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!

I'd be unwilling to go for a trial of labour if I weren't sure I was happy attempting a VB. Simply because I wouldn't trust that any desire of mine for a maternal request section would be honoured once labour had started. It's harder to insist and advocate for yourself once you're in that more vulnerable position. So the only way I'd be waiting for labour to start is if I knew I wanted a vaginal birth.

Fwiw, I've done it both ways. The only way forward is to appraise yourself of the different sets of risks and benefits for both ELCS and attempted VB, and decide which ones you prefer. NICE guidance is your friend here.

Also, treat with extreme suspicion any person or organisation who only wants to talk to you about the positives and negatives of one of the options. Because it's not as simple as one is riskier or more beneficial than the other, anyone who tells you it is must either be poorly informed or have an agenda.

You’re not guaranteed to avoid a prolapse if you have an EC

Really appreciate everyone sharing their experiences - clearly there are pros and cons to both and it very much depends on what happens on the day...such a tricky decision but as someone pointed out, if I'm going to request the section I know I need to go in there confident and be assertive as they will want me to go for a VB.

Thanks again everyone!

I asked for and chose a section with my first and only baby.
I had to speak to two consultants who told me the risks and a midwife who did the same. If a consultant doesn't agree with a section they have to legally send your details to another consultant to sign it off.
You can have whatever birth you want.

I decided to have a section so I could plan everything to within an inch of its life. I knew if I'd end up with an emergency section then I wouldn't recover as well and still have all the same issues (driving, lifting etc) with nothing in place. Plus there are so many different things that can happen with a vaginal birth.
I'm glad I did as most of my NCT group had vaginal births with pretty bad tears, inductions, EMCS and they took quite a lot longer to heal then I did.
However, it is major surgery. Day 1 to day 5 is pretty horrendous. But from then you start feeling a bit more normal.

I've had 2 natural births and 1 planned c-section. Despite NICE guidelines, I really had to fight for my section so just be prepared to have to put up an argument. The natural births were obviously more painful and more difficult but with that came the euphoria when the baby was born and a fast recovery. The c-section was calmer and pain free but significantly more painful afterwards, recovery took much longer & I didn't get the euphoric feeling. I definitely think women should have a right to choose but personally I would not choose a c-section again.

Your choice entirely. I would just add that you can still be incontinent from c-sections! Your pelvic floor takes a hammering either way...

My situation was a bit similar to yours and I had natural births without any lasting problems. Never had forceps/ventousse with either of my deliveries even though they were both pretty large. Also had growth scans and all the symptoms of gestational diabetes, but normal BMI. My second was well over 9lbs and had a particularly large head but the birth of his head was crazily quick (4 pushes and out - although this was my second). He did suffer shoulder dystocia and I was cut and they eased him out with their hands. He had a bruise on his shoulder/arm but no long term damage. My episiotomy healed well and I've never had any other problems - certainly not had a prolapse and never had any incontinence, even immediately after birth. Big babies run in my family and my mum naturally gave birth to my sister at 10lb10oz without any interventions or lasting problems.

YANBU. I ended up with an episiotomy and forceps with my back-to-back DS. I wouldn’t recommend it, unless it’s totally unavoidable.

(Not to terrify anyone though; it was basically fine, but more long term damage and pain than you get with a section, I believe, but the forceps nearly blinded DS in one eye).

Totally up to you and I hope it all goes well. It's your body and your choice.

I had a maternal request c section last year and don't regret it at all. The whole experience felt very controlled and I recovered really quickly. No issues with the baby and overall I had a really positive experience.

I had to push for it, but when they realised that I going by statistics they agreed. It's hard to argue with numbers. Your 1 in 3 stat really factored into my decision and of my antenatal group (excluding me), half had forceps/episiotomy and the other half ended up with emergency c sections. This may have been a particularly unlucky group, and it's just anecdotal, but considering they spent maybe 20 minutes of the 3 days of antenatal presentations on 'complications', they certainly try to play down the risk of vb.

Good luck with whatever you decide

It should be entirely your choice.

You've researched, you've found the risks for each, now you asses those risks and choose the ones you're willing to take.

I wish I'd understood those risks before heading into induction with DC1 NHS prenatal missed a few key points luckily the EMCS at the end of it all was great. DC2 was an ELCS and that was also excellent. Good luck!

I'm glad I did as most of my NCT group had vaginal births with pretty bad tears, inductions, EMCS and they took quite a lot longer to heal then I did

Do bear in mind though it seems to a thing to describe vaginal births in excruciating detail, and compare war stories. You never hear of the shrug it was fine tales. I had many people tell me that I was “lucky” to have a section and then tell me how horrific their vaginal delivery was, without even bothering to find out how I’d found it. It’s generally assumed a section is the “easy” option.

Most people can’t compare directly as it’s relatively unusual to have both without good reason- if your first birth was a sneeze them out delivery you aren’t going to choose a section for the second.

Like I said, my emergency was far easier than the elective. I healed much faster and with fewer issues.

Bottom line is nothing is a guarantee, whatever anyone else experience was. It’s balancing the risks.

I had two vaginal deliveries, both fine no problems.(Just thought I would say that I am one of the shrug it was fine ones)

This may have been a particularly unlucky group, and it's just anecdotal

Similar to my group

3 out of 3 were instrumental or emergency section.
Of the 5 vaginal births, only 1 had a straighforward/no repair needed birth.

It’s totally your choice, I’ve had both.

Natural birth recovery was far easier even with a second degree tear but it took me longer. So less intense pain but a longer recovery. Plus it honestly felt amazing to give birth naturally and bring my baby into the world (as cheesy as that sounds). I had an epidural so loved the pushing part! It did take a while for things to feel normal again physically, I’d say about 6 months.

I actually also loved my c section. I only chose one because I was having twins. I had the option of natural as twin one was head down but didn’t want the risk. I had my own music, lavender oil etc. the hours in recovery was so special holding my babies. Not going to lie though those first few day are brutal. It was harder though because I obviously had twins and a 3 year old to look after! However a few weeks on I’d basically forgotten all about that. It was nice to have a plan but I was very scared before the surgery. The scar isn’t bad at all though, and I feel physically I’ve been ‘damaged’ less by my section than natural birth.

Both births were very different and each one was the right choice. I wouldn’t change either experience.

I had two elective sections and recovery was good for both. Both my children latched on in recovery and breastfeeding was no problem.

I had concerns as my babies were predicted to be big and both were over 9.5lb, I have no regrets and in both cases I went home the next day.

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

This is not true. I was a 7lb baby and my mum had a relatively easy birth with me and my equally small brother.

My own birth experience mirrored my MILs almost exactly - long difficult labour then a cat1 emergency c-section. They are a family who make large babies who refuse to get into nice birthing positions.

I had a maternal choice elective c-section a couple of years ago. If you want to go down that route, start the ball rolling ASAP so you can get into the system as there are plenty of hoops to jump through as others have mentioned. I think I had to see a consultant twice and the head midwife (can't remember exact job title) and they were keen for me to go for a vaginal birth. I got the elective CS and for me and my baby it was the best outcome. Very calm and relaxed and I've never been able to join in any of the birth scare stories you hear at mother and baby groups! I always want to recommend it to pregnant friends but I don't want to impose my views or tread on anyone's toes. In other countries EL-CS is very much the norm but the combination of NHS policy (they are focused on short term costs rather than long term) and the semi-cult of NCT drives people to vagina delivery here. I agree with a PP that the stats for elective CS and emergency CS should be separated out. They reason they don't do this is that it makes it clear that an EL-CS is safest for baby and usually the mother too. Good luck whatever you decide, it's just one day in your life and at the end of it you'll have a lovely baby!

Consider your options and make your decision. It should be up to you how you give birth. Don't let anyone pressure you into something you are not comfortable with.

@DeepaBeesKit

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.

Actually there's research that shows the dad's birth weight is a good predictor for the baby's

I did exactly this. Recovery was slow and painful but I still don't regret it. I didn't have the trauma at birth I was worried about, no nasty surprises, and therefore I felt able to bond with my baby. So I feel it protected my mental health. But recovery is slow and especially if you're overweight you'll struggle, so I would only consider it if you have a VERY supportive partner who can take parental leave and literally do everything except breast feed for at least the first fortnight.

Also, buy in a load of COOK meals to stock your freezer up for the first month.

@DeepaBeesKit source: pubmed.ncbi.nlm.nih.gov/9609578/#:~:text=After%20adjustment%2C%20fathers%20in%20the,association%20with%20infant%20birth%20weight.

My wife has recently had an elective cesarean, there were medical reasons but it was ultimately recorded as maternal choice. It was great, her recovery was excellent, she was up and out walking properly into town for example within a week. Only real downside we can see was the delay in milk coming through, but she has managed to breastfeed with real effort. It was scary, but I suspect that’s true for all births!

In our NCT group there were two elective Cesareans both of which went well, of the other 7, 4 ended up with emergency c-sections which were far more stressful and difficult than my wife’s. One had forceps which led to a dislocated shoulder for the baby. If we have another baby she will make the same choice.

Our hospital was great (or the consultant) and there was no pressure to labour. As it should be, but as I understand it a bit rare.

Good luck with whatever you decide OP.

@LondonDweller83 totally agree on Cook! We haven’t managed to move off it yet 😂

A section is major abdominal surgery. I really feel like people forget this. You are cut in half and the baby literally pulled out from you. There are greater risks to your body just because it is surgery, adhesions, your ureter might get nicked during the surgery (so end up with pee problems anyway), DVT risk also especially since you are heavier as you mentioned, not to mention healing time. Also consider the long term health to your baby. Babies born by vaginal birth are generally healthier than c section babies. There are pros and cons to both.

I would research but also listen to your consultant. They are the experts.

I think every woman who wants a planned section should watch a c section video to fully understand the risks they put themselves in. Personally I would try a vaginal delivery with low threshold for c section. Have a think about your options and go in with an open mind.

Best of luck