First baby, aged 41, elective caesarean?

[blueskies2]

Hi

I'm still only 21+5 weeks, but thinking ahead to the birth.

Saw consultant obstetrician at 13 weeks and he immediately discussed / offered ELCS. I was surprised (and secretly relieved?) it was offered to me so readily; he said it was mainly my anxiety (largely health anxiety, can be very bad) which is clearly in my notes already. I opted then for hospital VB but with a view to reviewing this at a later date.

Two friends have recently given birth over 40 - one emergency C section, the other (non-planned) ELCS at 40 weeks on the dot; both said actually they would go for the offer of an ELCS at my age. Other close friend gave birth at aged 39 - induced, cord wrapped round neck, ventouse and episiotomy. Not nice but I know that's childbirth for you.

I've read old threads on here about ELCS for first time mothers, but would be very interested to hear views about ELCS post-40 mothers in particular. I fear that EMCS might be v likely at my age, so would it not be better to opt for ELCS first? My concern is for the well-being of my baby - I have very low fertility, it was a miracle I conceived at all and there won't be another pregnancy! I just want my baby's delivery to be as safe as possible.

Any thoughts really welcome - thank you!

Are there any other medical complications? I have had both and a c section wasn't an easy option. It affected my ability to feed and my recovery was slow. VB recovery was better and feeding a dream.

It is obviously your choice about how you feel about it. For me c section definitely not the easiest option. To clarify mine was an emergency c section and I know family who had emergency section then elective; it is a different experience but recovery was similar.

There is no reason that a vaginal birth should not go perfectly normally. I have no experience of a CS but I know someone of similar age to you who had one (planned) and recovery was very difficult for her. Similarly lots of people have good CS experiences.

Yes you never know what you're going to get with birth but a CS is major abdominal surgery so bear that in mind.

I had a lovely first (natural/vaginal - not sure what right term is!) birth using only gas and air and am a very anxious person - people only seem to like to share horror stories - but everyone is different. Guess all I am saying is don't assume that all vaginal births are awful and all CSs are a dream!

Maybe think in it some more and talk with your consultant again.

Best of luck with your decision.

I was 42 when had DS1 and ELCS not offered to me though I know of other mothers of similar age who were. I had vg delivery by the traditional route! I'd have been very if CS has been 'pushed' - I'd personally have found that quite patronising.

I'm 45 now and 23 weeks with DS2 and go for my consultant apt tomorrow - so watch this space!

There are many reasons why a CS may be appropriate - physical and mental, but I think there is a culture of thinking that a CS gives a guaranteed outcome. It's a major abdominal procedure and needs to be treated as such.

Unfortunately there just aren't guarantees around childbirth - except possibly that it definitely won't go like you want it to

I think your comment about being secretly relieved tells you what you're really thinking. I'd say - sorry to be vague- you need to be honest with yourself what your worries are - there's no right or wrong answer, no points to be scored. It's early days!

Thanks to all of you for your helpful and kind replies. Considerations about recovery / feeding / major abdominal surgery have got me thinking again, and certainly I will mull this over a bit more - as you say, catdoctor, it is early days!

Reassuring to hear that even an anxious person like myself can have a lovely natural birth, timeforgin.

Only other (minor) complication so far is a cervical polyp, which may or may not impact on the decision re a natural birth v CS, so we'll have to wait and see!

Thanks again.

The easiest labour I have ever seen was a 41 year old first time mother. She came in and she was so calm and normal in her behaviour that we thought she wasn't even in labour - she was 9 cm dilated! My friend caught the baby and she said the labour never really got much worse for her.

Risks of cs are generally overplayed and risks of vaginal birth underplayed. It is almost knee-jerk to describe cs as major abdominal surgery. It is but it is also surgery that is routine and many women recover quickly and uneventfully from.

In terms of risk, the highest is with an emergency cs. Natural birth is unpredictable (particularly if maternal anxiety is factored in). It is worth considering the more controlled environment and certain outcome to mother and child that that an elective has over a natural birth, if only to avoid the emcs.

Blueskies, you would also want to consider whether or not you want to have many more children after this. I guess your age is limiting but if you intend to stop at one or two, then you don't particularly have to plump for a natural birth.

Only you can decide, but just wanted to give you food for thought.

FWIW, I had an emcs for a first birth and was wavering between a VBAC and elcs for my second. The minute the consultant agreed to my elcs, I felt instant relief and knew from then it was the right decision. Good luck

I had DD at age nearly 42. A C section wasn't discussed. It was assumed that I would go for a natural birth unless there were complications. My labour lasted for exactly 6 hours and afterwards the midwife told me that mine was a textbook labour - straightforward and uncomplicated.

I was back in my size 12 jeans when DD was 3 weeks old, and by six weeks my body didn't even feel like it had ever had a baby - oh, and no stretchmarks either.

I just had an 'emergency' section after a failed induction. Induction was due to age (41). Wish I had been brave/assertive enough to ask for planned section as obstetrician said he wouldn't have come out any other way. In my case he was fairly big too.

I can't help but agree with the previous poster who said risks of a section are overplayed and vaginal underplayed.

One thing to think about is whether you will want another child. A friend of mine told me she has to wait a year after her CS before trying again due to having to let scar tissue heal. At 41 you may not want to be voluntarily putting yourself in a position of having to put off TTC again for that long.

I would go for the ELCS. I was terrified of giving birth, went ahead with it, had hideous birth damage, which then resulted in PTSD and PND.

My take on it is that if you are already pre-disposed to anxiety regarding giving birth, unless it's goes like a textbook dream it is likely to weigh on your mind afterwards.

I have two friends who had bad birth damage from vaginal births, followed by ELCSs, and they both say the electives were much much easier to recover from.

Thanks to everyone for your replies. Really helpful. I would really like to avoid induction / failed induction so I think I am going to opt for ELCS with the proviso that I might try for a natural birth if I go into labour beforehand, but will make a final decision nearer the time. Thanks everyone!

Like you, I was anxious about a vaginal birth as I've always had anxiety about stuff 'down there'. I had two abortions when I was younger, which contributed to my anxiety and I would always whip myself into a frenzy when going for a smear test, to the point that one nurse said I was 'the worst she'd ever had' to deal with. When I got pregnant at the age of 39, I decided to do a hypnobirthing course to try to get my head around the idea that giving birth is entirely natural and to give myself a toolkit from which to draw on when the moment came. I'm not a relaxed person at all, so doing deep breathing exercises didn't come naturally to me, but I have to say that I felt more empowered by having learnt some of the techniques. Anyway, fast forward to Christmas Day 2011 when I was 13 days overdue and the hospital are calling me in for induction! I said no and ended up going in on Boxing Day instead. There followed two failed induction attempts and several sweeps, all of which I knew would fail as I had a low Bishop's score (see thread here: www.mumsnet.com/Talk/pregnancy/a1364965-Anyone-over-due-and-fed-up). So it all ended up with me needing to have a C-section, although the hospital stressed that it was 'elective' even though we all knew that the baby wouldn't come out any other way.

Positives of a C-section? The sense of relief once I knew I'd be meeting my baby soon. The procedure itself was fascinating - really theatrical - and the staff were amazing. No worries about vaginal tearing. I didn't have much post-birth bleeding (maybe 2 weeks but not really that heavy) as they suck most of it out during the op. Surprised at how thin the scar is.

Downsides? Your body doesn't necessarily know that you've given birth so your milk may be slow to come in. My flow was slow for weeks but guess what, I'm still BF now that my little boy is 20 months - who knew??!! The biggest impact for me was the lack of mobility. I was super fit before giving birth (still doing personal training at 39 weeks) and suddenly I couldn't even get up the stairs. It took MUCH longer than I expected to be able to move around normally - probably 3 weeks before I could walk at a normal pace again - and there was the abdominal pain of course. I would literally count down the minutes until the next painkiller like some kind of junkie, plus the codeine gave me constipation and I ended up in A&E a week later with a litre of urine trapped in my bladder and a poo stuck. Not being able to drive for 8 weeks was a PAIN! Later on, an annoying after effect for me is the little flap of skin you get over the scar which doesn't seem to go away. I'm a size 8 so not big by any means but still I have this little belly that wasn't there before.

Everyone's different and people recover in hugely different ways after a C section but just thought I'd share my thoughts. Good luck!

Just to add, it's the delivery of the placenta (vaginally or as part of the c section) which lets your body know you have given birth, and thus encourages milk production. I had an elcs as I had a low lying placenta. DS latched on fine and my milk came in on schedule on day 3

I've had 2 CS one emergency and one due to failure to progress as I was trying for a VB this time round. I'm 32.

Just a couple of things really, CS is NOT the easy option.

After surgery you will be bedridden for a while as you will have a catheter. You will find walking uncomfortable for some time.
You can't lift anything too heavy.
You can't drive for 4-6 weeks.
When you are discharged, you will not be sent home with anything stronger than ibuprofen if Breastfeeding. I gave up bf after 4 days because the pain of the baby laying on my tummy was unbearable. With my first I was given stronger drugs but new research has now put a stop to this.

I don't want to scare you, just pass on my experience. Obviously the safety of you and the baby is number one. Good luck x

Longfufu I'm sorry you've had bad experiences but what you're describing isn't typical let alone the given youre making it appear to be.

My children are all ivf babies whom at one point I never thought we would have. I was 39 when I first gave birth and asked for ELCS because my logic was this:

• I was probably only going to do this once
• I wanted the lowest risk event for the baby which when everything is equal is an uncomplicated vb. But at 39 that was actually a whole lot less likely than it would have been if i had been younger or this wasn't my first baby.
• I absolutely didn't want a complicated vb - the thoughts of not getting the right pain relief, something unplanned going wrong etc terrified me.
• A planned CS would be just that - planned.

My consultant agreed without question. I had a very straight forward ELCS and it was the happiest moment of my life.
No panic, no pain, and a lovely baby! I bf no trouble at all, for a year, and had another CS the following year. I'd asked how close they could be and my surgeon said so long as there was a year between deliveries that was ample. I was discharged with plenty of meds, drove at 3 weeks and felt back to normal at 6 - well as much as you can if you're feeding every 3 hours!

Go for it. Very best of luck and congratulations.

FourWillies the medication you Will be send home with if you have a cs and breastfeeding is ibuprofen nothing more. I had a cs last week.

When I had a cs 2.5yrs ago I was sent home with a lot more painrelief, but research has identifiem issues with sleep apnea in babies.

I'm probably airing more on the negatives but they do exist and thought I'd share.

But like I said before do what's right for you and your baby op x

I'm sorry you were only sent home with ibuprofen. I breastfed and each time was discharged with voltarol and cocodamol. I checked with the anaesthetist and she said she was still breast feeding herself and they were fine. As it was I didn't need the voltarol.

Your experience doesn't sound a happy one, (and its such early days i hope youre ok) and a planned CS is a world away from an emergency one, or even one when you've laboured for a while. I got my hair done the morning of mine last time and was chilled by the time I went to theatre!

Re the breast feeding and the baby lying on your tummy, if it's uncomfortable I found putting a pillow on my lap helped or tucking baby under my arm in a rugby hold, or lying on my side.

steady on longfufu - you may be describing YOUR experience, but please, do not present this as fact.

Re Painkillers. The protocol and what cs patients are sent home from hospital with seems to vary from hospital to hospital, reading mumsnet.

I had a cs a couple of months ago - I was emphatically NOT sent home from hospital with just ibuprofen. I had diclofenac and prescription strength paracetamol and codeine (ie not what you can just get over the counter in Boots). And a lot of them. I never finished them, as I didn,t need them all. This was the same as I had going home 3 years ago. I also had morphine for the first 12 hours in hospital.

A friend who had a csection last week came home from hospital with exactly the same - diclofenac and strong paracetamol and codeine. No question of there being anything less.

OP, if you are anxious about painkillers and what you will be allowed, you can talk to your consultant beforehand. I did.

longfufu, I don't know where in the country you are, but you may wish to take the issue of painkillers up with your hospital.

btw I am breastfeeding no problems - same as first time round. Some women are given advice on how to bf ('rugby ball hold') if they have trouble positioning baby around their scar (I had no problems, just used cushions).

I had a catheter in overnight both times. Personally I don't count that as being 'bedridden for a while'. They actually offered to take my catheter out this time the same day, 7 hours after cs, as I was able to stand and walk - I actually asked them to leave it in overnight, as after weeks of peeing every couple of hours during the night in late pregnancy, I wanted a break!

Longfufu, I'm sorry you have had a bad experience with your cs, I really am - but please don't post misleading information.

Oh yes I loved my catheter! What handy things they are!

I loved my catheter too and was gutted when it fell out!

Just to add my experience, despite mine being an emcs my milk came in fine on day 3 and feeding went well. I got sent home with various drugs but only ever needed the ibuprofen. It's just the luck of the draw, really.

Hi peoples x thought i would weigh in on this discussion lol.

I had a c section with my first at age of 28 as she was breach and not going anywhere... Scariest thing i have ever done but that was my issue as the doctors etc were great x my little girl had some issues clearing her lungs and my mik unfortunately never came in and after two months breast feeding she was still her birth weight and qte sick so move onto formula.
I didnt find the pain after too bad but stayed in midwife led unit for 5 days a was an unexpected sungle parent... Let hospital with no painkillers lol and told to take paracetamol if i needed it!, lol i do have an ok pain threshold though so wasnt bothered by that..

My second child is due in 5 weeks which doesnt sound much...... And hoping for a vbac with minimal pain relief although i am aware that i wont ncessarily get what i want... Im now 31 so would rather not have a c section to recover from with a very very energetic three year old although thank god my partner hasnt changed his mind and we are moving into our first proper house together once it goes through the mortgage etc yay
Lol

Doubt this helps much but it is an unbiased view as i hated the c section but i can see that it was my anxiety at the operatin etc a i really wanted a natural birth and felt my body had let me down lol silly but i got my gogeous girl x x