To ask why having an elective C-Section is so frowned upon?

[Rosesandbutterflys]

I am (hopefully) having an elective C-Section soon. First baby, don't want anymore children after.

I've always had a fear of child birth, which over the past 5 years has been compounded by a lot of people around me having children and the vast majority of these (though I appreciate I'm probably unlucky here) have been pretty traumatic births that have ended in severe tears, forceps and a lot of the time, an emergency section anyway. Granted their experiences have mostly been better on their second birth/ child.

Nothing and I truly mean nothing about natural childbirth/ labour appeals to me. Not the hours of pain, pushing, potential rips/ tears, forcep intervention, epidural (yes I appreciate I'd have one of these for a section), damage of my pelvic floor and the panic and stress of potentially having to be rushed to theatre because it just wasn't going to happen naturally and the baby is in distress or whatever.

Now don't get me wrong, nothing about a c-section appeals to me either, it's absolutely no walk in the park and I'm dreading it, but it has to come out some way and I am a person that likes to plan things and to somewhat be in control/ aware of the plan. I have also had abdominal surgery before (though not as severe as a C-section) and I know recovery is likely to be painful and slower than if I were to have a natural birth. But for me, this is the preferred/ lesser of the 2 evils option.

I have also spent hours pouring over research as to the benefits of a vaginal birth over a c-section and last night came across a NICE/ NHS study/ research that found that actually, for a planned/ elective c-section, the risk to the mother of a c-section compared to a vaginal birth is pretty much the same. It states that the risk of the baby ending up in NICU with a C-section is 13.9% compared to a vaginal birth which is 6.3%, so double the risk, BUT it says the research does not take into account the fact that most c-sections undertaken are for medical reasons and therefore the likelihood of the baby needing NICU attention after it's born is increased anyway.

It then went on to say that the risks of an unplanned, emergency C-Section are a lot higher than a natural birth/ elective/ planned C-Section. So I guess if each woman was guaranteed to have a straightforward, natural birth, then great, but a lot of women do end up needing an emergency c-section so, technically they are more at risk than someone who has chosen an elective.

This now seems like I am bashing natural delivery and I'm not at all I totally admire and respect women that chose that route, I only wish I were that brave.

However, the responses I have had from people my whole pregnancy when I have admitted I am opting for an elective C-section have been ridiculous. Not one person has responded positively, all I've had is 'Oh, really? Are you sure??' and 'Oh, why on earth would you elect to have that?' etc etc. Or just a stony faced, tight smile and 'oh right' making it clear they disapprove but not actually coming out and saying it.

I got told last night that the reason I'm getting these reactions is because a C-section is 'taking the easy way out '😕

If that's the case, why on earth wouldn't you? Why is it that it seems the prerequisite to being a good mother is seemingly having to martyr yourself all the time?

So many of my friends that have had children and also the women in my NCT class who are preparing for their births have all expressed dismay/ distress at having to have any pain relief, they all want it to be as natural as possible and I know my friends that haven't had 'textbook' births still harbour 'guilt' and sadness to this day. Why? If you need gas and air or an epidural, so what? What exactly am I missing? If they ended/end up with forceps or an emergency section, it's not their fault, it's just one of those things. Surely modern medicine has provided these things to make childbirth safer?

Anyway, gone off on a tangent now but if you disapprove of someone having an elective c-section, could you tell me why?

Have you actually read any of the thread?! And any of the supporting evidence/ statistics re risk and cost? It's NOT true that it's riskier and it's NOT true that it's more costly. You've literally just come on and arrogantly and smugly said the sky is green and then trotted off all self-satisfied.

So much misogyny on this thread, made even more hideous by the fact that it's coming from other women.

I've had two ELCS and they were fantastic experiences. Couldn't really give a toss what anyone thinks about it, and I never did when my children were babies either. I was happy and confident that I'd had the births that were best for me and my babies. No lasting health effects, which I am grateful for. I think it's a lottery as to whether you will recover well and be left with ongoing health problems, whether a vaginal birth or a C-section. And the chances of problems are less for ELCS than EMCS for obvious reasons.

Women should be supported to make the choice that is right for them without judgement, be that a vaginal or CS birth. All this nonsense about cost as well- PP's have correctly pointed out the costs around inductions, instrumental deliveries, the support needed for a woman choosing to have a VB when a CS may be safer in that instance, and also the care required after for those who have suffered traumatic injuries. All of these things probably cost similar or more than an ELCS. What about number of children as well? I have had two ELCS on the NHS- what about women who have 3,4,5+ VB's? Does anyone criticise them in the same way for the cost to the NHS of their births?

Don’t try and make this poor woman feel bad for exercising her rights - rights that have been put in place by medical experts and policy makers with far more information and knowledge than you. Shame on you
That's ridiculous. It is a selfish choice, but that doesn't mean anyone should feel ashamed. Everyone make selfish decisions at one point in their lives. As I said clearly, it's not the end of the world!

I would have thought though it was obvious that it was more expensive.

It's not at all obvious, no.

Is that your way of saying that you just made an assumption about cost and didn't look into it at all?

It's more than a uncomplicated, non instrumental, no induction required and no traumatic injury sustained vaginal delivery but honestly, how many of those actually happen?

The costs around the VB's that are not entirely straightforward are never scrutinised in the same way as ELCS. It's all misogyny against women- how dare a women make a choice of something that may cost more but that in all likelihood benefits her. The costs of dealing with traumatic injuries are ok, because at least she's suffered! Disgusting but that really seems to be the attitude of many.

I think the key word is "elective", you've chosen this route. Many don't have a choice. And yes, natural is always seen as best just as breast feeding is viewed better than bottle feeding. There will always be judgement but an Emergency C section is viewed v differently than if you choose to have one iyswim.

@JustDanceAddict that’s your experience. I’ve had 3 and never had any problems whatsoever establishing breastfeeding and it certainly didn’t take me 3 weeks to feel “normal” I was up and about normally by the end of the first week each time and drove after about 10 days

Here, here 🙌

Genuinely don’t know how anyone could argue with @LunaLovegoodsNecklace post

@vivainsomnia there is nothing selfish about exercising your rights, and as people have explained, there is nothing ‘obvious’ about the cost implications of either birth choice. Is popping a kid out at home with a community midwife cheaper than a team of surgeons performing a CS? Yes. But when you factor in blue lighting to hospital, NICU care, repairs to the mother and all the other frequent traumas birthing mums face, the equation isn’t so simple.

And that’s even before you start factoring in any mental health costs - which we all know aren’t taken seriously enough at any level.

I can’t work out if the women castigating others for choosing CS are dim or just extremely misogynistic.

I firmly believe that women should have an informed choice about their health, their bodies and giving birth.

To those that don’t, please explain how forcing a woman to give birth vaginally against her wishes is reasonable.

And then please explain how that is different to forcing a woman to give birth against her wishes by denying her safe access to abortion.

To those that don’t, please explain how forcing a woman to give birth vaginally against her wishes is reasonable. And then please explain how that is different to forcing a woman to give birth against her wishes by denying her safe access to abortion.

Everyone should be able to make informed choices about their health and bodies. However, a more reasonable analogy would be why don’t we give an MRI to everyone who comes along and demands it, which is pretty much every second person these days. Ultimately, would more people benefit from an MRI, yes. Can this be justified with cost/resource, no. Why can’t people make informed choices and have the medicine they want? Why can’t they just demand a 2nd or 3rd line agent as first line rather than waiting to see if first line does the trick or fails? Why can’t they have an informed choice? Because while it may benefit an individual, cost/benefit it doesn’t stack up in the greater model.

The harsh reality is there is no bottomless pot for health. It’s a finite pot and you have to make it stretch to cover everyone, and often that means most people have something that, while not ideal is adequate as opposed to a few having something ideal and leaving the pot empty to cover everyone else.

Again, why are you still maintaining that providing ELCS is more expensive for the NHS? If you're going to claim the cost/benefit doesn't stack up, especially if for some reason you think it can be compared to giving MRIs to 50% of the population, the onus is on you to prove that.

@HoppingPavlova you mention 'harsh realities' about no bottomless pit for health- you are aware that the 'reality' is that women are able to request ELCS and have been able to do so since the NICE guidelines changed in 2011? And whilst not perfect, most trusts are following this- indeed even trusts like John Radcliffe in Oxford have changed their stance having been awful over ELCS in the fairly recent past. So you can say all you want that ELCS isn't justified- NICE don't agree with you however.

And nor do they have to juggle with making a pot stretch.

A very interesting article here on this:

A few relevant points:

Cost - "According to a 2011 Nice analysis, the expense of MRCs [Maternal Request C Sections] is only marginally higher than that of planned vaginal births, if treatment for related issues such as incontinence is taken into account. El-Chaâr thinks this might be especially true for parents over 40, who are often induced early but then sit around for a long time, waiting for active labour to start. “I would not be surprised if it’s cheaper to have a planned elective in that group,” she says." - and that is whilst the NHS provides next to no care for birth injuries, as all sufferers know. If it did, Caesareans or vaginal births: should mothers or medics have the final say?the costs would easily tip the other way.

Risks- "The risk of vaginal birth is often underestimated, so the comparison is skewed. This is because researchers do not always account for emergency caesareans as an outcome of attempted vaginal births. In fact, many older studies lump in the emergency C-section risk with the risk of all other caesareans, despite the fact that they are clearly more dangerous and almost always the result of a vaginal birth not going to plan. As Nice makes clear, ideally, studies would compare people planning a C-section with those planning a vaginal birth, but this information is rarely available.
These factors make it very tricky to estimate the risk of choosing a C-section versus planning a vaginal birth, but not impossible. In 2021, a team of Canadian researchers found a hospital database in Ontario that, unusually, had logged MRCs. This allowed them to compare MRCs to other low-risk pregnancies where the plan, but not necessarily the outcome, was a vaginal birth. The data shocked the study’s head author, Darine El-Chaâr, a perinatal researcher at the Ottawa hospital. In the planned vaginal birth group, there was a higher percentage of negative outcomes compared with the MRC group, driven by serious vaginal tears and babies admitted to intensive care."

Sorry that the link pasted in a really funny place in the above. It wasn't like that in the preview!

Again, why are you still maintaining that providing ELCS is more expensive for the NHS? If you're going to claim the cost/benefit doesn't stack up, especially if for some reason you think it can be compared to giving MRIs to 50% of the population, the onus is on you to prove that.

You want me to justify that a bed for a standard vaginal birth is not more cost effective than a bed for a C-sec? And this is why trial of labour is standard unless otherwise indicated (and of course there are reasons why it wouldn’t be).

@HoppingPavlova so are you suggesting that NICE guidelines aren't important then?

@EarlGreywithLemon that's a very interesting article and shows clearly why NICE changed their guidelines. Actually based on evidence rather than blatant misogyny and an apparent desire to want women to suffer/be punished, which has frequently been expressed on this thread.

@HoppingPavlova

”a trial of labour” is the same as forcing a woman to give birth naturally, it’s abhorrent and misogynistic.

A woman may seek a c section to avoid the possible complications of a natural birth like incontinence or tearing… is that really so weird and deviant??

A bed for a vaginal birth is missing, at minimum, required theatre staff including but not limited to ob and anaesthetist, recovery staff, duration of stay is longer on average so add in ward support, additional pharmacy spend.

Nope. Although the fact that you think that's what it actually comes down to says a lot.

I want you to justify your claim that offering maternal request ELCS doesn't stack up on a cost benefit level and can't be justified due to resources. This is very, very different to comparing the costs between an ELCS and a straightforward vaginal birth.

The first reason for this is because attempting a straightforward vaginal birth doesn't mean you get one. Instrumental births and emergency sections are both consequences of attempting vaginal birth rather than having an ELCS. They're both obviously more expensive than a straightforward vaginal birth. They go into the costs of attempted VB not the costs of ELCS column.

The second reason is that costs persist after the births. Costs of treatment required after complications of vaginal birth and indeed of EMCS are both costs of attempted vaginal birth. They have to be part of the pot as well.

There is also the issue of legal costs, which are part of the NHS maternity care budget. You're going to have to factor those into your cost benefit analysis.

Lastly, it's also wrong that trial of labour is standard unless indicated. NICE guidance is that women can request elective section without any medical indication other than their preference and while that's not observed across the board, it happens enough that trials of labour unless indicated most certainly are not standard.

That’s fine but where are you then clawing back money. Are you going to take it from oncology services, paeds? Who’s going without or being left with less than adequate? Things would be great in an ideal world where there was an adequate pot of money for everyone to have every choice they want and everyone to get ideal treatment. We don’t live in such a world.

It can only be solved by increasing the spend on health and god knows that’s needed. But where does that come from, education, defence? Hang on, here’s an idea, people pay more tax so the pot is bigger and they get what they want. What, they don’t want to pay more tax because they are being squeezed with increasing cost of living?

What’s your solution so that all of this is funded so that this utopia can be enacted?

I needed a year of physio after my vaginal birth so I’m sure that was costly 😄

At the end of the day it's your body and your choice, I had an elective c section, I was meant to have a home birth but baby was breach, they would have tryed to turn him but the risk and complications that went with it wasn't worth it, I had the c section and was out the next day, recovery is different for everyone, you do what you think is best for you and baby that's main and the most important thing, the fact you have a high risk pregnancy, if I was in your shoes I would do the exact same thing, x