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!!))

Well, just to offer a different perspective ... my elective c-section was fab! (DD was breech and turning procedure not possible owing to my wierdly shaped uterus!)

But I live in a country where the health are is really excellent and birth is generally quite medicalised.

I didn't have any lochia/post-op bleeding at all either btw!

Thanks Million - that's really helpful.

I found 2009 stats, which are really interesting. Am going to crunch the data!

I think all births are so different it is impossible to go off the experiences of others.

I have three children, my first was an EMCS, my second and third VBAC.

I think my EMCS was particularly bad as it had to be done so quickly, so not much care taken, which obviously means an ELCS would likely be much better.

However when I was given the choice with my second I jumped at the VBAC as I had such a hideous experience with my first birth.

I personally found the vaginal birth so much easier, and I no way came out unscathed, in fact (too much information) I still have a bit of a kink down there where things were stitched. But I found the whole experience so much better that when I was given the choice with my third I again opted for VB, the third time it was a breeze!

Oh slack I have a weird uterus too! I've always suspected it but on the scan today I learnt it was "anteflexed" (or something).

Gennz in my humble opinion as long as your pregnancy is going well with no complications both will have a similar risk factor,likewise if you have problems both will have a similar risk factor.

I genuinely think I had problems because my ds was 10lbs and 2foot long when he was born (almost half my height )
I think had I had a c section with him rather than vaginal birth I would have encountered less problems, then I could have had a natural delivery with my girl who was only 5lbs.

If you think a c section is for you then go for it. Just don't expect yourself to be running marathons 5 days later on . Expect a 2 - 4 week recovery time. If you are up and about earlier then thats great. I just personally found it upsetting I was ill for 2 weeks as I expected to bounce back and stupidly felt like a failure for not doing.
Stupid I know those bloody Hormones have a lot to answer for

Almost half your height !!!!

Don't worry there is absolutely no chance I will be running marathons ever after the baby arrives.

I really can see both sides.

I'm a midwife so I see a lot of straight forward, uncomplicated vaginal births.

I do see some vaginal births where its not so straight forward. But I also see LSCSs which have problems inc El LSCS.

My Em Lscs was really good. Wasn't the scary thing you might imagine it to be. To be honest its very, very few emergency sections which are crash life or death mad rush sections. So for the majority of them I don't think they're that different to an el lscs. But that's my take on it.

If you're in a position to choose I don't think there's a right or a wrong answer. Everyones' perception of risk is different and some things which would be considered a risk or a problem by some won't bother others.

Gennz - an 'ante verted' uterus is normal.

Sorry Op - delay in responding to your question. The only person with any ongoing issues has some mild nerve damage in her legs which she believes is associated with the spinal anaesthetic used for forceps (same as they'd use for Csection?)

Yes sorry I've got that wrong. I think it's retroflexed? Definitely has flex in there somewhere and is wonky!

Thanks baking

Really wish I was more of a go with the flow kind of person sometimes! I know I'm going to obsess about this for the next 32 weeks. ..

I've had two c sections, one emergency after a long labour and one elective. Recovery after the EMCS was horrible, long and painful and I do think that was in part due to the surgery being carried out on a uterus that had been contracting for days, I was exhausted and drained.

By comparison my elective was a walk in the park, I was rested going in, calmer and more prepared (still scary though)

I would say call it closer to the time when you can gage from your pregnancy how likely it is you might struggle. My first born was huge for dates and if I knew then what I know now that would have been enough for me to ask for an elective.

All that said, I have a scar and an overhang, weakness in my core and some numb areas on my tummy 18 months after my last birth. It was weeks before I could assume day to day tasks and that was a real problem once I already had a toddler. In contrast my friends who managed to deliver vaginally recovered much faster and don't have the ongoing core issues that I do.

(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.

You can easily look up the break down of this by hospital.

Just a couple of other points. When you look at generalised stats they don't give you a clear picture, because they are not spread evenly throughout the population.

You are far better to look at your individual risk factors rather than generalised stats; you might find that actually instead of a "33% chance of an uncomplicated birth" you chances are rather better than that.

Comparing yourself with people you know, is extremely unhelpful as it does not reflect YOUR chances.

For example CS are more likely if you are over 35. Likewise for instrumental deliveries. If you are in your mid twenties, they are considerably less. Likewise if you have underlying health conditions then you are much more likely to end up with complications. Do you know the full medical history of those people you know? The reasons for their CS, either ELCS or EMCS? Or for their instrumental deliveries. I sincerely doubt it. So what you are effectively doing is comparing a lot of women without considering whether you are high or low risk and considering whether they are low or high risk. Its like comparing apples and oranges - its not a fair comparison. You are already speculating about the state of their 'bits', rather than knowing from them telling you.

I am concerned that your reasoning and sources of information for making this decision are, at best flawed, at worse really ill informed and not necessarily in your best interests. There is nothing wrong with having an ELCS without a medical indication in my book, but it MUST be a properly informed choice not one based primarily on anecdotal information. At present I honestly don't think you are informed based on what you have said.

You've also not given any thought to where you give birth, which does seem to have an impact on outcomes for mothers. Counterintuitively CLU fair worse than MLU for low risk women. And whilst homebirths fair slightly worse for first time births (for babies) they are better for subsequent births.

Finally, given you are considering more than one child, you need to seriously consider the risk factors of this. First births are statistically very different to subsequent births in terms of comparing planned ELCS and planned VBs. The MAJOR criticism of information in the current NICE guidelines, is that this information is purely for first time mothers, and this effectively makes ELCS look much less risky than planned VBs. However, for subsequent children, planned VBs are usually much more favourable as risk decreases whereas the chance of complications for ELCS increases. By choosing an ELCS on the basis of wanting 2 or 3 children, you are not necessarily decreasing your risks, just choosing different risks.

You also said initially that you had a choice between an ELCS or a VB. Have you formally been given this choice by your local hospital or are you considering going private? The reason I ask this, is that although there is a perception that you can 'just choose' to have an ELCS, the reality in the UK can be somewhat different in some places despite the current NICE guidelines and public perception of choice.

I really do encourage you to find a lot more out about this based on your personal circumstances and potentially to explore things that seem to reduce your risks if you choose the VB route before making a final decision.

Like I say, nothing wrong with wanting an ELCS for the reasons you state, just make sure you are properly informed first though.

I've had one vb resulting in 3rd degree tear and one elcs 7 days ago. The section was fantastic.

I was really looking forward to a natural birth but instead ended up with failed induction and a EMCS - however recovery was fairly straightforward and I had little pain (lochia lasted about 8 weeks though!).

Next time I will probably have ELCS as I potentially have a condition that could make a natural birth high risk.

However, if I was still at the beginning of all this I would still go for a natural birth first time around. I know it's illogical but I am very jealous of women who were able to do it, and still feel like a bit of a failure - I know I'm not, but that's what the heart says. Bah!

You have to weigh up how you feel and yourself.

For instance would you feel more OK with stiches in stomach or down below?

If something went wrong, in either case where would you feel more safe? In mid labour with a baby stuck or on an operating theatre?

I had both and again there is no contest ELC all the way.

Harking back to Easters comment re her natural birth:

was able to feed my baby immediately and attend to them, myself and visitors

I had one normal supposedly fantastic first natural delivery and one ELC.
The shock and pain and trauma to my mind of normal labour left me traumatised for many years. I BF for only three months and that was intermittently with FF. I had issues with bonding too, and was in such pain below inspite of no stitches or anything, it dragged me down...and also I was so tired, after being awake for three days....

Compare that to, the ELC, I knew the date, had plenty of rest and sleep before the baby arrived. I had a quibble in the theatre but it was quick, I just felt safe, relaxed ( almost) taken care of, in good hands! They could see everything going on....everything as transparent as it could be ( for instance my first was back to back and no one knew)...I was able to BF and am still going over a year later. I felt I was coming at the whole thing with a totally different mind set because I was not mentally and physically traumatised!

I had issues with the possibility of being stitched below and so on, I much preferred having wound where I could see it and where it didn't affect me going to the loo. I had plenty of pain relief where I didn't get the epidural I asked for first time round and so on..

As for visitors, we had too many first time, and whilst I was able to tend to them looking back it was a huge mistake! Second time round was a few visitors and that was it. No problems, tending to visitors was not high on my list of priorities.

Know yourself, how do you react to things, if something goes wrong where would you rather be....you are physically stuck after section for a few days after....but you can be with normal too of course, where would you rather have pain...below or in stomach...and so on.

I am lucky though, I do not feel any pride or accomplishment in my body birthing my first so well, I was told it was rare to pass one so quickly, I have great birthing hips and was very lucky.

I do not see that as any personal reflection on me, Mydarling in any way at all, its just my body....I didn't make it, I didn't create those hips, why should I be proud of them?

Its a process, like pucking, having to pass a kidney stone, having appendistus...nothing to miss out on or feel proud of - or feel a failure because of.

There have been some really detailed responses already, but just to pick up on the lochia point.

Firstly, lochia really isn't that bad for most women. I wouldn't factor it into my decision making about birth at all.

Secondly, you have a wound inside you the size of a dinner plate where the placenta has come away. That is the case however you have delivered. Yes, they can 'clean you out' a little in a section, but the degree of lochia varies far more woman to woman than by delivery method.

My first section was an emcs crash section under ga due to cord prolapse but even though I had a bigger cut (almost hip to hip) the recover time was a lot quicker than my elcs

And my 2nd vb was good too, really quick no stitches compared to my first vb

Just to pick up the op's belief that cs can reduce the chance of bladder injury - bitter experience tells me the opposite is true. I'm lucky to still have any function in mine after a botched cs. I was catheterised for weeks and recovery has been horrendous. One year on I'm still very much feeling the effects and probably always will.

My understanding is that the risk of bladder injury is also much higher for repeat sections.

I think you might find it useful getting in touch with a doula.

One popular misconception I spotted was about maternal mortality rates in the past, what people generally don't realise is that it was only when birth became the business of men that mortality rates became as high as they did. The biggest cause of childbed fever was bad hygiene from doctors who didn't wash their hands after handling dead bodies. It does still happen today but whoever delivers your baby there are still antibiotics. The other cause of complications in the past was doctor centered birth - delivering flat on the back so the doctor can see what's happening. There are journals of midwives hundreds of years old where they describe things like safely delivering a baby with placenta previa.

There are ways to reduce the chances of things going wrong, a doula and NCT classes for example can help you to find out what they are. 25% conversion rate is actually high and by educating yourself you can bring that figure down. Nothing is ever guaranteed though, I could tell you about the most horrific caesareans I've heard over time where the baby has died from injuries or left with severe damage or where the mother has been injured. Same for vaginal birth. I find the best thing in life is not to avoid all potential risks but to minimise the chances. You wear a seatbelt in a car and choose one with good safety features, you don't avoid driving altogether.

It's been over 5 years since my last CS and I still suffer because of it. If you have PGP it can make recovery harder because the muscles that pull it all back together are the ones they go through (I still suffer and walk on crutches), I still have very little feeling in the area above my scar, I need to get a tummy tuck because there's no way of losing what I have been left with (which is quite common and probably not as bad as most as I only have pretermers).

I missed the lochia comment I was supposed to get less lochia??? Why did no one tell me?

Where on earth did you get that idea? Maybe less chance of retained placenta (but again it can be managed and avoided) but I've had 5 babies and bled for about a month with all of them.

As for your pelvic floor, it's pregnancy that does that not birth.

As for your pelvic floor, it's pregnancy that does that not birth.

My PF was far far better after section than labour. In fact everything down there including lower back was all far more normal than after labour.