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!

Thanks everyone for your replies so far - lots to think about! Re the incontinence - possibly bad phrasing, I meant it more as it seems to be viewed as "just one of those things" that women should be expected to put up with. Although I'm aware pregnancy can cause this anyway, I am trying to remember pelvic floor exercises!

To those who have mentioned section risks, I am aware of those too which is why I am finding it difficult to decide. I think my post was very geared towards the risks of a vaginal delivery because that's not something healthcare professionals really talk about in my experience. It's a difficult one and I know that if I go in undecided they will want me to have a vaginal delivery. I do have an appointment on Friday to discuss with a consultant, my midwife was actually in agreement and thought a section would be a reasonable ask in my case.

Feeling quite disappointed in myself with my weight really, heaviest I've ever been and this does put me and my baby at higher risk whatever I decide...

Erm, I'm completely out of the loop here as my youngest is now 11, but I'm pretty sure you won't get the option to just ask for a section and get one. I'm willing to stand corrected but I asked for an elective section after the medical incompetence I witnessed during my first birth, which ended in emcs. I had to fight tooth and nail and threaten to take them to court and even then I was told it wasn't guaranteed and if I was progressing well in labour they'd just leave me to it. Sadly its the NHS, you can't just choose!

Sadly its the NHS, you can't just choose!

NICE guidelines say its maternal choice. Sometimes they make it very difficult but yes, people do have a right to choose a section.

And it actually works out about the same price for the nhs as a vaginal birth, once the costs of recovery, complications, litigation following screw ups, corrective surgery and physio are taken into account. Ie the vaginal birth is usually cheaper initually, but by the time the secondary costs are taken into account they are about the same

YANBU. Your pregnancy, your birth, your body so it's YOUR choice completely.

If that's what you feel most comfortable with, then go for it!

Download the NHS Squeezy app! Best £2.50 I’ve ever spent, it reminds you to do your pelvic floor exercises.

I had a vaginal delivery to a big-ish baby in an awkward position with a big head. I had an episiotomy but no instruments.

I did wet myself for about 24 hrs afterwards because all the nerves were bruised etc but no lasting incontinence or bladder weakness.

Episiotomy was literally the least painful bit of the whole thing and recovery is usually quite quick.

Personally the thought of a c-section freaks me out a bit.. I don’t like the idea of being cut open and having a catheter.

But whatever you decide, don’t worry about the costs to the NHS, it’s a drop in the ocean, do what’s best for you.

Remember there are many benefits of a vaginal birth to the baby. Baby is likely bigger due to your weight.

I've had 4 vaginal deliveries - without complication or any incontinence ever
In my day we weren't given a choice , c section would only be done for medical reason , however now there is more choice so that's exactly what you should do - weigh your options and decide what's right for you
Good luck with your baby whichever way they arrive 😊

Make sure you talk all your options through with midwives, consultants, etc. You need to be fully informed of the risks, advantages and disadvantages of both.

I had an emergency c-section after an attempted instrument-assisted delivery which failed. I recovered very well, but I think that is quite unusual and I feel very lucky. It is a massive surgery - it is by no means an "easy way out".

Don't rush a decision and also don't let statistics make the decision for you - do whatever feels right for you.

Something else to consider is the benefit of a vaginal birth to the baby, in terms of allergy.

There's a lot of research being done which points to C section babies having lower immunity and higher rates of allergies, due to the lack of bacteria they would be covered in during a vaginal delivery.

An interesting point and probably worth researching in terms of your baby's health.

You sound like you’ve put a lot of thought and research into it so that bodes well. I think that they just don’t like handing out c-sections to women who consider themselves “too posh to push”. If you haven’t seen it yet then this is the stats that many trusts use to try to get you to change your mind: www.nice.org.uk/guidance/ng192/resources/appendix-a-benefits-and-risks-of-vaginal-and-caesarean-birth-pdf-9074971693
The incontinence stats should help your case.
Lastly, I wouldn’t worry at all about how much it costs the NHS. In the long-run, all the physio and pelvic repairs cost way more than the c-sections. Not to mention the £4.2 billion they pay out each year in obstetric compensation claims (59% of the total budget)!

@Catlady90

Have you looked at the evidence based birth website? Lots of good information to help you make your decision.

evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

Your decision and birth OP and you have the right to request a maternal section as PP have mentioned (look up the NICE guidelines).
I requested an elective for various reasons - had to state them at pretty much every appt I went to which was extremely tedious as it was clear I wasn’t going to change my mind, and ended up with an emergency c section at 34 weeks anyway….given I’d planned an elective and even had it scheduled I was fully prepared for it all. My recovery was great and I was up and showering about 8 hours after delivery (late night delivery; catheter removed at 6am and showered soon after that).

@Babyboomtastic

Sadly its the NHS, you can't just choose!

NICE guidelines say its maternal choice. Sometimes they make it very difficult but yes, people do have a right to choose a section.

And it actually works out about the same price for the nhs as a vaginal birth, once the costs of recovery, complications, litigation following screw ups, corrective surgery and physio are taken into account. Ie the vaginal birth is usually cheaper initually, but by the time the secondary costs are taken into account they are about the same

Yes, but what NICE recommend and what actually happens are usually two completely different things as its down to the CCG to decide what they will and will not fund. I suggest the OP speak to her consultant to see of its actually an option first!

@Babyboomtastic

Sadly its the NHS, you can't just choose!

NICE guidelines say its maternal choice. Sometimes they make it very difficult but yes, people do have a right to choose a section.

And it actually works out about the same price for the nhs as a vaginal birth, once the costs of recovery, complications, litigation following screw ups, corrective surgery and physio are taken into account. Ie the vaginal birth is usually cheaper initually, but by the time the secondary costs are taken into account they are about the same

Whilst I agree, the nhs will do everything they can to push a mother into vaginal birth if there is no medical reason to do a section. If it's something you're going to request you have to be willing to fight tooth and nail for and not back down.

It's your choice and you would not be unreasonable to make whatever plan you feel will suit you best.

I think in general forceps get a bit of a bad rep, I certainly wanted to try and avoid it when I gave birth but as it happened it was needed and it was absolutely fine. It was very quick when DD needed to be out that second (cord round her neck), quick stitch up afterwards, pessary up the bum and that was that, home the next day and healed very quickly.

Every birth is different you can only do what you think is right for you based on what you know and if you think c section is the way to go then great

It might be worth looking at the Birthrights website if you haven’t already - they have a lot of info about maternal request elective c-sections, including whether your particular trust complies with the NICE guidelines (in terms of supporting women to have ELCSs) or not.

I’m in the position of having to choose between ELCS and vaginal birth for my second, following a pretty traumatic first (vaginal) birth. I haven’t decided yet but I’m leaning towards an ELCS. I’ve previously looked at the link @SweetBabyCheeses99 has shared and found it pretty helpful (although it’s still not perfect data as they’ve lumped emergency and elective c-sections together and have been a bit economical with some of the risks of vaginal birth).

Incontinence really isnt standard even with prolapse. I had some prolapse, it improved even as hormone levels calmed down when I stopped bf, and then got better with physio and pilates and weight loss, never had continence issues though. My friends and I are very open about this stuff and only one had temporary issues in that area for a very short period.

Reading this thread with interest as I also think I want one. I had an epigastric hernia repair with mesh a few years back, the thought of rupturing that I’m labour brings me out in a cold sweat (even though it wouldn’t be life threatening, just agony and I hear they just tell you they’ll fix it again afterwards so it’s not a problem 😬 please god no) and I’m also terrified of instruments and birth injuries - I have a phobia of general anaesthetic and whenever I’ve had to have one I’ve had a panic attack and had to be wheeled in and (kindly) held down so they can get on with it. The thought of going through birth and then possibly having to have multiple surgeries to correct the hernia and anything else that might go wrong has literally scared me off getting pregnant for years. I’m in late 30s now so it’s now or never. My husband agrees with my thoughts on it. The thought they might refuse it and make me have a vaginal birth is keeping me up at night and I’m only 7 weeks, I’m not exaggerating it’s truly ridiculous how anxious I am ☹️

Having had an emergency section and a VBAC, I wish I’d gone for a planned section the second time. I have long-lasting and possibly permanent damage from the VBAC (episiotomy/ forceps). I found BF easier to establish after the EMCS than the damaging vaginal birth.

Do your research and make your own, informed choice. Good luck!

I also feel bad as I know how much more a section costs the NHS.

This is not really true. The comparison is likely to be against a vaginal birth with no complications and no physio or follow up for longer term issues afterwards.

I’ve had four c sections with differing recoveries but even the most painful and complicated one, was an easier recovery than many of my friends who had vagina deliveries.

I’ve had two planned sections, albeit medically advised. Recovery took a few weeks as you’d expect and it was three months before I felt “normal” again. I think the pain and inability to walk, lift, sit myself up etc contributed to my inability to successfully breastfeed. I had a lot of bruising second time round as baby was hard to get out and I was in hospital for five days each time.

It’s not without long term effects either - I still have some stabbing pains along my scar line and down one side of my groin due to nerve damage. I almost certainly have abdominal adhesions which cause severe menstrual pain.

Nothing went wrong as such during either section and I don’t regret them (baby and I would be dead otherwise) but it’s not a guarantee of no lasting effects.

It is your choice, but really go through all the risks with numbers on both ways of delivery. Both have their positives and negatives and you just don't know which will be better until you're in the moment.

FWIW I've had friends who've had lovely c sections, both planned and unplanned. I've also had friends who had horrific emergency c sections and horrible planned sections.

If it helps. I've had 2 vaginal births. I have no issues with incontinence. I can sneeze with perfect confidence. I had a good birth with my first. He was 9lb1 and I didn't need any help to deliver him. I bled a lot but most due to cervical erosion which mixed with waters and looked way worse than it was. I had a third degree tear and stitches.

My second was a beautiful water birth. She was 9lbs 3 and not even a graze. My stitches held which surprised me as it was only 2 years later.

I do feel that a c section would have given me a way worse recovery and longer after affects than the vaginal birth did.

Given what you've said, it might be that you end up having one anyway. You could try a natural labour and see how you go but have the consent forms all done for a c section ready so you can move to that. You don't have to accept forceps if you want to go straight to sections

[quote GemmaRuby]@Catlady90

Have you looked at the evidence based birth website? Lots of good information to help you make your decision.

evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/[/quote]
I have seen this - thank you 😊 I will also download the app you recommended!

It's your choice. For what it's worth; most doctors I know who have given birth have opted for elective CS.

I have had two vaginal births, both very straightforward and no interventions but for one reason or another the recoveries or both were pretty brutal. Having since seen the friends that I mention above and their recoveries I wonder if I would have made a different choice myself.

@SweetBabyCheeses99

You sound like you’ve put a lot of thought and research into it so that bodes well. I think that they just don’t like handing out c-sections to women who consider themselves “too posh to push”. If you haven’t seen it yet then this is the stats that many trusts use to try to get you to change your mind: www.nice.org.uk/guidance/ng192/resources/appendix-a-benefits-and-risks-of-vaginal-and-caesarean-birth-pdf-9074971693 The incontinence stats should help your case. Lastly, I wouldn’t worry at all about how much it costs the NHS. In the long-run, all the physio and pelvic repairs cost way more than the c-sections. Not to mention the £4.2 billion they pay out each year in obstetric compensation claims (59% of the total budget)!

Thank you, this is really helpful, will take a look before my appointment later this week