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!!))

Gennz that is do interesting about the lack of personal injury law! It's one of the downsides of the US (the adverts are terrible! They make better call Saul look classy!).

Being totally honest, I'd opt for a elective c-section over a vaginal birth. I had a VB and was home the same day, recovery was extremely fast and it was an overall pleasant experience.

That said, I've been left with a minor prolapse and it doesn't take much searching to find the hundreds of posts where women experience the same and much, much worse. The possible permanent changes involving your vagina, pelvic floor and the effect on your sexual life - It's something many women are afraid to talk about but in my opinion it is a huge deal and has a massive impact on your quality of life.

C-sections don't rule out the possibility of damage, but are about as close as you can come to saving yourself from a lifetime of repairs and misery. I personally would never have a vaginal birth again.

Thanks MsBumble, that's really what I'm afraid of. Everyone I've spoken to has talked about VB and said "it was fine, recovery was fast etc etc" and then say almost as an after thought "of course it will never be the same down there!" I don't know that I'm happy to accept that... I'd much rather a small scar on the lower abdomen than an impaired pelvic floor or vagina.

Dc1 - ELCS (suspected macrosomia) mother and baby fine. Driving after 4 weeks.

Dc2- vbac1 minutes away from emcs (back to back labour, failure to progress, but pushed him out practically en route to theatre - he turned as he emerged) baby fine, me not ready for discharge for 5 days whilst they repaired my undercarriage

Dc3 - vbac2 (apparently no clinical reason for cs, but had to labour in surgical suite in case intervention required) mum fine (although did have post partum infection which needed treatment) baby brain damaged for life.

I'd go for ELCS. My births were in three different countries btw, not NZ though.

It's worth noting that dc1 ELCS was in Germany. They looked at the risks, discussed appropriate management, and decided that ELCS would be safer for both me and the baby.

I wanted to vbac for dc2. Dc3 was my only NHS baby. Nuff said.

2 natural births, one c section. A few weeks ago I'd have said I'd choose a section over birth 1 but not 2. Now I am not so sure. I am 9 weeks post section and still not fully recovered. Having bad abdo pains as muscles knit together and beginning to suspect some bladder damage from the op. First birth was traumatic but recovery wasn't this slow. No way am I going through any of this again, but if I was and had a choice (I didn't, it was c section or both of us die!), there is no way I'd actively choose a c section.

Also, if you look online you'll certainly find women post both c section and vaginal birth who complain of long term pain. It is pick your poison unfortunately, though chances are you'll be fine whichever you choose.

Hi OP, you think very much like me with regard to the risks!

I have had two CS - one for breech (although I would have chosen ELCS anyway) and another that was supposed to be an ELCS but ended up being an emergency as I went into labour and baby's heartrate started dropping.

No problems establishing breastfeeding - I think that is a myth. Milk may take slightly longer to come in but you also get longer in bed to establish feeding and people give you a break as you've had surgery!

I found the surgery very easy to recover from both times. I was on my feet within 24hrs and walking a mile or so within a week. Slightly harder to manage not lifting the second time as I have a 2yo to look after.

I don't plan to have any more children. I'm not sure if I would plan to have 3 CS, as the surgery does get more risky each time (for you). That's worth thinking about.

I looked at NICE guidance to get an idea of risks. Royal College of Gyn & Obs also commented on some recent research and said a second CS is not materially more/less risky than a VBAC (both carry small risks).

Good luck with whatever you choose.

I've had 3 babies, and 3 ELCSs. Absolutely fine. I was back in the gym after 2 weeks each time. ELCS does not make Breastfeeding harder.

"ELCS does not make Breastfeeding harder."

I'm sorry but it does. If you have a large recently sutured wound across your abdomen holding a wriggly baby across your stomach to breastfeed will hurt. Exploring the positions needed to establish breastfeeding and find a good latch become more difficult if your mobility is restricted.

The initial skin to skin period to allow primary rooting will be compromised by the surgical atmosphere. Antibiotics are given routinely after CS and may make Mum and baby open to thrush organisms. Milk may take longer to come in after a CS than VB.

many women have sucessful breastfeeding relationships after CS, but it is a bit more challenging, and something to be aware of if you intend to breastfeed.

I had a lovely ELCS and I am planning a second one. No complications, bf with no problems (my consultant said that 30% of ELCS may experience problems with bf but they can be overcome).

However I don't think you should decide on anecdotal evidence. If you have a look on Google Scholar or similar databases (e.g. PubMed) you will find plenty of studies that differentiate between ELCS and EMCS risks, especially from countries with high ELCS rates (US 26% and China 45% when I last looked in 2011).

As a summary you will find that the safest method of birth for both mother and bay is VB with no complications but if complications do take place you face the most severe risks for the baby (and quite severe risks for the mother). I like as much control as possible in my life so I accepted the small risks of ELCS to know I would avoid the severe risks of VB with complications.

I'm not convinced that C-sections make breastfeeding harder. I think there's a correlation/causation confusion happening here. I've looked at the studies and yes people who have C-sections are less likely to establish breastfeeding in the delivery suite and are more likely to not breastfeed at all, or breastfeed for a shorter period.

There are a few issues with the studies.

There's no discrete data for EMCS vs ELCS. If you have had a crash EMCS, of course you are less likely to BF in the delivery suite. There could be all sorts of issues with the mother or the baby that need to be resolved before BF takes place.

Also the type of person who ends up with a CS is I'm guessing much more likely to be the type of person who does not place as high a priority on BF.

To say the fact of the CS - in my case potentially a planned ELCS with no risk factors - "makes breastfeeding harder" just isn't logical to me. All the people I know who had CS (yes anecdotal but still persuasive to me) were able to establish BF with no more difficulty than their VB counterparts.

Thanks Booboo Quite agree re the data but I must admit I am finding everyone's experiences helpful for forming a picture as well. How long was your recovery from ELCS? Were there any negative aspects you hadn't anticipated?

"Also the type of person who ends up with a CS is I'm guessing much more likely to be the type of person who does not place as high a priority on BF."

Why do you think that?

I had an ELCS for an underlying medical condition - we knew I'd have to have one before we started ttc. It was brilliant, breastfeeding was great and I loved the whole experience. I recovered a lot quicker than my vb friends and am not worried at all about the second one I will be having later this year.

The breastfeeding point one is interesting though, because while there may be physical reasons why it could be tougher after a cs, the fact you are in hospital for 2 days with midwives to help teach you I think counterbalances that. I left feeling confident unlike some of my friends who were home after only one feed.

Good luck with whatever decision you choose!

Also the type of person who ends up with a CS is I'm guessing much more likely to be the type of person who does not place as high a priority on BF.
What is that supposed to mean??

Booboo - the vast majority of emcs are uncomplicated and would be better described as 'unplanned' rather than 'emergency'.

It's also worth considering that some factors which make emergency c/s more likely - namely obesity and substandard care, also make abdominal surgery vastly more risky, whether planned or unplanned.

There is insufficient evidence that c/s is linked to breastfeeding difficulties.

I felt more in control and relaxed during my vb then I did in my c-section with ds2. Unfortunately the c-section wasn't optional. It took longer to heal and feel ok after a c-section. Despite 2 blood transfusions and surgery under a general anaesthetic after my vb I was walking around our local country fair 6 days later.

Once you've had a baby and been pregnant your body is never quite the same again.

Mini, an emergency section after a trial of labour of some length is going to leave a women in need of a lot more recovery than if she has had either a planned c/s (add to this it is a daytime event so no loss of a night either) or a straightforward VB.

Exhaustion and health level greatly effect your resilience to the relentless demands of a breastfeeding baby.

minifingers- there is no doubt though that breastfeeding after a Cs does require special considerations.

Babies often need some "juggling" to find an establish a good latch, often requiring Mum to be mobile and flexible. This can be hampered considerably by having a CS wound to content with.

Imo if your biggest fear is "lasting damage down there" I think you should book in for elcs.

No one can predict your vaginal birth scenario. It is an unknown scenario.

But if you choose a cs you will reduce the risk of your biggest fear to zero. :)

No my ELCS was truly wonderful.

It was scheduled for 39+3 but my waters broke at 38+3. I never had contractions, went straight into theatre, my DP was allowed in with me (I did insist though!), DD was out within a few minutes of the procedure starting, they checked she was breathing fine and then she was placed on my chest for skin to skin. The rest of the operation went by really fast because I had DD to concentrate on!

My hospital then had a policy of keeping all post-op patients in a recovery room for 2 hours, while DD was whisked off to be checked over by various doctors. I could have skipped that bit if possible, but if there is a medical need I think you need to be a bit patient. DD was waiting for me in the room and we had a go at bf. My milk came in on the second day.

I got up from the bed the day after the CS (on the day one leg was still numb so I couldn't put weight on it), by the day after I could have a shower, and day 3 I went for a little walk. I stayed in hospital for 4 nights and took all the painkillers on offer, then took paracetamol for another week and I can't say I had any pain. I was walking about as normal a week after the op, driving 3 weeks after and riding the horses 7 weeks after, although it's not a race and you have to go with what your body tells you! My scar healed really well and I didn't have problems with constipation.

Mini I was using the standard terms used in the literature, namely ELCS and EMCS, for more information one would need to read each study and see exactly how they classified EMCS. For example, my CS took place a week earlier than planned so may have been logged as EM.

Total guess re CS/BF. My reasoning was that people who are v committed to natural birth are very likely to also be very committed to BF-ing (NOT to suggest that others aren't). And the people who are committed to natural birth are more likely to favour birthing centre/midwife-led/home birth - not more medicalised ob-led births.

Hope that makes sense.

Booboo to be honest that sounds ideal to me!

A close friend of mine is a Physio specialising in internal pelvic area mainly seeing clients following birth....often traumatic.

She opted for an Elcs as have a couple of Friends of ours who are Dr's. Someone mentioned up thread that medical professionals often opt for Elcs....