was back on my feet. It's really no wonder so many new mums end up with PTSD after things go wrong & how many have to be treated for PND.

YANBU

I agree with all the reasons you've stated and echo your experiences in obstetrics & gynaecology

There are things you cannot un-see or erase from your memory, no matter how many hypno birthing books/resources that you read!

For me, I had an elective section for maternal request with baby number 1

Freely admit there was no clinical indication and it was mainly based on the experiences/knowledge like you have described

It was the right decision for me and no regrets

Baby number 2 also an elective CS

I would say go for, open the conversation with your midwife about a CS, if you get resistance I'd suggest trying your GP & see if you can be referred to consultant at hospital where you are booked

I had a MRCS. Absolutely right choice for me. I have a deep rooted fear of all things medical and as a result never thought I'd have children. I did hours and hours of research, including an foi to my trust looking at birth outcomes and interventions for first time moms over the age of 35. I poured over nice guidelines and evidence and loads of articles and studies.
In the end I concluded the more controlled/planned nature of a c section was best. I could prepare mentally for what was about to happen and put mitigations in place to help me cope. A VD was just too many variables. And longer term I was concerned about the impact emergency interventions and tears etc could have on me physically and mentally. In my trusts case over three years only 7% of first time moms over 35 made it through labour with no interventions, and no tearing. Those odds just weren't good enough for me!

It was the best choice and I thought before hand I'd only be able to handle having one baby. As it is it went so well I would dearly love to have a second, but age is not on my side. But if that wasn't the case I wouldn't hesitate and it would be another MRCS (in the hope it went as well second time round!)

@08Puppysharness not patronising at all The OP asked for opinions. As I said my natural birth with no pain relief was miles away from what I thought I could have after complications with the others. A c section takes more staff, ties up anaethetists, it's not as simple as saying every mother should have the choice on the NHS.

Your body and your choice.

Do the research on risk vs benefits of both and make an informed decision that suits you.

Do be conscious that your rl experiences will influence you. If you spent a few weeks observing pool deliveries etc then you may feel differently.

Thanks for all the responses, most of which have been very helpful.

Not that I have to defend myself but a few weeks ago I thought I’d gotten over this and enthusiastically ordered stuff for perineal massage etc but then it doesn’t take much and I’m right back there again fearing the unknown.

I might be accused of drip feeding but I’m already under consultant led care because I have pre- existing conditions which are risk factors and it’s likely I won’t have a choice of where to give birth- it will probably be on the obstetric labour ward rather than the lovely midwife led unit on the same site with pools and birthing couches. This then in turn as some have pointed out means I’m more likely to end up with interventions and effectively being forced to give birth on my back in a bed- which is not how I wanted to attempt VD and makes me feel very anxious.

I’ve found antenatal care pretty lacking thus far- hard to contact, tick box exercises, unable to answer questions I have. I even got told to make sure I lie to the pharmacist 😳

I’m going to ask about my delivery options on Monday - I am willing to give VD a go if I can go in the active birthing suite if I go into spontaneous labour. I’m pretty against induction as a choice for me and would probably rather a CS still in that circumstance.

I had both a VB & a ECS & was quite shocked at the recovery tbh. Same for my friends who have experienced both. One could feel it so had to be knocked out.

I’ve had a vaginal birth in obstetric unit and midwife-led birthing unit. Both were fine, about the same length. I think the birthing pool (nice though it was) - prolonged labour for me as it removed the effect of gravity.

Just because you are on obstetric unit doesn’t mean you have to be on your back. People move around. I’m pretty sure there would have been space for a big ball to sit on in mine. But different units are different - could you ask to visit a unit or see pictures of what the room is like?

The choice is yours. As this thread has shown - people have good and bad experiences with both these modes. Like you I’m nervous of induction and would consider c section. Talk to your your consultant and try and figure out what things are most important to you

@Miphy

Thanks for all the responses, most of which have been very helpful.

Not that I have to defend myself but a few weeks ago I thought I’d gotten over this and enthusiastically ordered stuff for perineal massage etc but then it doesn’t take much and I’m right back there again fearing the unknown.

I might be accused of drip feeding but I’m already under consultant led care because I have pre- existing conditions which are risk factors and it’s likely I won’t have a choice of where to give birth- it will probably be on the obstetric labour ward rather than the lovely midwife led unit on the same site with pools and birthing couches. This then in turn as some have pointed out means I’m more likely to end up with interventions and effectively being forced to give birth on my back in a bed- which is not how I wanted to attempt VD and makes me feel very anxious.

I’ve found antenatal care pretty lacking thus far- hard to contact, tick box exercises, unable to answer questions I have. I even got told to make sure I lie to the pharmacist 😳

I’m going to ask about my delivery options on Monday - I am willing to give VD a go if I can go in the active birthing suite if I go into spontaneous labour. I’m pretty against induction as a choice for me and would probably rather a CS still in that circumstance.

Knowing this, I would definitely say go for the C-section.

I was under consultant led care with pre-existing conditions and the insistence on a vaginal birth (by me, supported by the consultant and the midwife team although they had offered a C-section) had consequences which could have been avoided. They didn't let me anywhere NEAR the birthing centre, which is good because I ended up needed every bit of care the obstetric ward provided.

By contrast, the elective c-section with my third was lovely and relaxed, apart from not having the impetus of labour pains to encourage me to get the epidural!

YANBU!

I was induced with my first & was terrified of more intervention but only needed the pessary & that was it. My CS they needed a ventouse which apparently is not uncommon. I personally would rather not have had a CS as the way my skin doesn't lie flat on my stomach annoys me (vain!) but defo the right choice for my dc. You need to do what's best for you.

but post maternal care regardless of delivery is pretty shit.

Your body your choice.

I had VD with my first. Ended in induction, red button, forceps and a terrible recovery. I'm pregnant again and in pain everyday where I had the epesiotomy. The pain gets increasingly worse with the pressure.
ELCS has been offered, as well as birth psychology. Now I'm further on it's bringing back the memories of the first time.
I don't regret having a VD. However, I had an epidural, didn’t experience the feeling of "birth", cut open, stitched up, couldn't walk for weeks. If I'd have had an ELCS I would've cut out the exhausting days leading up to the birth, constant monitoring and worrying about the condition of baby. That being said if this was my first I would try VD because the way I see it is I wouldn't know unless I tried.

Sorry my post may not be helpful. You need to trust your gut. It doesn't matter if your experience with birth trauma is first or second hand, everyone has their reasons. I know those who work in birth theatre who've chosen ELCS through maternal choice.

You could probably look up the stats for the bad vaginal births, rather than rely on the small number of ones you saw. It’s not a good sample. The C section will always come with a recovery - it’s surgery (routine, frequenty done, but still abdominal surgery). The vaginal birth can and often is easy and natural and often leaves no permanent damage. What you don’t see in the hospital doing rounds is how these women are 1,2, 6 weeks post partum - the breastfeeding, the healing, the stiches. So aside from a small sample you are also getting a very limited picture.

For the record (anecdata again), I’ve had 2 vaginal births, one complicated and one easy. The first one was complicated, and ended in an episiotomy with lots of stiches. I still chose vaginal birth for the second, and would again.

Yanbu. I had full on traumatic birth and emergency csection. Awful. Had ptsd.ruined my first year with my child. Elective section second time round a total doddle in comparison. If I knew then what I know now. I would have definitely gone elective. But then I suppose some people have good natural births.. I don't know who those people are because I haven't met one yet but they must exist. You just never know. Good luck with whatever you choose. It's your choice after all.

Also I would say that a tear is not necessarily bad. I had a small one & they debated whether I needed stitches or not & in the end I had a few. No discomfort at all.