To request an elective section for my first baby?

[Catlady90]

Just looking for some opinions/experiences!

I'm due my first baby soon and am thinking about asking for a maternal request section. Ironically I originally wanted a home birth, but at my last appointment they said it would be against medical advice because of my weight (BMI was 30 at booking...I would have lost weight prior to becoming pregnant had this been planned). Also, I have had reduced movements and growth scans as he has been a bit up and down centile wise - all fine now, on the large side...(I do not have gestational diabetes though).

My reasons for thinking of a section are:

• I really don't want an instrumental/assisted delivery and my chances of one as a first time mum is 1 in 3 according to the RCOG.
• I've been told I'm higher risk of a larger baby and shoulder dystocia - although I have had differing views on this from professionals.
• Partner and his siblings were large babies needing assisted deliveries that were traumatic.
• My mum had babies with large heads and ended up with a prolapse.
• We don't plan on anymore children, so some of the section risks I terms of subsequent pregnancies don't necessarily apply.

I'm not anxious about labour per se, it's the after effects. It seems that women are just expected to deal with incontinence as standard, and the more severe birth injuries which seem to be fairly common but not talked about. On balance I feel I would rather recover from a planned section than end up with a traumatic vaginal delivery or end up with an emergency section anyway.

I know it could go smoothly - but it seems statistically there is a reasonable chance it won't. I also feel bad as I know how much more a section costs the NHS.

Any thoughts or experiences much appreciated!

If you feel a c-section will be better for you, then go for it. It's your birth, your body and your choice.

Its your decision. I wouldnt have liked forceps either. The very thought. But I wouldn't have liked a section. The only thing you can do is talk it through with the midwife then make a choice.

I've had both. Labour (including forceps) was physically less pleasant on the day but I did not like the c-section emotionally/physically, I felt very out of control/disconnected from it.

Bf definitely harder to get going from c section.
Recovery.... first 3 days were similar for both, then after that I found the vaginal birth recovery was much quicker than the C.

If I had had the luxury of choice I'd have chosen v birth for both, and that's despite having some mild prolapse after first DC- bit of pilates/physio and weight loss sorted it.

Ps. The size your DH & siblings were is not really relevant - it's more relevant to consider your own mother & sister's birth experiences.

Yes, I am a full advocate of c sections being a mother's choice.

I've had two, an emergency and an elective.

My first birth was an induction due to Obstetric cholestasis, but my baby was also back to back and over 9lb at 38 weeks, when they were born. I was told afterwards that I should have had a csections from the start, as the position meant a 'normal' delivery would have been difficult from the start, which I found when her bloody massive head got stuck on the way out, not even forceps could make it budge!

Take the advise they give, do your own research but be firm with your decisions. Yes, there are risks to a section and recovery can be slower, but due to my shit induction I had a 4 litre blood loss, sepsis and a 3 week hospital stay. With my elective, with a BMI of 29 when I fell pregnant so similar to you, I was feeling pretty much normal within a few days - with my emergency it took a year!

Its up to you if you want to ask of course. However please consider that c sections a major major surgery and come with a long recovery and can have long term consequences too.
For what its worth i had a forceps delivery with my first due to long labor that wasn't progressing and she wss getting too tired etc she was 7lbs at birth. My second i was induced at 37 weeks because of her large size. I'm quite small and slim so it was a worry. I had her with no intervention and it was ok. She was on the larger side but the recovery was so much quicker and I have suffered no lasting affects.

Following as I am genuinely considering the same thing.

Incontinence is not standard .

@Pottedpalm it is just about standard, except it doesn't get as much publicity as it is viewed as a "female problem" (a view of a consultant I talked to about it), therefore considered almost irrelevant.

You can certainly ask for a discussion with your consultant about your options. Having a trial of labour can be a good option so there is a low bar for moving to LSCS if things aren’t progressing well. Also you could say you don’t want to be induced if post term or, conversely, be induced at 39 weeks if your cervix is favourable and then have a trial of labour.

So keep an open mind since the majority of babies are born naturally and their mothers do not have lasting birth injuries ? They may agree CS is a good option but do be prepared to consider alternatives.

Your body, your choice. Make sure you're well informed and able to advocate for yourself.

Also following as I have had similar thoughts. YANBU in my opinion, your reasons are sensible.

My reasons: DPs family are all much taller and were much bigger babies than on my side. I am tiny. I've had HCP remark on it before when doing gynae treatments. Family members with my build have struggled, had bad births and been told to have DC they want close together and then never try again. Jokes about birth "destroying" you etc are very distressing to me knowing this and I already live with damaged joints. I am frightened of more damage to me.

Between DP & me too, chuck PTSD and an anxiety & panic disorder where I need some semblance of order into the mix as well and an ELCS seems like the least damaging option to me (and him, watching) in the longer term. Not risk free, not complication, pain or recovery free but the option I most likely come through the least broken.

Good luck OP!

I did this.
Zero regrets. I had two pleasant and virtually pain free births, and recovery was much easier than I anticipated (basically back to normal in a few days).

[quote Lagomtransplant]@Pottedpalm it is just about standard, except it doesn't get as much publicity as it is viewed as a "female problem" (a view of a consultant I talked to about it), therefore considered almost irrelevant.[/quote]
Do you have evidence of that?
It sounds like a gross exaggeration.

Ps: i was literally going down slides at soft play 10 days after my second was born.

Every recovery is different, but there are a lot of misconceptions , a lot of which cover from either women that haven't actually had an elcs, or those that had an emergency section.

If you feel a c-section is best for you, then go for it. I had an elective for my first born. But be aware of the risks and complications. Babies delivered by c-section are more likely to need breathing support post-birth - I didn't get to see or hold my baby for 2 hours as she had to go to special care. Babies can be very sleepy (not as good as that sounds given the need for feeding!) and breastfeeding can be harder to establish.

Also don't think of a section as being a way to avoid pro-lapse and incontinence problems - you risk both from just being pregnant no matter how you give birth.

I’m assuming we are talking long term, not temporary stress incontinence for a short while after birth.

It's your body, your choice. Well within your right to ask

Pottedpalm

www.sciencedaily.com/releases/2012/03/120325102613.htm

It's completely up to you, but personally I really think that a babies position is much more important when it comes to labouring, than their size. Have you looked into options like hypnobirthing if you do decide to go for labour? I mention it, as it can be so helpful in reducing fear around birth.

From personal experience, I had my dd in hospital, she was 7lb2, back to back, and I needed an episiotomy and injection to get my contractions going again (did hypnobirthing thankfully so this didn't feel too traumatic at the time). When I had ds, I had a home birth. He was 10lb3, had him at home with no problems and only slight grazing. Obviously every woman's body and experience is different and you 100% should do what feels right for you, but personally I wouldn't view having a big baby as a huge warning sign (this is just my view of course, and I'm sure many others feel differently)

I had forceps with my first, 9lb 7oz followed by 2 natural births 8lb 2oz and 10lb. My forceps delivery healed quicker then my DIL's section though. A section is not an easy way out so think it through thoroughly. It seems you know the side effects possible on natural birth so you need to know what the results of a section could be . Then you can make a measured choice.

If you have a high BMI a section will not mean the risks are reduced.

You will have a higher risk of blood clots post surgery, a higher risk of complications from the anaesthesia, and a higher risk of infection at the surgical sites.

It isn’t an easy fix for the problems your weight might cause.

I suggest you ask for an appointment to discuss the pros and cons of both options. An instrumental delivery may not be ideal, but it’s better than a post surgical infection. Friend of mine developed one due to her weight- was in and out of hospital for 6 months for cleaning and revision, couldn’t walk or mobilise so was on blood thinners, her husband had to take 6 months of work to care for her and the baby.

I am normal weight and found a section not a nice experience at all. Mine was relatively uncomplicated and the recovery was pretty awful.

@goose1964

A section is not an easy way out so think it through thoroughly

You haven't had one though...

I have, and found them very easy.

Ps: I'm also fatter than the OP.

Yanbu. However I would implore you do thorough research.
A c-section isn't the easy way out. It's major abdominal surgery, and there are many risks attached. Possibly more than that of a natural birth. Recovery can also be extremely rough in many cases.
Whatever decision you make, just ensure you make it completely aware and informed of what is going to happen, and what the risks are.

I have had both. My DD was an assisted delivery with forceps and episiotomy. I didn't want to go through that again so had an elective with DS a few years later.

In my honest and personal opinion, my section was much better for me in terms of recovery and mental trauma. However this will be different for everyone. If I were to ever have a third child I would take an elective section over a vaginal birth as for me this was the much better option.

*A section is not an easy way out so think it through thoroughly

You haven't had one though...

I have, and found them very easy*

Anecdote is not data. Just because you found it easy doesn’t mean everyone else will.

I’ve had one, I didn’t find it easy. The elective was far worse than the emergency.

You can’t base risk on one or two individual outcomes. This is why we have population data, which shows an overweight person is more likely to experience complications.