To request an elective caesarean?

[Ethels]

I’m 37 and on blood thinners that’ll need to be stopped at a set point before birth. I’ve always been anxious about childbirth which is a large part of why I’m pregnant for the first time so late in life. My local birth unit is closed due to midwife shortages, and the next nearest is rated inadequate. I’ve had previous abdominal surgeries and understand the healing process. My midwife care so far has been quite lacking (they are underfunded and understaffed).

Am I being unreasonable not to want to risk a vaginal birth? Am I likely to have an elective caesarean approved on the NHS?

Firstly i want to start but saying your body your choice and whilst i will always advocate for a natural childbirth I also feel like you should decide whats best for you after research.

But this struck me I’ve had previous abdominal surgeries and understand the healing process

Yes, but never with a newborn, picking them up, getting in and out of bed, no driving for 6 weeks.

A newborn is hard enough without having major surgery, and a C section is just that.

I take my hat off to anyone thats had a c section then has to care for a newborn as mentally and physically its a huge challenge.

Amongst other surgeries, I’ve had a major laparotomy for a large ovarian cyst for which I had an epidural. I’m not expecting it to be easy but I have more experience of similar surgeries than most in my position. After the birth, I’ll have my husband on hand for two weeks (we’re planning to combifeed) and then my sister living with me for two weeks so I’ll have support on hand for the first month.

I know there are benefits to mother and baby by having a vaginal birth but I also know my anxiety would be through the roof throughout, and I wouldn’t feel safe or trusting.

Then you are absolutely within your rights to request one and the NHS will have to accept.

A friend of mine elected to have a c-section with her first as she had concerns about a vaginal delivery. She had to have a few discussions about it and they did ask her to consider vaginal delivery, but she was clear about what she wanted and was allowed one.

Given your past medical history, i would expect an elective C-section would be preferred anyway.

Are you under a consultant? You should be based on what you have said here..

I requested it with my second (had to have one with my first ad breach) as my experience was very good, and I seemed to be much quicker up and about than my NCT friends who had an emergency C-section or had forceps.
it is your choice, they will talk you through the pros and cons. In some trusts you may have to push quite hard, in others, it will be ok.
i mean, it isn’t fun and you are full of drugs… but it’s ok

The no driving for 6 weeks thing is a myth. As soon as you feel fine to do an emergency stop it’s usually fine (but by all means confirm with your insurer).

You can care for the baby no problem, just don’t lift anything heavier and as no doubt you know from your previous surgeries, avoid bending and twisting. The tough part comes with baby 2 when you can’t lift your toddler, no.1 is no issue whatsoever. It’s a lovely calm experience and one I’d definitely recommend. I’ve heard from friends though that the NHS can be stingy with the pain relief so you might be in for a shock if you are expecting whatever they gave you post op before, so you may want to check this and/or bring your own (I went private so can’t comment on my own experience).

I requested ELCS at my booking appointment, I had the date before my 20 week scan.

The recovery wasn’t easy. I’m quite sure the recovery from a straightforward vaginal birth would have been easier, but they’re not so easy to predict. For me the ELCS was less of a gamble. Almost half the women in my NCT group ended up with an EMCS so they were tired after labour then had the abdominal surgery anyway. All the women who had vaginal births had forceps or episiotomies.No one in the group had the intervention-free birth that had been held up as the gold standard in NCT classes. I think the leader was quite disappointed in us really. My sister did have an easy time (her words) with one of her births, so it’s not that they don’t exist.

I know people who drove after 2 weeks, if they feel well enough and it’s cleared with insurance. I didn’t feel well enough at that point. I also preferred a bit of help with some things at home that I could technically manage with difficulty.

I found full breastfeeding easier than combi feeding as no bottles to factor in.

I would make the same choice again.

The no driving for 6 weeks thing is a myth. As soon as you feel fine to do an emergency stop it’s usually fine (but by all means confirm with your insurer)

I would agree with you but annoyingly this is written in my discharge notes and was told this by several doctors and midwives as I was being discharged. Otherwise I would take my own view on whether I was ready, but because it’s written in my notes, going to have to observe it just in case…although will need to start doing short journeys before the 6 weeks is over as will need to do nursery pick up once DH goes back to work.

It's absaloutley your right to choose op.

I had an elective section with my 2nd and wish i hadn't, it took me months to recover but that's my experience.

I am under consultant care but haven’t met him yet (due to next week). My biggest fear would be having a long and difficult labour followed by an emergency caesarean or something going wrong. In order to get the correct blood thinners and painkillers I’d rather it was planned in advance.

It’s good to hear some of you have had positive experiences with elective caesareans.

I have had 2 elective c sections, the second being just two weeks ago. I have also had several abdominal surgeries so have a good idea of what recovery is like.

Everyone is different but both times for me, recovery has been smooth, even with a newborn and now with a toddler and newborn. The key thing is staying on top of your pain meds but I have found it completely fine.

I had a planned c-sec for medical reasons. Like you, I'd had previous abdominal surgeries and was confident I could manage. The operation and recovery were pretty straightforward, but I just wanted to flag up a couple of things that you might not have thought of.

During the operation, I lost a little more blood than is usual and then developed a minor infection, so I was kept in a bit longer and spent 4 nights in hospital. My milk didn't come in straight away, as is usual with planned caesarians, so I had to spend several days faffing about with pumps, trying to increase my supply. Getting feeding started with my baby was a nightmare and in fact I never successfully breastfed, I pumped off milk for some months but never enough to be sole supply (I appreciate you say you are planning to combination feed). The previous poster who reminded you that you will not have previously recovered from surgery while caring for a newborn also had a point; it was absolutely exhausting, and I was tired to my very bones.

I certainly don't regret having a c-sec, I didn't really have a choice, but it was hard, and if you are otherwise healthy, you should weigh your options very carefully. Best wishes!

You don't say why you're on anticoagulants (whether it's pregnancy related or a longer term health condition), but in either case my experience is that no one lets you near a birthing unit with a whiff of complication. It's on the ward, with all the whistles and bells on hand (no birthing pools, aromatherapy or whale song).

If you have to come off the drugs, they are presumably going to want you to commence labour in a short window, or they'll be talking about induction (and possibly the failure of the microvascular of the placenta). Statistically, I believe (was told) that having your first child at this age (and potentially factoring in ethnic differences), you are more likely to go post-dates anyway. So you could find yourself under pressure around your birth window to comply with things that bring you stress.

Regardless of whether you have a grasp on what a C-section is like, I would have thought that you have enough risk factors around the blood condition to make a controlled approach preferred. I've had two sections, the second elective, and the happiness on my consultant's face when I consented to removing the known unknowns was quite memorable.

I also was taking anticoagulants and I have no idea if there was a real risk of the placental microvasculature failing because I didn't do exactly what the (different) consultant said, but at the time it was used in a bullying way and did my head no good at all.

I loved my elective, it was great. EMCS was awful and I wasn’t risking it again so went for ELCS and I have zero regrets.

I've had 2 electives and I would anytime. The first week is tough but if you have help, it is so worth it.

Everyone has a different experience , so it’s hard to know how you would react.

PP mentioned breastfeeding - my milk came in on day 3/4 both times, which is completely normal timing wise. I had a really good supply with my first and so far, have a good supply with my second. Others I know who had c sections also had no issues whatsoever breastfeeding. Equally, I know two others who had vaginal births who really struggled with their breastfeeding journey.

So everyone’s experience is personal to them, which I know is unhelpful, but something to think about when deciding.

I had an elective booked. I happened to be under a consultant anyway before I spoke about a preference (other reasons) so I already had an appointment with one where I could raise the topic.
I imagine it would have been harder if I had needed to convince my midwife to refer me because none of them like doing it.
I was told repeatedly though that it's a good job I landed with the consultant I did (luck of the draw) because if I'd got the other one she would have said no and i'd have had to battle to see another one who would say yes.
As it was, I was listened to and allowed my section with no argument beyond the minimum conversion they are required to do.
When it came time though my waters broke at 35 weeks and my planned section turned into an emergency one and it was still amazing. Truly the best birth experience and best recovery experience of all my friends and family and NCT groups.
Most of them who had natural births had follow up appointments for months and 2 even ended up having to go back for reconstructive surgery. I could have skipped down the corridor by day 3 post surgery with no problems. By day 5 I had no dressing or problems. Could barely see it. Just looked like somone had drawn on me in purple pen. No problems doing anything for the baby (admittedly a lighter baby than some people have since he was early) lifting/changing/feeding post surgery once feeling came back. I did have to have help for the first 8 hours until I could move my legs again but beyond that it was all good.
I understand its not for everyone, but just thought I'd let you know that if it's something you want then it can absolutely be positive. Healing from a section doesn't mean you HAVE to be bedridden for 6 weeks or all the scare stories you hear to make it easier for the hospital.

If I were you I’d perhaps speak to a consultant to discuss your particular situation and the risk levels with a vaginal birth and then make a decision.
During a scan it was found that my placenta had split and was told there was a risk of the placenta not delivering. When I spoke to the midwives they insisted there was nothing to worry about. I’d even told them I had private healthcare which had confirmed they would cover a c-section in this case but I felt they were unconcerned so I stuck with the vaginal birth. When I then gave birth I did indeed have a retained placenta and lost a huge amount of blood and was rushed to the operating theatre, my husband left holding our new baby. I really wish I’d spoken about it with a consultant and made a decision based on that.
Despite that, I wouldn’t rush to have a c-section if we have another baby. The recovery sounded really difficult when I spoke to other mothers. Whereas even with my difficult birth I was up and walking with no problem within hours of delivering.

Hi op

I totally empathise when you say you wouldn’t feel safe to have a vaginal birth in their care. I had an EMCS with my first and one of the reasons i’m not attempting a VBAC with my second (due next week) is for the same reason.

Recovery from a section while you have a newborn and can’t rest much is awful, and like others have said, you need to demand stronger painkllers from the hospital, either dihydracodeine or morphine.

However, as a PP said, not all, but most first-time mums I know had a birth that either included some kind of intervention or vaginal injury.

I wouldn’t personally recommend a situation where you have to be induced if your local hospitals have issues. There was a recent thread on here about lots of women who were induced, then left in limbo and pain when it was time to go down to delivery but there were either no staff or beds. This is what happened to me and part of the reason i ended up with EMCS.

The other advantage of booking an ELCS over attempting a vaginal birth and ending up with EMCS is honestly the time of day. With an EMCS, it’s possible you could end up with one in the evening or middle of the night. Many hospitals don’t let partners stay overnight so you’d be sent to look after a baby by yourself 2 hours after major surgery without help as there isn’t enough staff. This is also what happened to me and it was horrific.

I would say if the NHs maternity wards were in a better state, then fewer women would be considering going straight for sections.

Good luck op with whatever you decide :)

Do it!! And don’t stop until you get one.

If you think your likely to have more kids in the future then I would try for a vaginal birth I've had a planned c section and a VBAC and would choose the vaginal birth everytime but it was uncomplicated

It really wasn't a challenge personally.

I'm a total wimp when it comes to pain (in wrapped up in a blanket not working today because of a heavy cold), but I found c section recovery a doddle both times. Seriously, I've had worse periods.

My first one I even even up googling 'when does a c section start to hurt' because it was that painless. Getting up and down was mildly painful for about 48hrs. My second one I had done minor discomfort but it just felt like mild bruising.

Everyone's experiences vary and clearly it is painful for many women, but it's not a given that it's tough.

I had the easiest recovery from my nct group!

Have you actually asked your insurer though? They tend to go by their rules not what's on your notes? Mine was also in my notes but when I phoned and asked they said you can drive whenever you feel safe to do so- they have no set rule.

There's not a chance in hell I'd attempt vaginal birth in your situation.