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?

I didn't even have to read your post to say YANBU - any woman should be able to request and receive an elective c-section.

I think your reasoning is perfectly valid and logical btw. Vaginal birth is all well and good when it goes smoothly. I have had three very different deliveries and had an elective c for my last. It was more 'predictable' in terms of risk, and that gave me peace of mind. I was assured it is a very safe operation- DD and I both fine, she's three months old now.

I say go for it, especially with the good support you will have during recovery.

I’ve just had my second c section, also on blood thinners for both pregnancies from positive test until 12 weeks after, and aspirin for life (Due to APS). I’ve also got a history of abdominal surgeries - a burst appendix that nearly killed me and took hours in surgery, plus a surgery that left a scar similar to c section - my first surgeon actually went through that scar for the c section. History of surgeries can be a concern as they worry about adhesions - I don’t have any though and there were no complications due to previous surgeries.

I never wanted a vagjnal birth, even less so after several miscarriages. I wanted to be in, baby handed to me, and out as quickly as possible. Both deliveries were at 37 weeks. My consultant recommended induction but I didn’t want to do it, asked for section and got it. There was a bit of having to ask repeatedly but I think that was more a lack of communication between doctors than any real push back. There was never the sense that I would be told no, I just had to be really clear that I wanted a section, knew the risks, and wasn’t prepared to give birth any other way.

I didn’t have any problems with recovery. Less than 400ml blood loss. Standing up after 6 hours. Walking up and down with no issues (the trapped wind was horrible but that’s how it is).

I was in hospital for 5 nights the first time and 6 the second - I am rhesus negative and this meant babies needed a bit of help due to jaundice - mainly they were in a light box next to me. I didn’t need any help getting my newborns in and out of the cot after the spinal wore off. The first was born during covid and I had to do everything myself as partner wasn’t allowed in, it was fine.

I managed to sleep on my side the first night after my second section. It took me until day 3 the first time but that’s because I hadn’t developed a technique. Hold your belly tightly around your stitches and go for it!

By the time I got out I was moving completely normally, and both times I cooked a beige feast (buffet food that I couldn’t have due to gestational diabetes!) on my first night home.

I was driving again at 2 weeks.

For context, I was 14stone + going into each pregnancy, age almost 39 and almost 42, with a clotting disorder. I got a bit of a sweat rash/fungal under my overhang but sudocrem sorted it and only needed applying once.

The worst bits of recovery - ITCHING. And the trapped wind. Both uncomfortable rather than agonising. Day 3 was the most painful, day 4 was a drastic improvement. Iron tablets leading up to and after the section will help recovery, get these prescribed not over the counter.

If I was younger I would definitely have a third (and I’ve not ruled it out!) and I would have a section again.

I had an elective 6 weeks ago after a traumatic first birth that resulted in an EMCS. It was an amazing experience and I certainly had no trouble looking after my newborn after, even with a 5 year old to also look after. Pain was manageable and my community midwife had prepped me to ask for dihydrocodeine on discharge. In your situation I would definitely push for an elective. I would never want to be in the situation where an induction was suggested, especially where the unit is short staffed. This is partly what led to my traumatic first birth. Every woman should be made to feel comfortable and supported in choosing what birth is right for her no matter the reasoning.

I had 2 ELCSs, one where I lost half my blood volume, and drove after 2 weeks both times.

My vaginal birth on the other hand, I’m still not recovered from 8 years later.

I'm pretty sure you're entitled to one tbh, especially being over 30. I am saying this as 2 women I know (who have recently had a baby at 32 and 34,) said they were told anyone can have an elective section when they're over 30, (especially if it's your first.) Because the likelihood of problems and issues with the birth is higher at 30+ than in your 20s or teens. Again, especially if it's your first. You just need to ask for one. Many women don't realise they can.

Good luck @Ethels

I had an ELCS for my second birth, had no issues requesting it. I found the first week was the worst pain wise, then it improved rapidly. I was driving again without any pain at 3 weeks. All the drs and midwives told me the 6 weeks no driving is a myth and you can drive as soon as you can do an emergency stop without pain. My insurers said that as long I wasn't driving against medical advice they didn't care how long post section i was.

You can definitely ask for an elective and they will have to give you one. Check out the NICE guidelines that state this. You may come up against some pressure to go for a VB but this is very much financially driven so just stick your ground and you'll get one.
Good to request this and reasons why at your next appt so it's in the paperwork - and your consultant too when you meet them.
I also requested an elective at my booking appt as a previous poster and for various reasons ended up with an emergency c section but just stick your ground and you'll get one.
FWIW, don't pay attention to people scaremongering you with tales of awful recoveries - everyone is different in terms of how they recover from surgery and it sounds as though you have had your fair share of surgical recoveries. I was up 7 hours after my EMCS, showering and visiting baby in the NICU and had a very good recovery too. Top tip from a paediatrician friend - ask for a consultant to do the section (they are more experienced, naturally). Good luck!

Lots of abdominal surgery will likely mean lots of
adhesions making for a more complicated CS and likely bigger blood loss because of this.

I had an EMCS first time, and VBAC 2nd with complications. Planning another VBAC for a few weeks time as no way in hell Do I want another CS. But everyone is different and you can’t take personal opinions into it.

Of course YANBU. You get to decide what's best for you. People are very quick to talk about the risks of c sections, not as quick to talk about the risks of vaginal births. And there is no way to get the baby out that doesn't come with risks, it's really a case of picking your poison. I had a vaginal birth and I will regret until my dying day that I didn't opt for a c section as I had considered. Anecdotally, I've had friends who've had c sections and found it absolutely fine and been up and about much sooner than anticipated. I've also experienced being incapacitated and in agony for a long, long time due to a vaginal birth.

Ignore the first poster! Sounds like they've never had a C-section.
I had an elective after an emergency. Had to
Get grumpy for it but I got there. Best decision ever. So much more manageable and was at a playgroup with both kids after 2 weeks!
You'll get push back from those who think a C-section means your child will fail for life, but if it helps your mental health than that's your choice. I had someone who had twins telling me how easy natural birth was blah blah!
As for adhesions, I had really bad ones for the 2nd C-section. Made it a bit more complicated but they admitted that if I had needed a Emergency c-section it wouldn't have been pretty and my recovery would have been horrendous.

I had 2 elective C sections out of choice. The perfect decision for me. Go for it!

I had similar fears to you and also asked for (and had) a C-section in 2020. If that's what you want be clear to those you speak to- midwives/consultant etc never tried to put me off, just checked my understanding especially as mine was height of COVID.

I also had a huge ovarian cyst removed with open surgery about 2 years after I had the c section. I recovered better with the c-section than I did the laparotomy (laparotomy was done via the existing c section)! I think it was baby endorphins or something! Or maybe because I was well when I had the c section but unwell with the cyst (it had ruptured and I had a raging infection).

Either way, if c section is what you want, you can ask for it and should be given it. Don't let people put you off! Also I think elective c section because something is wrong (e.g. baby is not doing well) is different to a c section purely because of personal choice. I'd have another c section again!

Thanks everyone for your stories. I feel more confident to state what I want to the consultant now.

Just curious about the people who’ve said AIBU - is this due to the cost to the NHS, or do you think people should take their chances in an inadequate system?

Lots of abdominal surgery will likely mean lots of adhesions making for a more complicated CS and likely bigger blood loss because of this

It is a risk but not guaranteed. For me, I had a colorectal surgeon on standby but in the end, there were no adhesions and minimal blood loss in both of my c sections.

No driving for 6 weeks is often trotted out, normally by people who haven’t had c sections. As a general rule, it’s rubbish. You can drive when you are safe to do an emergency stop.

OP in any event is going to have another adult around for at least 4 weeks so driving not likely to be a massive issue. You’d have to be incredibly dependent on driving for this to be a good reason not to have a section you otherwise want.

Good luck, OP, I hope you are listened to.

No it doesn’t mean it’s ‘likely’ there will be lots of adhesions. Yes a history of abdominal surgery raises the risk of adhesions, but Increased risk just means that more people will have adhesions in the group that has had lots of abdominal surgeries compared to the group that hasn’t had lots of surgeries. That’s not the same as ‘likely’ which suggests ‘most people’. Risks are risks, not guarantees.