Under what circumstances can I have an elective cesarean?

[Pinkflipflop]

Just wondered about this? It's very hard to find info about!

If you had an elective cesarean, did you find it hard to convince your doctor?

I'm not pregnant (yet) though if I ever managed to get pregnant, I really feel that a cesarean birth would be for me.

I'm in N Ireland - so interested if there are any experiences from here too!

I had IVF so I was totally sure of my dates and my DS had TTN (fast breathing) which MAY have been associated with him not being left to cook for longer, but although I wanted a cs, I actually had it because of placenta previa, and they said they didn't want to leave it too long in case the placenta started to breakdown or I went into labour etc. He was in SCBU for 3 days but mainly for observation, not for any treatment as such. It was scary, and I beat myself up at the time for not pushing for a later section date, but I suppose it's a toss up of when to deliver, and I just took the advice of my consultants.
It really is very rare though - from those stats, less than 2% so we were v unlucky perhaps.

When I worked in SCBU, we had several routine 37 week sections due to 'wet lungs'.

Lougle do you mean the sections were performed because of wet lung? How is it diagnosed prenatally?

Sorry, that wasn't very clear, was it?

No, I mean that they were sections performed for various fairly routine reasons, such as placenta previa, increased amniotic fluid, transverse lie, etc. but that because they were born by c-section, they hadn't gone through the birthing process, so had slightly 'wet lungs' which caused them to be a little grunty and so needed some time in SCBU.

Ah I see! Thanks for clarifying!

I've had two 'elective' c-sections. Neither of which I wanted to have. 'Elective' is not really the true sense of the word. It just means the Consultant has decided you are not able to give birth naturally. Both of my children I was not able to give birth naturally with. One of which was a low lying placenta which totally blocked the birth canal (placenta praevia) which meant there was no way I could give birth normally. It was still classed as an 'elective' c-section.

The recovery is not quick and it makes the first 6-8 weeks of being a Mum a very uncomfortable one. Elective surgery over vaginal birth is a very big decision and one I wished I'd had the choice over.

This thread, as always, shows that there are a wide range of experiences of CS births and recoveries (as there are with VBs).

The info from Hazeyjane, and the clarification from BagofHolly, I've found very interesting, and the kind of clear research and info I wish there was more of about elective sections.

While personal experiences are illuminating and always valid, I don't think the tendency to generalise personal experiences is helpful.

I had a very quick recovery from my section. I was up and about feeling close to normal within days.

However, I do try to be careful to say 'that was my experience' - and not 'this will be everyone's experience.' Obviously tinksandfloris had a harder time than me, and I'm sorry about that - but with all due respect, I don't think it's fair to say therefore a CS "makes the first 6-8 weeks of being a Mum a very uncomfortable one." That's just not true for everyone.

As regards other posts - I'm afraid I don't find the 'someone at my mother's group said her stitches burst when she coughed' response useful, or that appropriate. I see threads on MN everytime I log on about refusing induction/going over due dates etc. I know someone who recently went a long time past her due date, had a huge baby via VB (over 12 pounds...) and has horrific birth injuries as a result. Bad 4th degree tear, and has already been told that surgery will offer her limited recovery. But I DON'T post about that on those threads. Because (a) I think her experience is awful, but not common enough to flag up, and (b) it's not my story, and I think personal experiences are much more helpful. Also, I expect I would get flamed for posting such a negative story about a VB.

But CS threads seem to attract a legion of second hand alarmist responses. I want to be clear I'm making a distinction here between people who say 'this is what happened to me', and people who post either dubious 'facts' about CS, or 'word of mouth' warnings.

pinkflipflop - this isn't exactly the answer to your question, but Chynah started a thread asking for personal experiences of CS a little while ago, to counter 'misinformation and scare tales' - www.mumsnet.com/Talk/childbirth/1053355-C-Section-Information-Real-Life-xperiences

It has good and bad experiences on it - a whole range, in fact. You might find it helpful reading - I think it's very informative.

I don't want to upset anyone with this post - mosschops, I know you had an awful experience, and hazeyjane, I've read some of your posts on the thread about elective Csections after traumatic birth. And I am absolutely not belittling or dismissing what you say here. I hope that's clear.

Why would you want a CS? It's major surgery. And there's a lot of research now to show that a vaginal delivery (if it's possible) is best for the baby. Being squeezed out has a purpose apparently.

Wannabeglam, some women, for all kinds of reasons don't want to squeeze anything out. And those reasons may be perfectly valid - it may well be the right choice for them, and choice in childbirth is a basic right. Yes, it's major surgery but it's also very routine, straightforward, and the burden of risk is on the mother, not the baby, which for some women is an overriding positive.

Why should the OP have to justify her birth choice? Birth whichever way is a risky business and I'm sure she will have researched the various pros & cons before deciding that it is the best choice for her and her baby.

At the end of the day people opting for VBs or CSs sometimes make the wrong decision for them or their baby but it is, and should be, THEIR choice.

wannabeglam - "there's a lot of research to show that a vaginal delivery ... is best for the baby"

Really? Please link if there is. But even if there is, then that's not directly relevant to the choice here.

The distinction here is between attempting a vaginal delivery (and therefore covering not only a non-assisted vaginal delivery, but also the other possible outcomes of an instrumental delivery or an emergency CS), or having an elective section.

It is impossible to decide to have an unassisted vaginal delivery. You can decide to try, and take the risk of instrumental delivery and/or emergency section, or you can decide to have an elective section.

By definition, if someone has an unassisted vaginal delivery then nothing went wrong. Taking statistics for caesareans, which include emergency caesareans (by definition when something has gone wrong) and also electives done for reasons such as pre-eclampsia, slow foetal growth etc etc - well of course outcomes are worse. If someone asked you "are outcomes better in cases with no complications or cases with complications?" I think you'd find answering easy.

In order to make a scientifically justified decision (and I fully recognise that there are emotional issues too) you'd have to compare elective caesarean versus [vaginal (including instrumental) AND emergency caesarean]. And so far as I know there is nowhere that these statistics are available. NICE, for one, does not distinguish between elective and emergency CS in its statistics.

Sorry that was really long. It's late and I'm going in circles. Hope you can make some sense of it.

There are some studies comparing 'intention to treat', i.e. comparing the outcomes in a group of women who planned a vaginal birth (though they may not have been able to have it in the end) and those planning cesarean birth. I agree this is the best way to compare the two routes as you can't possibly know how what you plan will actually turn out.

e.g. here which looks at outcomes for the baby, you can find similar for maternal outcomes.

"Planned vaginal delivery was associated with a lower risk of NICU admission, oxygen resuscitation, physiologic jaundice and a shorter length of stay, but an increased risk of meconium passage and 1 min Apgar ≤5 (Table 2). For the composite measures of respiratory morbidity and neurologic morbidity, there were no differences between planned vaginal and planned cesarean delivery. When assessing Apgar scores on the basis of actual number (0 to 10), the median 1 min Apgar was 8 in the planned vaginal group and 8 in the planned cesarean group (P=0.29). The median 5 min Apgar was 9 in the planned vaginal group and 9 in the planned cesarean group (P=0.11). In addition, there were no differences in the other secondary outcomes."

It's worth noting that in this study the C-sections were on average a bit earlier than 39 weeks as is usually recommended here, and that the higher NICU (SBCU?) admissions may at least partly be down to different hospital practices in the two cases.

SCBU, I mean

see here for maternal outcomes, I can't get access to the full text unfortunately.

"Planned cesarean delivery had less chorioamnionitis (2.2% versus 17.2%), postpartum hemorrhage (1.1% versus 6.0%), uterine atony (0.6% versus 6.4%), and prolonged rupture of membranes (2.2% versus 17.5%) but a longer hospital stay (3.2 versus 2.6 days). There were no differences in transfusion rates."

Pink - not sure if anyone has stated the obvious yet, but you can just pay for a section and get it. It's your choice & you would definitely be able to find a consultant who will perform the surgery. But it will cost you. I did it this way and I'm really glad I did. Do your research and work out what mode of delivery you think you would prefer.

Also want to add that it is very nosy for other ladies to comment on a woman's preference for an ELCS or to question her reasons for wanting an ELCS. If you're not the one pushing it out, then but out.

Scarabeetle, that's true. The OP is in N Ireland and there are no private maternity services there afaik so to pay to have it done privately she would have to go to London or maybe Dublin.
And you're quite right about questioning people's choices. I read comments like "it's major surgery" and think "no shit, I never knew that." Sooo patronising.

Its not patronising.

I didn't realise how major s C section till I had one. And for many people, probably those who had a more difficult time of it, it may seem strange to want to choose one.

I think its resonable to ask why OP would like a C section. Maybe its becasue she is terrified of vaginal birth and seeks reassurance? Maybe its becasue of a existing condition which would help us frame our answers.

Mumblescrumble, I don't mean this in ANY kind of a patronising way, but how could it NOT be major surgery?? What did you think would happen?
And supposing the OP wants one because of fear of VB, that doesn't mean she wants reassurance necessarily, just information on how to enable her choices.
I'm sorry you had a poor experience of CS, was it planned or emergency?

Becasue when somebody says it would be safe to get the baby out by C section one doesn't start thinking about the specifics of the procedure. But more than that the experiecne has changes my perception of all surgery, horror films, gory stuff and body stuff.

I seem much more squeemish and sensitive now. I was horrified by my wound [not the place for a scare story - and it really wasn't as modern medicine meant wasn't in real danger)

It was a elective (so wasn;t all running and rshing) after failing (I hate that term) to progress after a long long labour. (had epidural so that bit was fine).

The experience of major surgery was muchmore major than I had thought, depsite watchng C sctions, youtubing it, looking at medical books etc. It was much more major when it was my body and it knacked by the way.

Think I had some mental trauma too though.... there were ladies in beds near me who were galvanting around after a few days!!!

Gosh I think you had the worst of all worlds - big surgery after labour, when you're tired, and hadn't planned it turning out that way. Just dealing with the mental side of that must be tough, never mind the physical side of it.
I think a planned (booked days/weeks ahead when you've got time to get your head round it etc) section can be a very different experience. I didn't see any blood and gore at all and was up and about quite quick but that's cos I hadn't spent the preceding hours labouring. I really feel for you, and for all women who've had a bad time of it, and ended up with something very different that they'd planned. X

Thanks Ephiny. When I was trying to decide I couldn't find anything. Could you link again please, as current link is to this thread(!)

Sorry, don't know what happened to those links! This is what I was trying to link to -

Neonatal outcomes:
www.nature.com/jp/journal/v30/n4/full/jp2009150a.html

Maternal outcomes:
www.biomedsearch.com/nih/Maternal-Outcomes-Associated-with-Planned/20235001.html (abstract only)

Thanks again Ephiny.

Unfortunately I can't access the Nature one as I'm not a subscriber.

I don't understand the second one (!) - it says there were 26,356 deliveries then further on says there were 3,868 planned vaginal deliveries and 180 planned caesarean; I assume these later figures are for the subanalysis but don't understand why such a small sample was used, or how it was picked?

If you have time could you try and explain? I'll get my dunce's hat out...

I agree with Mumblechum, as regards not realising quite how major the effect of the section would be, so although I knew it was major surgery, I really didn't expect the huge emotional response. I truly felt like a woman who had been sawn in half. I still can't bear to touch my scar, and burst into tears when the physio massaged it.I also didn't expect to end up having quite so much pain, despite maximum morphine and codeine.

I always worry about posting on threads like these, because I don't want to scare people out of having a planned cesaerean, I do think it is a perfectly valid choice, and obviously a lot of people have fantastic experiences and recover quickly and well. But I do think it is important to read the negative stories too. When I was trying to make the decision whether to have a section, I really had only heard positive stories, with lots of people saying, 'oh don't worry it will be fine, I had a section and because it was planned it was so much easier to recover from than an emergency one....'etc. I suppose I just want people to be prepared that it might not be that easy, and to not feel bad if they find themselves struggling to stand up a week after having the section.

I think I probably made the right choice, who knows. I have hopefully avoided having worsening double incontinence problems, but still feel a wave of sadness when I think of ds having chest problems.

On the other side of Hazeys experience. Both my planned sections were great but I never had the emotional side to deal with as I had planned a CS from the start (never wanted a VB)

I did recover very quickly and was back out running after 5 weeks BUT

• I never went in to labour so wasn't tired etc before the op.

• Me and baby were fit and healthy & babyfull term (no medical reason for section purely choice).

• I was also very fit (still running til weeks before birth)

• I put on very little weight (1 stone) with both pregnancies.

I think all of the above definitely helped my recovery plus as I got exactly the birth I wanted I never had to deal with the disappointment/other issues that those whose births have ended differenly from how they intended have to cope.