Surprised by the ill feeling from others towards elcs... For twins!

[legallyblond]

I'm 20 weeks with dcda twins (big surprise - already have a 2.5yo DD!) and, after a long discussion with my consultant, will almost certainly be having an elcs.

I am a lawyer and therefore think in "risk" terms so was keen to go through the details of all the risks with the consultant. Considering the risks to twin 2 after twin 1 is delivered, including the risks of emergency medical intervention at that stage, an elcs seems safer. The consultant said that she would prefer all twin deliveries to be by cs as its so much safer in her view. So.... With that in mind, it's looking like elcs!

But given what the obstetrician said re safety (to the babies!), I have been totally shocked by the reactions of some people I have told about my decision! Some seem to think its all a con by the medical profession and can't believe I've allowed myself to be "swayed". The main concern from these people seems to be maternal recovery. I am just that some might place maternal recovery over the babies' safety! Also, re breastfeeding, that has been given as a reason by some (ie it's harder after c section), but having bf DD until she was two, I know how versatile it can be in terms of positions!!!

I had a wonderful very natural birth with DD (mostly in water and no pain relief throughout). It was really amazing, but the recovery wasn't a bed of blinking roses! I had a significant episiotomy and, although no infection, I would say I was in pain for 7-8 weeks...

Are these RL reactions normal? Cs was not remotely discussed with DD do this is the first time I've encountered this strength of feeling about what seems to me to be a non issue!!!

Yes, it's a common reaction.

Usually from people who don't realise "elective" means "decided as best medical course of action before onset of labour" and not "just chose it".

Some people are weird. Your risk assessment approach makes total sense to me. I've breastfed for 18 months after an EMCS and 17 months after an ELCS without problems,so that's no reason to aim for a vaginal birth.

With regards to recovery, make sure you take your painkillers regularly and don't wait until you notice that the pain starts, that way it won't build up so much.

It's nobody else's business how you give birth, so ignore the idiots.

Yep, idiots. To many an elective is seen as having the medical equivalent of a suite at the Ritz. Hey why not get a facelift whilst you're there?

Ignore them. Your body, your babies, your choice.

People can be so judgemental about everything and anything regarding pregnancy, childbirth and parenting but at the end of the day it's up to you.

I would do the same in your position - I was dead against cs but dd was undiagnosed breech and we had 30 seconds to make a decision about how to get her out because I was c6cm dilated. Went for emcs and it honestly was far better than I expected. Dd came out easily - no difficult birth for her thank you very much, and I was out and about (slowly) within days and at 6 weeks was happily going for walks, gentle exercise. I would go for the least risky option in your position. Why put yourself in a situation where there is a greater risk of complications and where you may end up having a cs anyway?

I've not had twins but have had 2 x EMCS. I would totally plan an ELCS for twins, rather than risk delivering one then needing elcs for the second anyway, and having to cope with both a section wound plus a battered vag TBH.

I'm due to have an elcs in july.

Have had some odd responses also. I had a cs with my 1st due to breech presentation, and have considered all my options carefully. Consultant is very supportive of my decision.

A good friend, in particular, seems almost agitated with me for opting an elcs and I've found myself almost arguing with her about it.
I've come to the conclusion that some people will always believe that they know better, and I won't be drawn into discussion about it anymore, other than to say I have chosen the safest option for my baby in my given circumstances.

I had an elcs after a traumatic first birth.

Loads of people didn't hesitate to tell me how I was crazy. I didn't have a medical need for wanting one, I just didn't want to go through labour again (turns out I would have needed a c section anyway but that's another thread!)

I just told them well it's my decision, it's not you that has to do it. And that's that.

And for me it was absolutely the right decision and I found recovery better than my vaginal birth. At least I could sit down!

Don't feel you have to explain or justify. You don't.

Congratulations on your news, twins are amazing!

Mine were born by elective cs at 34+4 on the advice of my consultant. I was always going to have a cs anyway, due to dc1 being an emergency cs (foetal distress and my labour failing to progress). Recovery was fine.

Re the breastfeeding - even with the early delivery, a c/s and the twins beign tube fed in SCBU for a fortnight, I breastfed them - I just had to express regularly while they were in hospital, so that's not a reason to avoid having a cs and is completely do-able.

The other thing I found while I was pregnant was that people are so negative and nosy! I was asked if they were natural or IVF a number of times, and the other comments such as 'You'll have your hands full' and 'Oooh, double trouble'. I found that a big smile with 'I know, aren't I lucky being doubly blessed!' took the wind out of sails of the doom-mongers quite well. (Not that you've raised this point, but it was something that surprised me!)

As a mw, I am often asked by women how to justify their birthing decisions to critics, my answer is, don't!
Its none of their fecking business?

Never justify, never explain. Its your body, your babies.

My other favourite for over interested critics is the fake edd, 2 weeks after the real one?...

Some people are just righteous twats and have to have an opinion on everything.

You're doing what is right for you. You've weighed up the risks and made your decision.

I would want to tell them just to fuck off and that you weren't asking for their opinion but i know I wouldn't have the balls to do so!

I think telling them it's none of their damn business would be a start tbh. Are they asking you about it because unless I knew someone well I wouldn't a ask them about how they are birthing anyway. I know two people at work who have recently had/ Having twins and I have no idea how they are intending to get them out!

I've never been pregnant with twins but if I had the experience I would have found stressful enough without moronic twats lecturing me about birthing. Probably if you had opted to not go for c section there would be people going on about the risks of that

Who ever is giving you these opinions are ill informed of twin pregnancies and births.

I'm also expecting twins and the pregnancy has been very different compared to my eldest 2's and I know the delivery is to also be very different

Multiple births carry greater risks than singleton births

I too am having elcs

Good luck with the rest if your pregnancy

Oh and you can most definitely bf after a cs, I did with my other two

Often you will find that the hospitals that are so 'proud' of their low LSCS rates are those with the highest instrumental delivery rates (foreps and ventouse etc) There must be a LOT of women that have delivered in these places who have suffered birth trauma, tears, incontinence, injuries to baby etc etc.
It makes me sooooo cross that so-called 'natural childbirth' is pushed and pushed (excuse the pun) by some people (esp the NCT) along with the value of making flipping birth plans. Such things are barely applicable to those of us with high risk pregnancies. The best birth plan, is 'Deliver my baby(ies) safely and keep me safe too.

My younger sisters are twins and after twin 1 was born my mum's cervix closed trapping twin 2s arm. She ended up needing an emergency cesarean and twin 2 didn't breathe for 5 mins after birth so I completely understand your decision.
As you know from the prenatal thread i'll be having my 5th medically advised cesarean in October and I get it a lot too. I think some woman see it as cheating somehow and don't want to believe you when you tell them that it's a medical requirement.
Do what is best for yoy

"Some people are just righteous twats and have to have an opinion on everything.

You're doing what is right for you. You've weighed up the risks and made your decision."

I think anyone who chooses a birth option that appears to go against the normal tide will experience this sort of reaction.

I had a history of gestational diabetes and macrosomia, but chose to have a home birth. The comments I got from friends and family were insensitive and ignorant to the point that I eventually decided to stop talking about it. A friend of mine who has just delivered her 7th baby at home (vbac after 2 c/s) at 43 weeks, after cancelling a planned c/s which had been booked in at 42 weeks, took to hiding on the school run because of all the comments she was getting from other mothers.

"Often you will find that the hospitals that are so 'proud' of their low LSCS rates are those with the highest instrumental delivery rates (foreps and ventouse etc)"

Actually the five hospitals with the highest c/s rate in the UK also ALL have instrumental delivery rates which are massively above average as well (average is 12.5%, all those in the top 5 for c/s have instrumental delivery rates of above 18%.)

"It makes me sooooo cross that so-called 'natural childbirth' is pushed and pushed"

Well, given that both the RCOG and the RCM hold the view that many more women than are currently doing so could be having healthy births which don't involve intervention, it's clearly not being pushed enough in the right places.

"along with the value of making flipping birth plans. Such things are barely applicable to those of us with high risk pregnancies"

As someone who's had high risk pregnancies I just don't agree with you, and I know many other women who feel the same. What a birth plan does it tell your care givers what's important to you. Why should your feelings about how you want to be treated in labour be irrelevant because you have a higher need for monitoring and medical input? If anything they are more important, so the staff don't lose sight of the fact that there's a an individual with feelings being looked after, and not just a vessel to extract a baby from. I had strong feelings about how I wanted to be looked after in labour and immediately afterwards, and my midwife took my feelings and needs very seriously. It's also worth remembering that women with high risk pregnancies are very likely to have a labour and birth which progresses and feels like the labours of low risk women. In other words, you need additional monitoring in labour, but not to be treated like a flipping bomb which is about to go off!

Well the Twin Birth Study (a huge decade-long RCT that was completed this year) has now shown that Caesarean is no safer than vaginal delivery when the first twin is head down, so your consultant is not actually correct that it is safer.

That said, it is a completely legitimate choice you are making. People just really like to judge!

Why are maternity units judged on their rates of cs and instrumental delivery anyway? It seems to me that demographic (average age, presence of mw led units, proportion of high risk women) will all distort. Personally I'd be more worried about the experiences of actual women and the number of negligence claims. .....

If I was having twins I would want to talk about the experience the midwives had in vaginal deliveries. Due the perception that ELCS is the 'safer' option I suspect it's getting harder to find midwives that would feel really confident. As another poster has mentioned, the 'bomb about to go off' is not a helpful approach to either party.

"Why are maternity units judged on their rates of cs and instrumental delivery anyway?"

Because even when demographics are adjusted for, huge differences in intervention rates are found between different hospitals.

There's an article about this in the current issue of the BMJ, which I don't have access to. Just read a comment to the responses to it by the authors: [Understanding patterns in maternity care in the NHS and getting it right BMJ 2013; 346 doi: dx.doi.org/10.1136/bmj.f2812 (Published 1 May 2013) Cite this as: BMJ 2013;346:f2812]

"In the report, we describe the variation in intrapartum care across 165 NHS maternity units in England with more than 1,000 deliveries. Taking the rate of induction of labour in primiparous women as an example, there was a two-fold difference between the rate in hospitals that were in the top 10% and those in the bottom 10% (17% compared to 38%). Similarly, there is a two-fold difference in the emergency caesarean section rate after induction of labour (20% to 40%). This striking variation is a major concern, and suggests that women with complex obstetric needs ? which often only become apparent during labour ? are not always getting the best possible care".

If you look at the NICE guidelines on caesarean section, it's very clear that certain patterns of care are associated with lower rates of emergency c/s - namely continuous one to one support from a midwife, consultant input once a labour becomes complicated, and availability of fetal blood sampling. Some hospitals have terrible midwife/mother ratios, poor consultant cover and patchy provision of fbs. This may well impact on their c/s rate, as well as their protocols surrounding induction.

I totally agree OP. I had an ELCS for my second dc, who was stubbornly breech. I had a lovely calm caesearean birth but felt like people (esp many natural birth enthusiasts I know) didn't want to hear it.
I felt like I wasn't 'allowed' to be positive about a c-section or tell my birth story in the same way :(

I won't lie, for me recovery was quite tough but I don't regret my decision as for me DD's safety, rather than my birth experience, was paramount. Also tbh my birth experience, bonding and breastfeeding were all easier than with my difficult vaginal birth with dc1.