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!!))

I don't know anyone who has had difficulty with breastfeeding because of a CS. I do however know several people who had difficulty bf because they had no MW or HV support at home (and they were home within 24 hours of a VB). Unless they were able to travel to a bf clinic (most weren't up to it) there was no support available.

In my NCT group, those of us who had ELCS/EMCS benefited from MW support in establishing breastfeeding during our 48 hours in hospital. This included a specialist MW who came to see each of us (more than once a day) specifically to help us with establishing a latch.

Because our blood pressure had to be checked hourly, a MW was frequently there and would hand baby over if need be (I kept dd in bed with me) and help with anything we asked about, including bf.

I don't think I would have found bf as easy as I did without that initial support.

The 'at home' support available consisted of a 5 min visit by a HV and MW to fill in some forms and give baby a quick once over. My MW didn't even visit me at home until 10 days after birth!

I think it's unlikely we'll ever discover fully some of the more subtle or less obvious long term impact of side-stepping the birth process, because research tends only to focus on fairly short term clinical outcomes. Some of the new research into gut flora at birth is very interesting, particularly as they are now connecting a whole host of health problems, including mental health difficulties, with gut microbes. here

I think about things like this a lot. There have been recent questions raised about the use of syntocinon in labour in relation to autistic spectrum disorders, which now apparently affect 1 in 98 children in the US. I have a son with autism and I had an augmented labour - I sometimes wonder if that might have been a factor but I don't suppose I'll ever know.

Massively disrupting to normal hormonal physiology of the birth and postnatal period in the cavalier way we do - whether it's in the case of medically managed vaginal births or planned c/s - well, I do wonder whether we really fully understand what we're doing.

Hi Op. I had excellent experiences of CS. I had one EMCS and one ELCS.

My EMCS sounds traumatic - DD was 12 overdue, went in to be induced, I was keen for low intervention, natural water birth but during routine monitoring they couldnt find her heartbeat, resulting in an immediate category 1 EMCS under GA and they didnt quite wait until the anaesthetic had fully taken before scapal hit skin (I moved when it did), and they also had to use forceps to get her out because she was so wedged, she was born in less than 30 seconds from scalpal to skin, and covered in meconium. I am also morbidly obese which increases all risks.

Despite this, I recall the experience really positively. I was well looked after, recovered extremely well, no infection, was up after less than 24 hours, BF without problems (although she had to wait around 3 hours for the op to end, me to wake up and be steady enough to hold her), no issues with scar. Waited 6 weeks to drive but because I didnt need to, was up and about and well, had excellent after care, and was given chance to speak to anaesthetist 3 months later in case of any resulting issues from the whole experience.

When pg with DS, I decided on ELCS for various reasons but really because the consultant made it clear that there were no guarantees that I could have what you describe as gold/option 1, and that in his opinion, it was less likely than the average % chances for me personally. This was totally the tipping point for me. The (known) risks of ELCS were preferrable to me than the unknown outcome of trying for a VBAC.

It was a good choice for me as DS was also similarly wedged and required forceps to be brought out and the OB confirmed a VB would have been extremely unlikely. However, while the atmosphere was v relaxed in theatre (a massive difference to my first CS), I was actually quite scared and shook throughout the operation. This surprised me a bit. I also said immediately afterwards that I didn't want to go through that again.

Recovery was even better with the ELCS - I felt like myself throughout (when coming round from the GA I had been a little woozy), was up less than 12 hours later and discharged under 24 hours from the op. I was also able to lift my toddler within 48 hours and felt absolutely fine after about a week. Also BF DS with no problems.

Good luck with your pregnancy and the decision.

Doctors are more likely to opt for a elcs than the general population.

Midwives are much more likely to opt for a home birth, or birth away from obstetric settings.

And it's midwives who are involved in caring for women from across the risk spectrum as part of their day to day work. They see a representative spectrum, and on the basis of this are less likely to chose a medically managed birth.

Good luck with your pregnancy and making your choices.

I only have positive experience of my own Elcs and the opinion of some friends who have also elected to deliver their dc this way. We all had a good experience I guess.

I feel incredibly lucky that the birth of my dd was such a peaceful and great experience.

I think you are going to leave no stone unturned on collating all the information on making your choice....
The right choice for you. Take care.

Thanks Zamboni

I don't know if it's different in the UK mini but here midwives do not see a representative spectrum of births. They are the experts in normal deliveries. If there are complications during pregnancy, care is transferred to an obstetrician. If there are complications in labour, care is passed to an obstetrician.

I guess the difference can be summed up as to whether you believe that childbirth is inherent safe or inherently risky. Without freaking out, I believe the latter, hence the choices for care that I have made (and luckily enough which I can afford. I don't think birth choices should be the preserve of those well-off enough to pay for them, but that's a whole other thread.)

You don't have a section because you aren't committed to a natural birth!!!! That is an idiocy of the first order. Many many women choose home births/midwife led units etc but still end up with a section. Sure there are trigger-happy obstetricians, but if your labour is going badly you'll end up under their responsibility regardless. I realise you haven't done this before, but it seems like you have this baseline assumption that labour outcomes are in women's control, and that if it doesn't go to plan it is because they don't try hard enough.
No-one chooses a high a intervention birth.

For the record, I've spent 5 years breastfeeding so far, and keeping going through shredded nipples, repeated mastitis and a breast abcess has taken more grit and determination than anything else I've ever done. Section didn't make things noticeably more difficult this time round, though the tongue tie did!

Yes 1scoop I am like a dog with a bone!! Thanks for your response.

No zoe I absolutely don't think this: you have this baseline assumption that labour outcomes are in a women's control

Have absolutely no idea how you've got that idea, basically every post I have made has been about how I am thinking about an ELCS because I know you can't control labour outcomes

And as for no one choose a high intervention birth well I am very tempted to! (Assuming you include ELCS in the high intervention category)

Actually as per Million's post, I also found my breast-feeding benefited from staying in hospital post-EMCS. They had nurses and bf specialists come around to check us and pass baby over and I really couldn't do anything those first few days EXCEPT sleep and breastfeed. I didn't enjoy being in hospital that long, was climbing the walls by the end of it, but I do have friends who struggled to get feeding started because their stay was so straightforward and short.

Gennz your BF/CS comment is so far off the mark it's frightening.

Good luck with your pregnancy, birth and beyond. I was going to contribute to the conversation but I won't.

Really, what's frightening about it?

My thoughts re CS + BF partly arose after reading this study:

www.ncbi.nlm.nih.gov/pubmed/22456657

It notes that CS delivery seems to be associated with lower BF rates, but in the conclusions states "if [emphasis added] breastfeeding is initiated, mode of delivery has no apparent effect on the number of mothers breastfeeding at 6 months."

So it made me wonder why some women who deliver via CS don't or can't initiate BF-ing. The reasons that occurred to me were that (a) medical complications resulting in a CS could also prevent initiation of BF-ing and (b) people who steer clear of birthing centres/midwife-led care are statistically more likely to have a CS; conversely people who birth in birth centres are probably (massive guess) v committed to BF-ing. Which should not suggest that women who labour differently others aren't.

Another massively relevant point is delivery pre-39 weeks, often happens in second round CS', and obviously clearly affects BFing.

My point is that it's not the simple fact of the CS, it's various circumstances around it that mitigate against BF-ing.

Where does CS with complications come on your list?

Seriously - from the way you are analysing this it sounds like you would be best going for an ELCS.

Yes you are probably right Bunny I have a long time to mull over it I have never been very good at leaving anything to chance (parenthood should knock that on the head pretty fast)

CS complications would obviously suck! I would put it at option 4 with EMCS. I do feel a lot more confident that the risk of complications with ELCS is v low though.

This is anecdata, but most of the people I know who've struggled to establish bf and ultimately ended up ff have had quite severe pph (2 litres or more) and transfusions. That's from across natural, elcs and emcs deliveries. Blood loss is a risk, however you deliver.

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.

I think there could be something in this, in the sense that someone choosing to have an ELCS might be more inclined to see things in terms of balancing the needs of mother and child rather than feel as compelled to breastfeed at all costs because of pressure to do so (afterall they may already have resisted strong pressure to have a vb). Its a theory that makes sense in principle, but I don't think there is any evidence to back this up at present.

I don't think thats true for every woman who has an ELCS by any means though (especially since many ELCS are for medical reasons and these women may not have any element of choice in the matter) and I think there are a lot of women having an ELCS who think breastfeeding is extremely important - in some cases, more important than women who have a vb for a whole string of complex reasons that would take too long to go into here.

I think that data does need to be split into EMCS and ELCS including reasons for them. I also think that data for both VBs and CSs should reflect whether women intended to breastfeed prior to giving birth too as this may show different patterns as well. However despite recommendations to standardise, categorise and record nationally reasons for ELCS by the government over ten years ago, this has never been done, so we have no way of really studying the relationship between CSs and breastfeeding in a way that gives us the information that we really need to fully analysis that information.

So I do agree with Gennz, in the sense, that the current research has huge gaps which are extremely important to our understanding of whether various choices, psychical reasons or access to support are affecting some groups of women more than others. By only looking at method of delivery you are missing enormous parts of the picture.

I still think that we are at a point, where we are making huge assumptions and are being influenced by preconceived ideas rather than truly understanding the relationship between CS and breastfeeding.

Your use if the word 'type' nobody is a 'type' when it comes to giving birth. Everyone has a path and a story, you don't know until you come through it what will happen.

My 32 weeker and 38 weeker were both cs and bf, although I didn't bf the 32 weeker for long he had bm for 3 months.

Personally I find that sentence about people who have sections choosing not to BF deeply offensive.

It makes out that an ELCS is indicative of a selfish mother who puts her own needs above that of her child.

Considering that you started a balanced and factual thread, Gennz, I find your more recent posts quite goady and provocative. So I will not contribute to this discussion any more.

Gennz
Any closer to making a decision or more confused than ever??

chances
I don't think she means to be offensive at all, these are just sensitive issues for some people

tak1ngchances Wed 23-Apr-14 11:58:47
Personally I find that sentence about people who have sections choosing not to BF deeply offensive.

It makes out that an ELCS is indicative of a selfish mother who puts her own needs above that of her child.

Thats only because there is a cultural background about breastfeeding and indeed choosing an ELCS being associated with selfishness within our society. The statement itself does not necessarily suggest that.

A lot of women who have an ELCS - including those who don't actively choose one - do so because they ultimately end up feeling that on balance the needs of the mother and the baby need to be balanced as they are closely linked to the other rather the the alternative stance that the needs of the baby must come first at all costs. The reality being that this mentality neglects the idea that if the mother suffers or struggles in someway the baby won't necessarily get the best start anyway.

I would actually encourage you to think about how and why this idea of selfishness creeps in, instead of this idea that the needs of both need to be balanced and taken into consideration.

Its not clear cut by any means, but I do think its important to acknowledge that the idea of selfishness is one that sometimes seems to be ingrained in our psyche without us being as conscious of it as we might like to admit.

For the record: I also think that there are cases where many women might choose to have an ELCS to put their baby first (as they would have preferred the experience of a VB and struggle with this, despite it ultimately being a choice they make) and in turn also think that breastfeeding is the best thing they could do, for similar reasons and may suffer trying to do so.

Having a C section and choosing to breastfeed or not are similar things in my opinion.

Basically with both of them you are rejecting the status quo and making your own mind up as to what is best for you. With both decisions come a great deal of research and weighing up pros and cons etc.

Unfortunately within the UK at least there is a massive push towards breastfeeding and natural birth, with no real weight of evidence behind them, bar its better for you/ baby.

Daring to stand up and say, actually I want to take control of my body and listen to it and work out whats best for me is often seen as controversial and wrong in the eyes of a society who have been told what to think by the powerful health system.