C section - do you agree?

[ndpp]

I always wanted a vaginal birth. Due to some significant trauma in my pregnancy, mentally I did not feel able to do this and I asked for an elective c section. I was sad at this choice but felt it was best overall in the circumstances I was in. Although it was a tick box exercise to have the elective, I was surprised at the emotional pressure from nurses, doctors, HV, friends, etc to avoid a c section.

However, having had it, and a close friend desperate to have a vaginal but ended up with forceps delivery and massive tearing that two years later she’s not recovered from, I can absolutely say that the c section was easier all round. I know that’s not the case for everyone. But since then, 9/10 women I know from work and friends have all ended up with emergency c section which is of course worse than an elective.

AIBU to think that the main driver for woman to have a vaginal delivery is actually cost and not safety? I wonder if men were giving birth whether they would have comments made to pressure them into going through such trauma when actually, an ELECTIVE c section, although major surgery, is less painful for a woman and less dangerous to her.

I had an elective & my recovery was considered textbook & a VB with no intervention. I would chose VB every time personally as I had much more discomfort post CS.

It's more complex than that. I'm sure cost is a factor. On the other hand, I think you are minimising it by say "[comma] although major surgery [comma]". It really IS massive and it's a wonder of modern medicine that women are able to get back on their feet, many the same day, and mostly have very good outcomes.

I also believe that statistically, a vaginal birth is safer for the mum, but I have have recalled that incorrectly.

I have had two ELCS for medical reasons, but they were not decisions taken lightly.

The safest for mum and baby is an uncomplicated, unassisted vaginal birth. The problem is that you don't know in advance what you will get, you can only work of known factors.

It's an important discussion to have and I think there's a hell of a lot which needs to be done to improve post natal care for mums, but I think YABU to simplify it to cost.

Choice is important, isn’t it? I wanted vaginal births and minimal intervention and luckily for me, my low-risk pregnancies and ‘textbook’ labours made that possible for me. No stitches and good recovery. I would be aiming for VB if I was doing it again which I’m not as I’m too old now 😭

Friends who wanted elective sections and got them also had great experiences.

I had 2 ELCS for medical reasons and would have preferred vaginal if possible.
the recovery from both ELCS was awful both times and there were complications the 2nd time during the surgery.

I would like to have experienced a vaginal delivery.

The statistics are a bit misleading though because more risky pregnancies have c-sections and therefore they’re likely to have slightly worse outcomes. It isn’t necessarily the c section that’s the risk factor, it’s the reason for the c section in the first place.

You are 💯 % correct, @ndpp .

I've had two elective sections. Both amazing. Baby comes out quick, minimal pain, no mental trauma, great post op care, wound tender but pain totally manageable. I love sections and would promote them and I'm a good spokesperson for them!

But...they are not always the safest option. Statistically Vaginal births are safer and elective sections are not less dangerous on the whole. I work in theatres and every single operation carries risk.

I do think every woman should be offered the choice. And I do believe cost plays a part.

Thinking back to my c-section, I had a surgeon, an anaesthetist, and a couple of nurses (one a midwife maybe?) in the room, and took up an operating theatre for about 1.5 hours I think? That’s all got to be expensive. For my vaginal birth I just had one midwife (two right at the end I think). I’m sure cost is a factor and it’s understandable given the pressures the NHS is under. You’re not unreasonable at all to ask for the best option for you in your circumstances, but hospital staff aren’t unreasonable either to try to persuade you into the cheapest and safest option.

I don't think it's only about cost.

You have to compare not just the birth itself but the entire experience and impact - so eg vaginal birth may have more pain during the actual birth but C-section pain might last longer in recovery. And it's obvious that major surgery carries significant risk, even if there are also risks with vaginal birth.

Equally C-section can impact the baby's microbiome and make infections etc more likely in infancy, and it can impact the ability to establish breastfeeding which also has later health implications. Maybe not massive ones, but probably enough to stop the NHS going 'sure, the game's up, every single woman should have CS'.

A baby born vaginally gets a bit of bacteria from the mother's digestive system which colonises their gut and establishes the start of a microbiome that shapes health throughout life. A baby born by C-section does not get this - they are colonised by a wider range of bacteria including pathogens in the hospital. CS is also likely to involve antibiotic use that impacts bacteria.

I'm a geek for microbiome stuff so that's important to me - it's increasingly being seen as a key factor in future health. They're trying to find ways of giving helpful bacteria to babies born by CS to help make up the difference.

Personally I preferred VB to CS. The vaginal birth bit was a horror show but I was ecstatic not to be stuck on a postnatal ward as I was first time with CS - those places are horrendous. I think people often focus on the birth only not the aftermath, like being stuck on a chaotic, noisy, baking hot ward.

I do agree that it’s a big part of but if you have a straightforward birth then that’s absolutely much better than a c section (I’ve had 2 c sections and would say recovery is not easy). It’s not straight forward to say one is safer than the other as it very much depends on your risk factors.
The views from non medical people were surprising to me; invasive questions and unasked for views. Mine were for medical reasons but I didn’t really think it was anyone’s business. In retrospect I wish I hadn’t shared that I was having a c section beyond people who needed to know

I'd imagine the main driver is naturally, with minimal intervention unless recommended otherwise, surely?

A C section is major surgery, yes choice is important but informed consent should include HCPs speaking about the alternatives, and it's not surprising for someone low risk the preferable route medically is a vaginal birth if possible.

I think there’s something in what you’re saying tbh

TTC and exploring options but unless it’s a very last resort scenario I never want to be induced. The stats are not great. My relative had one and ended up needing forceps, lots loads of blood and her baby needed physio after. Hearing lots of these stories lately. Our local trust keep publishing birth stats and a good three quarters of those induced ended up with instrumental deliveries/assisted or EMCS.

It will obviously depend on what they say, how baby grows and any risk factors identified but I think a section guarantees enough staffing and decent level of care. Ok recovery is bound to be immensely difficult but that is something you can plan for. A difficult vaginal birth isn’t really something you can set expectations for

I had an emergency C-section. That, and the recovery, was the main driver for not having any more babies.

The mental impact of being denied a vaginal birth was huge. It led to PND and struggles to bond with my son which, to this day 13 years later, I have huge guilt about.

The physical impact of major surgery was huge.

I had surgery a year later for something else and can say it was a walk in the park compared to the C-section.

I had an elective CS as I don't know anyone whose vaginal birth hasnt been a complete shitshow and I didn't want to put myself through it.

It was wonderful. So calm and I recovered really quickly. I can't understand why anyone wouldn't want one but different strokes for different folks.

Also it was easy getting it, midwife, consultant etc all said it was my choice, really supportive NHS.

A vaginal birth with no interventions has better recovery for the mother and outcomes for the baby. A c-section is major surgery. Any other time that you have major abdominal surgery you would be on bed rest and told to get plenty of rest, rather than try to look after a newborn while being very sleep deprived. It carries risk. That risk is somewhat forgotten because so many women end up with c-sections and most are fine after the initial recovery.

I think there are a number of reasons women pick an elective and it’s often seen as less than, or taking the easy way (despite it being major surgery). Elective is generally much easier to recover from than an emergency c-section, so I was always of the view that if I was going to have a c-section, I’d rather it be an elective. I think a lot of that is down to cost, particularly with the NHS. Women aren’t generally aware that during an induction they can ask for a c-section at any point if they feel it isn’t working, they don’t have to labour for 5 days with no progress then have an emergency c-section when they are exhausted and traumatised by the process. Some of it is also down to this push for “natural” and unmedicated births from those in the birthing community. Vaginal birth has better outcomes but for many women they require interventions and then these women are more likely to suffer PND because they didn’t give birth “right”. Informed choice should be given to all women, vaginal birth has the least risk but is not without risk. If you choose an elective c-section, you should be informed of the risks but should be allowed to make that decision without judgement. I think the induction process should be shorter - if the baby isn’t making it’s own way out after 4 days of the process, then it’s highly unlikely that the drip is going to work. I think women should be having those conversations earlier so they are less emergency c-sections and more informed decisions (I know they would still count as emergency c-sections in the stats but they would a lower category than mother and/or baby at risk c-sections, it would result in a lot less trauma and resulting PND).

I had an EMCS and then pushed hard to have a VBAC. For me it was the recovery. I was physical (spesis) and mental ill for a very long time after my c section and I did want to go through that again with both a new born and a toddler to look after. I also really struggled with bf the first time due to my physical and mental health.

Thank you for this. Did you know you wanted this from the start? How long did you have to stay in hosp?

Yep. I think cost is a major driver and l doubt men would tolerate the way woman are treated with this debate. I had a c section earlier this year and right from booking in stated l wanted a c section. No one would discuss it with me until 34 weeks. Doctor was then keen to say are you sure, despite the risk factors: l was 43, it was twins, an IVF pregnancy and it was my first pregnancy.

Zero chance of me going to be induced as l have heard too many horror stories. In the end both twins were breech anyway so it would have been a c section anyway

Recovery was fine but l was just glad to not be pregnant with twins (breathing was tough towards the end, never mind turning over in bed) and l have a good pain threshold

Same! Everyone I knew in real life had some sort of intervention and many ended up with emergency c sections so I just chose an ELCS for that reason and it was lovely and the right choice for me. I do think cost is a big part in the push for vaginal births.

Honestly, the truth is that the NHS wants you to have an uncomplicated natural birth, just as it wants you to breastfeed. It is best for baby and cheap. For the majority, that's a good outcome.

It does buggar all to help you to do either of those things though. Partly cuts and partly mad systems that don't do preventative care/triage and then spend more money later on.

I had an EMCS having been induced with a large baby beyond term and who was back to back. Not a single midwife spotted baby was back to back and discussed this with me at any point, or tried to help baby turn. They pushed me to a point at which I was throwing up blood into the sink, told me it would "definitely" happen if I tried harder, dismissed my concerns and then seemed surprised when the consultant called time on the experiment and delivered my nearly 10lb baby via CS.

If the system was sensible and wanted to be compassionate AND save costs, it would properly triage women and let them make an informed decision based on likelihood of good outcome.

The NhS currently spends more money on the outcomes of complicated vaginal births (ie disabled child due to birth, primarily) than it does on maternity care. That is probably an underestimate, since it doesn't include all the women who have prolapse and other issues from bad births and get little physio. There are a good number of women and babies in the system that a CS would have helped and which are very expensive - for those individuals, such as babies with cord round neck, whose heart rate keeps spiking during birth for unknown reason, it is not worth debating good bacteria or childhood asthma, frankly. It's about saving them.

The risk of complications is much higher with a caesarean than a vaginal birth. Injury to bladder or urethra, excessive bleeding, infection, delayed healing, scar abruption in future pregnancies... the list goes on. Worsened by the number of woman who now have underlying health conditions such as obesity.

That's why obstetricians prefer women to avoid CS unless medically indicated. Not cost. Not recovery time. It's just statistically safer to have a vaginal delivery.

(I also had an ELCS second time round, to much resistance. The junior doctor asked me why I wouldn't consider trying to do it for my baby and was VERY resistant to the idea that baby was likely to be big second time around given first baby was also big. Second baby was born during Covid and so it was a no brainer to have an ELCS rather than risk having a week in hospital unable to see my child like I did with my first one after failed induction, EMCS, monitoring for to blood loss etc. But for Covid, I'd have given a VBAC a go).

@PinotPony

Statistically safer for mother

Not statistically safer for baby. They never talk about risk of CP or death of baby when they talk about risks of CS.

2 vaginal births. One a long long induction which should have been a c-section, but ended up a traumatic vaginal birth. I will always regret point blank refusing a c-section that day.

2nd birth I was over due but went into labour naturally. Laboured slowly, but 3rd stage was fast and gave birth with no intervention and just a minor tear (mainly due to previous trauma). While I was sore, I wasn't in terrible pain and was able to drive within 24 hours which made a massive difference to me.