C-section or natural birth? Which to go for?

[Pinkandwhite]

If you could choose an elective c-section, would you do it and why? I'm currently 20 weeks pregnant with my first baby and I'm starting to consider my options. I am living in America at the moment and hospitals don't offer water births which is a shame. I could go to a birthing centre run by midwives and have a water birth there. In that scenario, if there were any complications, i would be rushed to hospital. Also, there are no epidural or other drug options available there should I find it really tough. At the other end pf the scale, my medical insurance will cover an elective c-section. It would be really good to hear from people who've given birth so that I can hear what you would choose given the benefit of hindsight. My instinct is to try and have as natural a birth as possible in a hospital but I want to consider everything.

Thanks for posting averyjessup. Sorry about your bad experience but I'm glad I'm not the only one who can't decide.

I will be having an elective c-section in 10 days time with my second baby. My first birth was pretty horrendous (two day induction, failed ventouse, episiotomy, forceps) and I have had a lot of anxiety and fear regarding this second birth. I have been seeing a counsellor throughout the pregnancy and my consultant gave me the option of a c-section as he could see how I have been affected by my previous experience. My baby is also measuring very big so more chance of me having a birth with intervention.

You have to make the decision that's right for you. Good luck.

That's interesting hippymama. Sorry to hear about your bad experience though. I hope all goes really well with you elective cs.

Bloody hell 1944 that's awful. It really goes to show how much things have changed in a fairly short space of time.

this book is amazing, i heartily recommend it. statistics and feedback from docs and consultants.

www.amazon.co.uk/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110/ref=sr_1_13?s=books&ie=UTF8&qid=1396936156&sr=1-13&keywords=caesarian

I'm five days into my recovery from elective csection and can honestly say, is incomparable to my natural birth.

First ds was 30 hours in labour in hospital, epidural after 12 hours, back to back baby, nearly needed forcepts to turn him, was told his heart rate was dropping so they were considering emergency section. Actually ended up with episiotomy but was then told they couldn't delivery the placenta, which was eventually wrestled out. I then had a three day stay in hospital. I was exhausted, in bloody agony from stitches, catheterised for 48 hours, unable to sit down comfortably and really feeling quite traumatised by the whole thing. This, when I requested a csection, was considered a straight forward birth.

Fast forward to last Thursday, when my ds2 was delivered by elective c section I was walking about the ward within 6 hours of the operation and home within 24 hours. I have been sore and achey, but am now on minimal painkillers (paracetamol and ibruprofen) and feel absolutely great, comparable to post six weeks with first ds. Whether part of this is because he is my second ds I don't know, but what I can say is that I personally would not consider another natural birth.

Whenever I look at the outcomes (statistics & correlations) I'm convinced that vaginal is much better. In dozens of ways. Maybe that's confirmation bias at work.Someone who wants CS might see completely different evidence.

Statistically, a vaginal birth is safer for both you and baby.

I don't think its as straightforward as either of those statements. A lot of data is flawed because it classes VBs and CS in a way which isn't comparable.

Data should be presented as planned VB (including EMCS) and planned ELCS. Not as VBs v CS which is so often the case. This makes VBs look much better on paper than an ELCS.

Also data is often flawed in that it looks only at first time mothers. Planned VBs fair better if you are looking to have more than one child as the risks associated with CS increase with each child and improve slightly for VBs if you have several children.

To be honest, given the sheer scale of information that is biased in various ways (for each side of the debate) it is extremely difficult to pick your way through what is helpful and whats not worth the paper its written on. The problem is the sheer scale that information has been tainted by ideological beliefs and agendas.

In terms of a more critical look at the data (and baring in mind this book has its own flaws), I would recommend www.amazon.co.uk/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110. It offers a different perspective of ELCS and over view of how cultural attitudes to CS differ throughout the world - as do the risks. Comparing a VB and ELCS in the UK to a VB and ELCS in the US there is a difference because of the way women have access to care and the way in which the two systems assess risk for example. You need to be careful about looking at statistics for this reason too. It is a pro-choice of CS book, but its a interesting read as it is controversial because it goes against the grain and there are very few debates out there which offer a similar perspective. I think its best read in tandem with a pro-VB book (or books), to get a level of balance though. One of the best things it does does help you filter how bad some of the statistics out there are (and tbh it falls foul of its own criticisms at times, but if you understand the principle of the flaws you can see some of these for yourself). One of the writers had two ELCS for no other reason than choice.

I think in the end the biggest conclusions I've drawn is that it is a hugely personal decision and depends hugely on your personally type and what your hopes, expectations and plans are for the future. There is no 'right' answer as such. Just right for you.

I've had 3 VB's and 1 CS. Given the choice I would choose VB.

I really wouldn't have a homebirth or MLU birth in USA, CPMs (certified professional midwives) are not the same as the CNMs (certified nurse midwives) who work in hospital. Regulations were recently improved so that CPMs had to have a high school diploma. There is no formal training, and beliefs about trusting birth, using herbs etc are common. The outcomes are not good, rates of perinatal mortality and hypoxic brain injuries are MUCH higher than hospital births. If you can bear her sarcastic tone of writing the skeptical ob has accurate statistics on american birth outcomes.

This is very different to the UK where NHS midwives tend to be reasonably cautious and transfer to hospital early if things seem not right (although there are still cases of rogue independent midwives contributing to poor outcomes). Personally I wouldn't have a homebirth here either as I would not be comfortable with the risks.

The decision of what type of delivery to have is up to you, I tried for a normal delivery in hospital with my first (had EMCS for fetal distress) as if it goes ok can avoid surgery, adhesions. Also maternal outcomes are very slightly worse with CS than VB (perinatal outcomes are good if delivery planned for over 39 weeks).

Good luck with your pregnancy and try not to be too anxious, everyone you see around you got out of their mums somehow!

Thanks for the posts and thanks kelly1814 and redtoothbrush for the book recommendation.

Redtoothbrush - I think what you say is true, it's very hard to get to the actual facts. I hadn't considered the difference in outcomes between the UK and US. I need to look into this further.

Josiemcdozie - thanks for sharing your experience and huge congratulations on the birth of your baby!

Itsnotrocketscience - thanks for that information. I'm going to take a look at the skeptical ob now.

Pink, one of the main reasons the statistics for the US is much poorer for the US than UK because their data collection methods are not as comprehensive.

In addition to this there are a lot of differences that we do know about between the US and UK.

There are poorer outcomes for women in lower economic groups, but because of the nature of how you pay for healthcare in each there is a difference (for example - less access to ante-natal care is associated with worse outcomes).

There are differences in obesity so the two demographics of the countries are not directly comparable. (More people in a higher risk group).

Also higher rates of CS in different US hospitals do not necessarily correlate with higher rates of maternal complications as you might expect if CS inherently bad. (again this might be connected with insurance resulting in the demographic at different hospitals being not as universal as the UK).

And because of the nature of litigation differing between the US and Uk, doctors are likely to act differently in different situations (eg intervene at different points).

Plus what itsnotrocketscience says about differences in the qualifications and education of consultants and midwifes between the US and UK is also very relevant.

That's REALLY interesting redtoothbrush. I hadn't thought about the differences due to obesity/lower income groups. I had thought about the litigation differences. I reckon all of those factors must make a massive difference. It's so hard to know what to do!

I am pregnant with my first baby and amgoing private in the UK specifically so that i can have objective discussions about everything and make my own informed choices.
I expressed a strong preference for ELCS to my obstetrician and he said said to me
"Oh absolutely. If it were me and I was otherwise fit and healthy I would have a planned section at 39 weeks, no question".

That's interesting takingchances. I'm in the same position as you (and pinkandwhite) - expecting first baby and have paid for private obstetrician so that I have more options available (ELCS is not available with publicly funded midwife here).

I don't think I would choose an ELCS first time (though I do find the idea tempting) - did your ob give any reasons for preferring an ELCS?

I have a complicated gynecological and bladder history, and have an extremely narrow pelvis. I am petrified of instrumental delivery, tearing, and incontinence.
That's what we were discussing when he said what he did.
His reasons were long-term pelvic health and quality of life i.e. related to continence. If vaginal birth could be guaranteed straightforward then obviously that is the preferred route but unfortunately there are no guarantees.

With respect, I'm going through the NHS and have had no issue what so ever in having my request for an ELCS listened to. I have anxiety which is the basis of my request, but they have been incredibly supportive. I have seen a lot of other threads from women who have particular psychical medical histories who have chosen an ELCS and been completely supported under the NHS too.

I do appreciate that this isn't the case everywhere in the UK though. But its wrong to suggest that you only get this sympathetic and objective discussion within the private sector. For many women in the UK, the NHS is the only choice either by location or by finance and it is important that they know that it is possible under its umbrella.

I would also be cautious about what a consultant's opinion might be, simply because there is a bias despite what you might think. Surveys done in both the US and UK have show that consultants are far more likely to have an ELCS themselves or their partners have an ELCS than the general population. They are not necessarily as objective as you might initially think. They are just approaching the subject from a different perspective.

Interesting article debating subject from the Guardian.

Interestingly midwives are much more likely want a more natural birth.

You do have to look at the reasons why there is this difference. And also consider why, if ELCS are supposedly 'worse' statistically than a VB, are so many consultants making the decision themselves or advising their partners to take that route? They are more educated than the general population on the subject, so you'd think they would understand risk more than most.

I think the answer is in part from the fact they are more likely to be involved in births that have gone wrong, and had to clear up the consequences unlike midwives who will see far more straightforward VBs, so the risk appears very distorted. Also they are more likely to have smaller families and leave having children until late, when there is more chance of complications.

So is it a purely educated decision, or are there more emotional and less scientific influences also at play?

I think it shows more that we should have choice and that both options have positive benefits over the other and each carries different risks that different individuals may find more acceptable than the other and this is a very personal issue. I don't think it necessarily shows either to be more dangerous than the other - they have to be safe enough for both groups who work in the field and understand the potential complications for each to think its safe enough to potentially risk their life or long term health (or that of their partners). I don't think there is an overall right answer, simply one that individuals might be more suited to over the other because they have different preferences over what they feel is the biggest and worse risk to them on a personal level.

tak1ngchances I actually think that you've simply picked a route where you are more likely to come across likeminded people or people more likely to support the choice you have already made in part rather than a route where you are more likely to get objective discussions.

There is absolutely nothing wrong with that. As you can see from what I've put, I've made a decision along similar lines (and indeed sort out and actively choose a hospital which I felt would support that decision without pressure or judgement), but you should be at least aware that those discussions may not offer you quite the lack of bias you might be seeking or think you have.

Yes that's a fair & balanced post but doesn't apply to me.
The alternative to private is my local NHS hospital where there is a blanket ban on ELCS at maternal request. So that is completely biased...at least my conversations can be slightly more objective than that...

Arhhh in that case... C&W by any chance? Or is there another London hospital at it?

I think blanket bans on maternal request are a disgrace because when is maternal request not really maternal request but has sound physical or mental health considerations behind it? My request has been deemed as clinical need - but not every hospital would do that.

Where you draw the line is very objective in itself.

Unless it was for medical reasons I wouldn't consider a caesarean.
You may turn out to have really easy births.

This is how I chose:

I went on Google Scholar and read as many studies directly as I could. On the whole studies tend to be better when they distinguish between ELCS and EMCS and also if they include adequate numbers of CS births (look for studies on US and Chinese women as they have high rates of CS and high rates of ELCS).

Then keep in mind that risks vary, some are more likely to affect the baby, some are more likely to affect the mother, but having said that the ranking I found confirmed time and time again in terms of risk was:

Less risky: unproblematic VB
ELCS
EMCS
Most risky: problematic VB

The greatest risks with a problematic VB were neurological damage due to use of forcepts and brain damage due to oxygen starvation (obviously both risks to the baby). By comparison the risks of an ELCS were mainly to the mother (bleeding, infection) and in the main manageable and reversible.

Therefore since one cannot control whether a VB is problematic or unproblematic I chose to have an ELCS. Of course all decisions about risk involve a personal and subjective element in the assessment of risks and benefits.

Beware of 'benefit of hindsight' thinking - it doesn't help. ELCS has some risks, in some cases these risks will actualise, this does not make the original decision unjustified as such because all birthing methods have some risks and in some cases these risks will actualise. Chose an ELCS if you think this is the best method for you, not in the hopes of avoiding all risks associated with all birthing methods.

I've said on other threads, I don't understand this idea of 'maternal request' being an invalid ground. Ok, so there is a tiny, tiny number of women who might want sections for seemingly fairly frivolous reasons ("I want to schedule delivery so that it falls out of season and my husband doesn't have to choose between a match and me", etc). But every other 'maternal request' is surely a mother who believes that she has either a psychological or physical medical reason for thinking it is the best choice for her. In which case why on earth shouldn't it be listened to (even if not necessarily agreed to without further discussion and exploration of those resaons).

Totally agree Penguin, maternal request should be considered (and I think NICE guidelines support that). But yes, my local hospitals including C&W have a blanket ban now.
Agree with the hierarchy/ranking Booboo. And as the first one can not be guaranteed, it stands to reason that the most reliable and safest delivery method is an ELCS.
I know that any major abdominal surgery carries risks but to me they are more acceptable than the risks of a problematic VB.

This is a very unpopular viewpoint on MN but I had two elective sections. I was signed off for driving in three weeks for each of them and could have driven earlier. I had no trouble caring for the baby each time and my toddler was only 18 months old when I had section two. I think like anything it depends on the individual circumstances and I'd have no qualms at all about recommending sections. I know someone else who had a dreadful experience with her second section and other people who had major issues with vaginal births.

If you are likely to feel more like you want a water birth, an elective section probably isn't for you. But an elective section with a obgyn who you know and trust can be a lovely experience. I had my music on and there was a lot of love and laughter in the room. I had skin to skin in theatre and lovely cuddles with the baby the whole time. Photos were allowed in theatre so I've got pics of both of them coming out and I will never forget what a lovely positive experience it was.