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!

Just to say again thanks to everyone for your thoughts and experiences, I'm reading them all and they're really helpful. Hopefully helpful for the other couple of posters who are having a similar dilemma too!

I think every woman who wants a planned section should watch a c section video to fully understand the risks they put themselves in.

Sure. I assume there are also a variety of videos for women who want vaginal births to watch. Forceps, ventose, maybe someone's clit being ripped in half (happens sometimes shudder), close up videos of 3rd and 4th degree tears, maybe an emergency epiostomy without anasthetic.

Or is just women that want sections that have to watch the unpleasant bits? At least with a section you don't FEEL any of it, in contrast to many of the complications of a vaginal birth.

I had some similar experiences to @Oliveandsage. My first birth was horrible - reduced foetal movement, induction, back to back labour with no progression, failed forceps, failed ventouse, crash section. I found it difficult to bond with DC1, failed at breastfeeding and my scar became infected. When I was pregnant again I went I to my consultant appointment prepared to fight to have an elective and he agreed immediately but then rolled his eyes and said he had to read me the risks of a section and I had to sign something to say I had considered a VBAC. My second birth was a beautiful elective section, I felt so in control and we bonded and breastfed instantly. I felt 'normal' after a week and my DH went back to work.

You know yourself and your body, do what is right for you.

Your reasons for wanting the c section are valid and sensible. It’s also slightly safer, overall, for the first baby.

I took the same decision for similar reasons (apart from BMI) and am so thankful I did. It was a really positive experience and despite DD being a bit premature due to IUGR and reduced movements she was very well at birth - Apgar score of 9! Recovery was very easy for me, milk came in a bit early if anything. The only lasting issue is very slight numbness along the scar line, but so what?! It makes no difference to anything.

Anecdotal, but I just wanted to counter the ‘major major’ surgery line, which always gets thrown about as if we’re talking of open heart surgery. It’s classed as major surgery because it involves opening the abdominal cavity. Yes, there are risks but it’s an incredibly safe and routine procedure in the vast majority of cases. Babies are not ‘pulled out’, they’re removed gently.

There are downsides, of course, but that is also true of VB and an elective rules out the chance of the two most risky options - instrumental and EMCS, which a VB does not. A recovery from a complicated VB can be longer and more painful than from a straightforward ELCS as well.

Decide what you want and then stick to your guns!!

I had an emergency csection after a long and difficult labour with a large baby who was badly positioned and got very stuck. I recovered remarkably well physically, breastfeeding got established after a few days, and I had no issues. I had a little bit of mental trauma around the birth but that went away with time. I think I was lucky, though.

Also, I had prepared for a difficult birth knowing my MIL and SILs history, but all the bouncing, spinning babies and hypnobirthing I did had no bearing on the outcome in the end.

Next time I'm planning for a VBAC but only if it's going well, otherwise I'll go straight to a section.

I wonder if you could do something similar? Try for a vaginal birth but if it starts to show signs of not progressing how you'd like, opt for a section. Obviously you can't always do that if the baby gets stuck too far down and then you decide on a section, but generally you don't have to agree to induction/forceps/ventouse if you don't want to.

OP, have you asked your midwife about birth education sessions? I am also pregnant currently and under the perinatal mental health team due to my anxiety. I am incredibly anxious about giving birth either way, but starting to lean more towards having a c-section as I am aware that the stress and anxiety of natural birth/not knowing when it's going to happen may result in complications anyway. My perinatal nurse is arranging for me to have some birth education sessions with a vulnerability midwife where she will give me a really detailed explanation of different types of birth, pros and cons, recovery etc maybe this would be helpful for you?

Your choice @Catlady90 , as you've seen there's pros and cons for both. I think you will need to be assertive when if you definitely go for section. A relative wanted c section for second (first was emergency c section), but she was told how she should be grateful she could try vb and it was ridiculous, to the point the doctor told her, they're happy to cut her open but because it was her choice she shouldn't expect the same after care as she had with first (so she might end up with infections and what not).
Anyway, needless to say she stuck to her guns and had c section.
Hope it goes well

This video is very interesting, op.

I watched it just after I had my last section and I found it very interesting.

@Brokensunflower

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

Heavier BMI doesn't always mean bigger baby, I had a BMI of 23 when I had my first and she weighed 2lb more than my second when my BMI was 29 - 2 weeks earlier!

@LadyOfLittleLeisure

I had some similar experiences to *@Oliveandsage*. My first birth was horrible - reduced foetal movement, induction, back to back labour with no progression, failed forceps, failed ventouse, crash section. I found it difficult to bond with DC1, failed at breastfeeding and my scar became infected. When I was pregnant again I went I to my consultant appointment prepared to fight to have an elective and he agreed immediately but then rolled his eyes and said he had to read me the risks of a section and I had to sign something to say I had considered a VBAC. My second birth was a beautiful elective section, I felt so in control and we bonded and breastfed instantly. I felt 'normal' after a week and my DH went back to work.

You know yourself and your body, do what is right for you.

So nice to hear you had a lovely second birth too, I had the same bonding issues with my first as well, and nothing at all this time round.

Sorry I forgot to add, where did you find that there's a 1 in 3 chance of assisted/instrumental delivery for first time mums? I would be interested to read that ☺️

This is a good thread OP, following with interest as I’m considering the same thing for my first baby in December. I don’t know anyone that has had a straight forward vaginal birth - most have ended in emergency C-sections. A couple of my friends are quite traumatised from their births. I don’t think a section is the easy way out but it’s something I’m very anxious about. My BMI is about 40, so I’m bigger than you, and while my partner is very slim he was 10lbs at birth which is a bit worrying.
Another thing is if I was going to have a vaginal birth I really, really want a water birth, something there’s no guarantee of even if my weight was much lower. I’m quite anxious about everything.

she was told how she should be grateful she could try vb and it was ridiculous, to the point the doctor told her, they're happy to cut her open but because it was her choice she shouldn't expect the same after care as she had with first confused (so she might end up with infections and what not).

This is APPALLING.

Please tell me she complained to PALS?

Your choice. You've obv thought about it.
But re incontinence. I had a huge first baby with a huge head and I can still happily jump on a trampoline at the age of 55! It is not standard IME, second baby was more 'average' but both were vaginal births.

I had 2 ELCS. I had to insist on the first ELCS against quite significant opposition from midwifes and consultant. My reasons for wanting an ELCS were largely the same reasons as yours, but also against a background of my BFF having a labour that went wrong and her son ending up with severe brain injury and life changing injuries. I wanted what I considered was safest for both me and my 2 babies.
Your body, your choice. You need to decide what is best for you and your child.
I had an excellent recovery from My ELCS and 2 babies born with no birth injuries. I couldn’t have asked for more.

@Kayl23

OP, have you asked your midwife about birth education sessions? I am also pregnant currently and under the perinatal mental health team due to my anxiety. I am incredibly anxious about giving birth either way, but starting to lean more towards having a c-section as I am aware that the stress and anxiety of natural birth/not knowing when it's going to happen may result in complications anyway. My perinatal nurse is arranging for me to have some birth education sessions with a vulnerability midwife where she will give me a really detailed explanation of different types of birth, pros and cons, recovery etc maybe this would be helpful for you?

I haven't actually- wasn't aware this was an option!

The stats regarding assisted deliveries I found here:

www.rcog.org.uk/en/patients/patient-leaflets/assisted-vaginal-birth-ventouse-or-forceps/

I had an emergency c-section to deliver twins. It was ace. No pain. Stopped taking pain relief after three days and recovered very quickly. I think I had staples to hold the wound together which was a bit disconcerting but they were removed soon enough.

I would have requested a c-section again if I had had another child. For me, it is about balancing both the physical and the mental health of the mother. Labour is hugely unpredictable. You could be in labour for days, in pain for days and suffer a traumatic birth which leaves you injured and exhausted and not in the right head space to look after your baby. Of course, some mothers experience fantastic labours (my mother had three textbook deliveries) and some mothers are in bad shape after a c-section (my sister in law was in so much pain she ended up in a wheel chair for a couple of days). It’s impossible to predict. I think the best you can do is to look at your particular circumstances and family history and make the best decision for you (which sounds as though it could be a c-section).

Finally, I breastfed successfully after my c-section.

@Silentnight87

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

If women were forced to watch videos of an ELCS, then they also need to watch them for EMCS, straightforward vaginal and every intervention vaginal delivery, including what follow up care women receive for their injuries and trauma. If this happened prior to conception then I imagine birth rates would nose dive or ELCS requests would sky rocket.

As difficult as this is for some people to understand yes, women are aware it is major abdominal surgery and (in my experience) medical staff go to great length about the risks. If only they'd been as forthcoming about the risks of an induced vaginal delivery, given me as much information beforehand about the risks, my Bishop's score and actually gained my informed consent, DC1s birth would not have ended with EMCS and PTSD because it would have been obvious that an ELCS was by far the lower risk option.

In risk order you have:

1. Straightforward vaginal delivery
2. ELCS
3. EMCS
4. Complicated vaginal delivery

Since you can't guarantee option 1 then it's surely no surprise option 2 is positively considered (and no, not because it is in any way 'easy' - that's just bollocks used to shame women who choose not to have a vaginal delivery).

@letsgotrilobite

I had an emergency csection after a long and difficult labour with a large baby who was badly positioned and got very stuck. I recovered remarkably well physically, breastfeeding got established after a few days, and I had no issues. I had a little bit of mental trauma around the birth but that went away with time. I think I was lucky, though.

Also, I had prepared for a difficult birth knowing my MIL and SILs history, but all the bouncing, spinning babies and hypnobirthing I did had no bearing on the outcome in the end.

Next time I'm planning for a VBAC but only if it's going well, otherwise I'll go straight to a section.

I wonder if you could do something similar? Try for a vaginal birth but if it starts to show signs of not progressing how you'd like, opt for a section. Obviously you can't always do that if the baby gets stuck too far down and then you decide on a section, but generally you don't have to agree to induction/forceps/ventouse if you don't want to.

Thank you - that is something to think about in terms of requesting a section if things aren't looking good. Although I think a previous poster mentioned that it might not be respected at the time, and more difficult to fight for in that situation!

I've had two c sections and I'm pretty sure I wasn't "cut in half" for either one of them.

It’s entirely your choice. There are also middle ground options like planning a vaginal birth but having a low threshold for opting to move too CS.

I had a clearly agreed birth plan that I would choose whether to have a CS at any time. My BMI is higher than yours and I had vaginal births with labours of 15 mins, 4 hours and 3 hours. I went out to breakfast eight hours after my first child was born.

DuggeeHugs - I agree the risks of VB are minimised by healthcare professionals. The amount of times I have heard of people told things like "yeah, but it doesn't matter because you'll have your baby afterwards" etc. I appreciate this is true for many but it goes to show how birth injuries are just considered part and parcel of having a baby.

My midwife said she and her team are in the process of putting together some data for the consultants to show the high level of intervention and birth injuries for first time mums. Not exactly sure what the answer is but there are certainly things to consider on both sides..

@Catlady90 yes, there can be huge pressure to just go along with a vaginal delivery without being made aware of the risks involved. From my own experience the risks were either ignored or chosen on my behalf and, especially given the outcome, I'm not at all in favour of that approach.

DC2 was born via ELCS but this, too, involved a protracted fight with the consultant, despite the clear risks. Their final gambit was 'don't you want to feel like you tried'.

My argument was that medicine should be evidence-based, not led by pie-in-the-sky ideology. That obstetrics is allowed to continue in this manner should be a concern to everyone.

@VainAbigail

This video is very interesting, op.

I watched it just after I had my last section and I found it very interesting.

Thanks for this!

I suppose the time to talk about risks of birth are before getting pregnant. Once you are, you're going to have to give birth.

The pendulum can swing too far the other way as well. South Africa has one of the highest rates of elective c sections in the world. I've heard from more than one person that there, rich women have sections, poor women have natural births.

There you can also sue your doctor for anything 'wrong' with your child. If you're child is autistic you can sue the doctor who delivered them for birth damage! It's meant that doctors are unwilling to have a woman undergo a vaginal birth. They can better defend these claims (and keep their insurance premiums down a bit) but only doing a planned section under very controlled conditions.

That's sad. I'd have hated to be forced to have major surgery when I didn't need it.