Elective C-section: yes or no?

[Gennz]

So I have the option of choosing a ELCS. I'm only 8 weeks so I have a long time to decide! This is my first child. I would really liek to hear your experiences of ELCS vs natural birth.

As I see it, the options from best to worst are:

1. Straightforward natural delivery, no complications;
2. Elective C section;
3. Complicated natural birth resulting in emergency C section;
4. Complicated natural birth resulting in other intervention for delivery.

(Numbers 3 & 4 may be interchangeable, this is a guess). The problem with weighing up the stats is that all we know is that 25% of births end in a C-section, and that a straightforward natural delivery is the preferable option.

However, we don't know:
(a) of the 25% of C sections, how many are emergencies and how many are elective. I think this is important because electives are vastly preferable to emergencies. With emergencies, my guess is that most of the damage and the recovery time results from the unsuccessful effort to push the baby out before the call is made to go for a EMCS, not the actual CS operation. Given elective C-sections are not widely available, my guess is that most of the 25% of birth resulting in CS are emergency CS.

(b) of natural births, how many were really natural & straightforward (textbook labour, delivery with minimal damage & no interventions) vs how many were complicated i.e. required forceps or worse e.g. sustained damage leading to surgery. (I'm assuming by the time you require forceps, you have had a long and painful labour?)

Because there are no stats available, I thought of all my friends who have given birth and collated their various stats. The outcomes from 18 births were:

• 6 straightforward, no complications
• 5 natural birth requiring interventions or surgery (meaning they were v long & painful and/or there was damage sustained)
• 7 c-sections (EMCS & ELCS)

The highly unscientific anecdotal evidence, then, suggests that chance of straightforward delivery with no intervention and not resulting in emergency C-section is 33%. Bear in mind that, even of the 6 births representing the 33% stat, I have no idea about the state of their bits after birth! They could be irretrievably altered or damaged for all I know.

Do I want to take my chances on 33% uncomplicated birth, or would it be better to go straight for the next-best option of elective C-section which presents more of a "known" risk. My biggest fear, even bigger than surgery (which I'm not really scared of, have had quite a few surgeries in my time so it holds no terrors for me) is lasting damage downstairs, resulting in problems with sex or with bladder. C-section would seem to remove this risk. I also like the idea that a CS "cleans you out" and reduces the lochia time.

However I would like 2 or maybe 3 kids so I know choosing a C section isn't ideal from this perspective.

(No doubt I am totally overthinking this. My job involves a lot of trying to mitigate risk (& controlling outcomes which I gather can be a bit futile when it comes to childbirth & parenting!!))

Yes I agree tak1ing but it's helpful to hear of other's experiences. My ob is happy to carry out an ELCS and doesn't think (at this early stage) there are any risks beyond the norm.

Gennz yes, she is my first. I'm a healthcare professional so have unfortunately seen a lot of complicated deliveries.
A lot of doctors & doctors wives have elective CS...
I agree with you a lovely normal VB is the best but we can't plan these things. Shoulder dystocia, tears, instrumental deliveries can cause pelvic floor trauma which can cause psychological distress for years. Maybe I'm just a control freak!!

Thanks Armadale!

That was my attitude too, until I realised that if I aimed for option #1 (straightforward natural birth) and failed, I would miss out on option #2 (ELCS) and jump straight down to 3 or 4.

I kind of feel like I'd rather have the silver medal (ECLS) in the bag than aim for gold (straightforward natural birth) but end up with the booby prize (emergency CS)!

I'm def a control freak too P!!

I hear that ^^ trotted out all the time, does anyone have the research to back it up? Where I work all of pur obstetricians are more than aware how big an op a c/s is and wouldn't/haven't had one other than for obvious medical indications.

There are stats available from the 1950s for VB comparing mortality of both mother and baby prior to the NHS provision of midwifery and after. I can't remember the exact figures, but do know that with an experienced midwife VB has very low mortality rates for both mother and baby.

My DD was breech until 37 weeks so I seriously considered a c-section I did all the research. VB for breech carries a 2% chance of infant mortality and c-section carries 1% chance of mortality for the infant. Interestingly maternal mortality was less with VB than c-section.
Ultimately my DD turned at 37.5 weeks and I had VB. My story is not a good one, but protocols have changed at the hospital as a result of what happened.

I do know what you mean....the thought has occurred to me too, to be honest.

I had a late loss in my first PG and afterwards the MW's lied their way through the investigation to protect their arses, and insinuated that I was too grief stricken to remember truth from reality , so the thought of being at their mercy by having a natural birth is not something I relish either and I'd much rather be having a doc watching me than a MW....

However, realistically there are no family nearby to help me, Dh works long hours and won't be able to take more than a few days off and so I think I might struggle after a CS, so think I'd probably better try for the natural option as a first port of call. I think if I felt I had more help to hand that would not be my decision, though.

Deep I think for me, the advice that you're giving was unhelpful. Mainly because I wanted to have an active birth with no interventions, but it was never going to be possible for me. However, so many people had stressed the importance of labouring on that I resisted all kinds of pain relief and intervention, lengthening my labour by at least a day. I never felt DD change position once during my pregnancy and it turned out she was well and truly wedged. I had almost 18 hours of active labour (48 hours after waters had broke and no sleep during that time) before accepting any pain relief because I wanted that active birth.

The pushing stage was 5 hours before I was whisked away for forceps and if that failed, c section. For some people, an active labour will make sod all difference.

During that time (about 48 hours of labour) I couldn't drink without vomitting and I was severely dehydrated, only blood was passing through my catheter and many doctors were arriving very concerned about damage to my kidneys. Continuing to try for an active labour would have damaged me and my DD significantly.

sorry that last post was to Gennz,

Have found it, only London obstetricians surveyed and only 17% in total would choose ELCS.

OP do what is right for you, personally I don't understand why anyone would opt for a c/s unless it was medically indicated but each to their own.

Oh god Armadale I am so sorry, that is awful - hope everything is going smoothly for you this time.

Lonecat I am not super worried about mortality - I'm pretty sure I will be okay. It's perinatal injuries I am more worried about.

christ Chase you sound like a trooper!!!!

Ive had 3 vb and 2 cs, id opt for vb any day even though I experianced perinatal injury, bloodloss etc etc with the first.

My second cs, which should have been straight forward wasnt due to bleeding during surgery and I had problems with the scar healing second time around too so wouldnt fancy having a thrid section

I've had a 10lb baby narurally OP and a 5lbs baby by elcs. I do realise my story might not count as I guess I'm one of the unlucky ones.

My vaginal birth resulted in a 4tg degree tear, major damage to my cervix meaning I had to have it stitched in my next pregnancy, I needed emergency surgery after my ds was born and didn't see him for 12 hours I also lost so much blood they ran out of blood at the hospital and had to send out for more....

But 5 days later I was up about and shopping with no pain whatsoever.

My second baby I had no choice but to have an elcs, unfortunately my uteral artery was severed (not uncommon) which basically mean within 2mins of this happening and the doctor trying to repair it I was losing consciousness, had an un recordable blood pressure and heart rate of 180. My 45 minute cesarean took 5 hours though my baby was out within the hour. I was so genuinely scared I was going to die.

I don't know if it was because I was 'open' for so long but My recovery was horrendous I was literally unable to move for 2 weeks. Theres nothing more frustrating than wanting to be up doing things and literally unable to move due to the pain. I'd take having a 10lb baby with no pain relief anyday over the pain of the c section.
I also got an infection (very common ) which led to a secondary post partum haemmorage and re admission without my baby 2 weeks post partum.

I genuinely don't think c section is the easiest option and feel like Slapping any idiot who tells me I was too posh to push or that its easier than natural delivery without ever having one.

As I say though OP I was probably the exception rather than the rule, neither is without risk.

Just remember even if all goes to plan you are likely to bleed more with A c section so Might be a bit anaemic afterwards.

Congratulations and good luck

yikes mockingjay that sounds terrifying. Hope you're ok now,

yeah My dd is 4 months old now i'm fine now, though unless someone invents teleportation I don't think I'll have another

I don't blame you!!! Was the ELCS the result of the tearing first birth?

I do think I'm the exception though I just wanted to tell you my story as everyone told me they were up and about within a week after cs I felt like Such a wimp and failure because I wasn't then I spoke to real life people who'd had a c section and they were ill for the first few weeks too..

Not everyone has the same risk of having a complicated or damaging birth.

If you are young, fit and healthy, not obese, no medical conditions, good hip size etc then your chances of a good birth are much higher.

But if you are 40+, obese, have hbp, diabetes etc then you are fighting the odds.

If you are low risk the least risky option for you, baby and future babies is a natural birth.

Gennz perinatal injuries are a risk of being pregnant and giving birth regardless of how you do it is risky. It comes down to the risks you can live with.

sorry x post yeah I needed c section due to birth injuries from my first birth... I just think i'm not built for having babies

Yes I agree lonecat - that's what I'm trying to figure out...

I should add I'm only 5foot and size 4 shoe not sure what shoes size has to do with it but apparently that caused issues I'm healthy bmi

That sounds awful jay, my elcs ended up being 2.5 hours due to bleeding and that was bad enough (the spinal didnt work properly)

Much rather the vb of 11lb 2 ds1.

Thats the thing though, vb or elcs you can never be sure what experience you will have.

Gennz: I did similar research when I was pregnant (I was concerned as my mother had very difficult labours). Try to find some hard figures for your chosen hospital if you can, I did and it helped me decide that I was far happier having a ELCS.

I cant remember the exact figures now but significantly less than 50% of births occurred without any intervention (ie forceps, ventouse, EMCS) at my hospital. This is despite its maternity and neo natal wards being considered some of the best in the country. Statistically that just wasnt something I was comfortable with.

The ELCS was calm and I felt safe and reassured throughout. I had skin to skin contact within a couple of minutes of dd being born. Didnt have any problems breastfeeding (partly because I had lots of help with that from midwives during my 48 hour hospital stay). I could get up and have a shower unaided the next day. Had no problems picking up dd or climbing stairs when I got home. A week later I was able to walk in the park.

In my NCT group 3 out of 8 had intervention free births which aligns with the hospital stats. Two of my close friends were due at the same time as me, at the same hospital. They both had horrendous births (in their words) and lengthy recovery times.

Get as much specific info as you can, as others have said hard facts are better than anecdotes ideally. I asked very specific questions of the obstetricians and they were very helpful. You could even make a Freedom of Information Act request for hospital stats if you had to.
Theres nothing wrong with wanting to be informed and theres nothing wrong with wanting an ELCS. Dont let anyone make you feel there is.