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.

It's all about choice. I ended up with a truly terrible birth injury from a c-section. Rare but it happens

I think the reasons are complex, but it would be naive not to think that the additional resources required for sections isn't an issue.
An elective section is definitely the right choice for some women but it is major surgery with its own risks and disadvantages so it is essential that these are discussed and alternatives explored.
Personally, I think the implications for future pregnancies and longer term issues often aren't given enough consideration. I guess it's human nature to focus on the here and now, but I think there is a tendency for both mothers and HCPs to only talk in terms of the procedure itself and the immediate recovery period. I had a medically indicated but planned section with my first baby and whilst there was a lot of discussion about the pros and cons of me having a section vs induction, I don't recall anyone mentioning future pregnancies and I didn't ask any questions. It wasn't until I got pregnant for the second time that I began to think about it. In my third pregnancy my placenta implanted into my previous section scar and I had very heavy blood loss and came close to needing a hysterectomy as a result. I don't know if knowing that would have led to me trying for a vaginal birth first time or not to be honest, but it's not an issue that is discussed enough in my opinion. I have a relative who has had 3 sections and also had complications as a result. She was sterilised after her third section as she was told it would be very dangerous for her to have another. She's also had other problems caused by adhesions resulting from the operations.
Obviously I am no expert, but it seems to me that if more women choose elective sections in their first pregnancy then it is likely that there will be more who ultimately have multiple sections and the kind of complications which my relative and I have experienced will become more common too. That has implications for the NHS as well of course for the individual women so I think there should be more discussion about longer term issues as well as immediate risks.

Less risky in terms of what?

You’re spot on. Cost is a huge driver of this. The NHS attitude and targets around birth is shocking.

I've had one vaginal birth and 2 elective c-sections. I had an epidural with the vaginal birth but no other interventions and no tearing. The c-sections were required on medical grounds, my consultant insisted on it. I don't think I would have felt comfortable requesting an elcs on non-medical grounds tbh, as I'm aware they do cost more. The recovery from my c-sections was fine both times, though it took longer than the vaginal birth - I pretty much bounced back from that the next day.

I did like the fact that the c-sections meant that I wasn't quite as stretched down below - a bit vain and I guess since I've had one vaginal birth the damage is done anyway. But I think it would have made more difference to my sex life to have gone through it a couple more times (especially with my bigger third baby). But I would never have opted for a c-section based on that.

AIBU to think that the main driver for woman to have a vaginal delivery is actually cost and not safety?

No, more often than not vaginal births have a relatively quick recovery and low complications. Sure an elective section is better than a very bad vaginal birth, but the recovery from most vaginal births will be better than a section.
A vaginal birth is better for the mum and better for the baby in most cases, and I say that as someone about to have their second section in a few weeks time.

Its not unreasonable to make a choice based on your own preference, its your birth experience after all. I do think it's a bit mad to consider an invasive abdominal surgery as being safer and more cost effective than the the natural way seeing as women have been doing it for literally as long as humanity has existed. We were MADE for this, its where our power is. It feels more and more like we accept supposed conveniences as the normal way now and hand our power over- in all things. Feeding ourselves, healing ourselves, and now birthing our own babies. I had a natural HB, no drugs or intervention, quick labour and recovery and no regrets. First baby and I'll do it again that way if I can. C-Sections have their place as with all emergency medicines, im not shunning hospital births etc, it all has its place. I just feel we're so quick to give away our god given power as women when we were built with this extreme strength and resilience. If alls well then birth seems like more of a family event than a medical one to me.

I had a VB that went so badly I was told a c-section was advisable next pregnancy. I had the next pregnancy and a c-section and found it a much better experience, but that's anecdotal. It doesn't mean it's better or safer than vb.

I don't think it's possible to take your singular experience and your friend's singular experience and extrapolate from there.

YABU

The risks involved with c-sections are massive compared to vaginal births.

Its like comparing key hole surgery with open surgery.
Open surgery comes with may more risks.

Most women can get straight up and do stuff after a vaginal birth but they can’t if they have a c-section.
As a single parent there would be no way I could have coped after a c-section.

C-section also run the risk of finding it difficult to bond with your child and obviously it comes with more health risks for the baby.

There is nothing wrong with having a c-section but they should absolutely be the last choice for both mothers and baby’s sake.

I also had an ELCS due to all the horror stories from my friends, who mainly required forceps or EMCS after trying to labour naturally. For me it was a very calm experience and straightforward recovery, much easier than friends who had horror show forceps births/one who ended up needing general anaesthetic for EMCS!!

I do agree with PP though that they don't talk about the risks with future pregnancies. Luckily I only want 2 kids but I would maybe have made a different choice if I'd wanted 3 or more and known about the ongoing risks in advance.

The majority of vaginal births that have ended with intervention and emergency c sections are from induction of labour, the use of epidural and being made to labour on your back.

I don't doubt that cost is a factor overall but I don't think most obstetricians are counting the pennies like that in appointments.

I think a lot of the risks around c section can be in subsequent pregnancies. So the original surgery may have been lower risk for that baby but the next pregnancy you have increased risk if placenta previa, placenta acreta, scar dehiscence, scar rupture, increased blood loss, abdominal adhesions. There are also some studies that suggest an increased risk of stillbirth following a section. So if you intend to have more children then you need to be aware of these risks rather than just thinking the doctors are telling you to do the cheaper option.

I also know of people who had elective sections who ended up with hideous postnatal infections requiring rehospitalisation. It is major surgery and I don't think we should be choosing that blindly without being informed of all the risks.

3 Vaginal non medicated births.

AIBU to think that the main driver for woman to have a vaginal delivery is actually cost and not safety?

The case is infact that once you start adding interventions into births like sweeps, hormone drips, epidurals then it massively increases the risk of further interventions being required hence "emergency sections". Also the term emergency section is used for any section that isnt planned so it may not necessarily mean its an immediate emergency.

Any type of c section has far greater risks than a natural birth and that is fact.

And for what its worth, i had sweeps and gas and air and examinations so im not a large advocate of either or.

A section is a safer birth

Can you link evidence to this please.

@Classicalyunderstated @Littlecatonthefence

What do you do if you're two weeks overdue and at risk of placenta degrading though?

Or if mum has GD and baby measuring large?

Induction does serve a purpose.

Ive had one vb and one c section (planned for medical reasons).
The VB was not perfect- had to have forceps and a bit of tearing (not too bad) but actually I'd still choose the vb over the c again.

I felt more in control with the vb and didn't like the whole process of the c section, although it was arguably "easier".

Of course it does and im not arguing it either way.

Its just factually that any interventions will increase the need for a c section at a later point in the labour.

So for example

-Induction required.
-contractions are sorer as they are made to happen so epidural is given.
-Mother struggles to push baby out as she cant feel anything.
-baby gets tired, heart rate not consistent.
-c section required.

@Littlecatonthefence

Depends who you are talking about. Mum slightly more likely to be injured or die during CS. Baby more likely to be brain damaged due to VB

•	2,473 claims have been made regarding cerebral palsy and brain damage due to medical negligence since 2011/12
•	Almost £5 billion has been needed to compensate for the life-long impact of maternity care failings

Almost no one gets CP from Caesarian delivery.

@Littlecatonthefence

Agreed, but often people talk about "interventions", as if they are things that people have actively chosen (my NCT teacher was very anti "interventions", as if you actively try not to have a VB). I never chose to be induced with a back to back nearly 10lb baby . It was the best option available at 42 weeks pregnant.

Classically understated - yup i was made to labour on my back.

They wanted to.monitor and prioritised that over me being in a sensible squatting type position to actually push out a baby. Lying on my back was really ineffective and tiring pushing.

I wish there was more focus in training midwives on recognising more effective positions women need to be in to open their pelvises and labour effectively. When i got into theatre the doctor said my baby was almost out, in reality needed very little intervention. Im certain if id been positioned better i would not have needed forceps & episiotomy.

For who?

It is surgery, so it’s obviously not safer for the mother because all surgery comes with risks.

And it’s not safer for the baby, as it’s very well known that c-section babies can suffer health issues as a result.

Yes and No

You are dismissing the impact of a MAJOR surgery because you were lucky with yours, it's not the "easy" option by all means.

Studies show that it's also not always the best for the baby.

I do have a problem with UK birthing centres however, run and managed by midwives but which generally do not offer any epidural let alone a theatre for c-sections. If they were part of a general hospital, with access to anaesthetists or surgeons "on demand", it would be great.

Denying the CHOICE of a woman in labour, by not offering all the options on site is outrageous. Having to be blue-lighted to the nearest hospital when you finally decide to have epidural is not a reasonable solution.

It can be quite easy to forget that childbirth is actually quite dangerous for mother and baby, and it is really only thanks to modern medicine that things are as safe as they are.

I had an elective C Section with my first DC. It was May 2020, I wanted to be in and out as quickly as possible, and without a crystal ball it was impossible to know how long a vaginal birth would take or what would happen. I also knew that my partner wouldn't be able to be in the delivery room with me until the final hour because of the rules at the time, and I didn't like the thought of being at the mercy of a midwife who could be split 4 ways whilst in agony. It seemed too risky and, as I was in risk mitigation mode, the least risky way of giving birth seemed to me to be an elective C Section, for myself and for the baby (I was worried about Covid). In addition, a lot of mums I know have ended up with forceps, tearing (all the way up to 4th degree) and longer term issues with their pelvic floor muscles and prolapses, due to their vaginal births.

I think a vaginal birth sounds wonderful in the ideal scenario where the baby is head down, in the optimum position in the birth canal, is of a small-average size, but even then there are simply no guarantees and anything could happen.

I have to say I'm glad that the obsession with vaginal deliveries seems to have waned slightly, I think in light of the various maternity unit scandals in which babies and mothers suffered horrifically and sometimes even died due to the excessive focus of some trusts on keeping c sections below a particular threshold. I think this will lead to a more balanced approach and allow women to have a more meaningful choice. Ultimately, it is up to each woman to make her own decision about how she would prefer to give birth and to action that as best as she can. For the NHS, I don't think there can be any doubts that some of the previous focus a reduction in the number of c sections was at least in part cost driven.