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?

that must be unusual though? I've never seen a scar on the body that doesn't indent the skin in some way.

@notapanday gosh, really? Perhaps I got very lucky then!

Are there any other posters on this thread with a similar scar to mine? I’m interested to know now!

Sorry an E ok CS should read an ELCS! Also wanted to add that I have barely any scar/ indent now.

So am I tbh. I used to work in the beauty industry & saw a lot of scars just because I saw a lot of undressed bodies! 😆

I don't have a pouch but the skin doesn't lie exactly the same way, it indents slightly.

and obviously there is a thin white line.

My sections were the best two experiences of my life so far. They were pain free, pleasant and allowed me to meet my children in a relaxed wonderful way they than after pain and in exhastion.

I'd assumed the recovery works be hard, but I was amazed by how little it hurt. Yes, I took painkillers just to make sure, and I had some mild discomfort occasionally in the first few days, but once home from hospital I was back to doing things very quickly because it didn't occur to me not to - it just didn't hurt.

Everyone is different, but my recovery was genuinely a breeze. And I'm the sort of person who takes to their bed for a couple of days with a bad cold. I'm an absolute wimp with pain, so it wasn't me having a particularly high pain threshold or being brave, it just didn't hurt.

I am so glad I chose to have sections. It was almost inevitable that I'd need stitches somewhere, and I'd rather that be done, whilst under a total pain block, on my tummy in a controlled way, then my sensitive genitals being ripped or sliced apart with none or minimal pain relief.

I've also noticed a big difference in how long people stay in hospital for after a CS & what painkillers they have.

@notapanday see my line is still a faint pinky red! I wonder if it’ll turn white eventually?

I think they do but takes years

I'd assumed the recovery works be hard, but I was amazed by how little it hurt. Yes, I took painkillers just to make sure, and I had some mild discomfort occasionally in the first few days, but once home from hospital I was back to doing things very quickly because it didn't occur to me not to - it just didn't hurt.

This was my experience too - and I had an EMCS!

I found day 2 & 3 hard but I was comparing it to my VB & stupidly thought I'd have a operation with zero pain or stiffness 🤦🏻‍♀️

I had a bad vaginal delivery I ripped half my flap off if we’re gonna really get into it. I had to be stitched internally first then externally and it was definitely more painful than the birth it’s self.

Sorry, but if that’s not an advert for c-sections I don’t know what is.

I honestly find the natural birth movement bizarre. People regularly died in this country through natural childbirth until relatively recently. Natural is not always best.

Im an ex midwife and have had 1 crash and 3 emergency c-sections. I would still go for any of those over a traumatic vaginal delivery and the absolute carnage it can cause down below.

The thing that always gets me is when people say 'oh there's so much what going on your don't notice tearing'.

I mean, how BAD must the rest be to not notice your fanny flaps/clit ripping apart 😬🤢

Not reassuring at all 😂

Have a look at this study that came out two months ago. www.cmaj.ca/content/cmaj/193/18/E634.full.pdf It found maternal choice C sections associated with better outcomes for both mothers and babies.

I regret not getting an ELCS.

With both my births I ended up with third degree tears. In addition, With the first I broke my coccyx, and on my second baby had to be suctioned out and I haemorrhaged. Couldn’t sit down, or walk and had little control down there for weeks.

YANBU. I deeply regret not having had an elective caesarean, turned out to have been one of the most stupid decisions of my life. The birth was horrific, took five days to be induced and give birth, I’ve been left with horrendous birth injuries that are permanent, and the recovery was just awful, weeks of agony, not being able to sit or stand while holding my baby, being incontinent re urine for months. In contrast my friends who’ve had caesareans found it a much more controlled straightforward process and their recoveries were a lot more comfortable than mine, no lasting injuries.

Anecdotes aren’t data but having had a vaginal birth once it’s the biggest regret of my life. Everyone talks about the risks of c sections. Nobody talks about the risks of vaginal births.

I had two (non-instrumental) vaginal births with tears, an emergency C-section, and finally an elective one.

I would take either of the C-sections over the vaginal births. I found the recovery comparable (for me), and felt far less traumatised and physically "damaged" after the C-sections.

I think a lovely non-complicated vaginal birth is the "dream" for many women (it was for me). But the sad reality is that it's a roll of a dice with a drastic spectrum of outcomes.

Which dice and outcomes you are willing to risk is very individual, but personally I would never opt for vaginal birth again.

A good friend of mine is a consultant in maternity hospital and openly admits never even considering a VB. The comment from a pp about high achievers needing to be in control definitely could be true though in this case.

That does not mean that those women aren't left with permanent damage

Exactly. I don’t feel the data we get given is particularly helpful. Knowing what proportion of women have intervention in their vaginal deliveries isn’t particularly helpful because as you say it implies all the others are fine, which just isn’t true. It seems to me that what women really need to know is - of all the women who have vaginal deliveries, what proportion experience incontinence/sexual dysfunction/prolapse 1/3/5 years on vs the same for sections.

But obviously that data will never be collected!

Delivery #1 was an emergency but I wasn't in labour (pre-eclampsia)

#2, was wavering, but my blood pressure was going up and so I had a repeat section. This time I had some notice and I knew it was possible and also that I had a hard deadline. It was much nicer because I was able to arrange everything.

#3 I didn't even bother considering it and scheduled it at my first visit with the only question being the date. Was brilliant.

There really aren't any guarantees, but I do think a planned caesarean is so much better than an emergency. Can't compare the two and I wasn't even labouring.

I still have flashbacks about my birth and feel huge guilt that I put my baby’s life at risk by not demanding a c-section.

of all the women who have vaginal deliveries, what proportion experience incontinence/sexual dysfunction/prolapse 1/3/5 years on vs the same for sections.

I think there are studies out there & VBs generally show increase risk of incontinence & prolapse but CSs don't eliminate the risk.
Pregnancy alone causes pressure on the pelvic floor as does ageing & the age of mum, how many dc, how spread out are the dc, pelvic floor before pregnancy etc all impact on the pelvic floor.
Looking after the pelvic floor is important, in France they respect that & provide management post childbirth.

@nonono1

that must be unusual though? I've never seen a scar on the body that doesn't indent the skin in some way.

@notapanday gosh, really? Perhaps I got very lucky then!

Are there any other posters on this thread with a similar scar to mine? I’m interested to know now!

I don’t have an indent. Had to google to google what that looked like.

My CS scar is very low down though - just a 2.5inch dark line (I’m black).
If it matters, I had my CS in a dedicated unit (is that normal?), surgeon reassured me he did them regularly (I asked in a drug hazed ‘don’t kill me manner ) and my community midwives did remark at the skill afterwards.

I do have an indent from a keyhole incision.