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- the thing that actually most put me off ELCS is the risk to future pregnancies of placenta praevia- this can cause massive problems which could lead to life limiting disability for future DCs- but this doesn't show up in ELCS risk stats- they only concern ^that^ pregnancy and birth.

Just gonna add this really quick.

Putting your needs first is not being a selfish mother. That goes for birth and whether or not you breastfeed. Look at any relationship advice and they'll tell you that making a relationship exclusively about that person is toxic. You are forming a relationship with your child, and that still applies. If you take care of yourself first, and put yourself first you'll be more relaxed and you won't get burned out. The only thing you NEED to get right with your kid is making sure they know they're loved and safe.

Quite frankly, I hated breastfeeding, and that's alright. My formula fed baby has been in perfect health at every appointment. Happy parents = happy babies. I can promise no one on here will say they had a great time while their parents were stressed out. I was breast fed, still ended up in the hospital as a baby, and had severe allergies to the point of needing shots for 5 years. My formula fed brother has an IQ of 148, and has had no real health issues. How your feeding affects your baby is going to be purely anecdotal evidence, no baby is the same. So do what works for you.

You do what YOU feel is right. My midwife told me this "At the end of the day, no matter how your birth goes the end result will be the same: a happy, healthy baby for you to hold". So don't put so much pressure on yourself.

Good luck with your baby! Remember birth is just one part, then you've got the rest of your life living an emotional roller coaster that I hear doesn't stop when they move out. :)

Bunny you misundertand the list, it's not a list of options with no complications that needs CS with complications adding to it, it's a ranking of the options by likelihood and gravity of risk. So a VB which does not require other interventions (that's what complications means here, no forcepts for example, no delay in the baby being born is another) is the least risky option. That doesn't mean there are no risk, but that the risks are unlikely and minor in severity.

The risks with an ELCS as mainly to the mother and include bleeding and infection of the wound site. The risks to the baby can be injury from the blade making the incision. Of course all these risks are relative to the individual's situation, a baby can be positioned so that there may be little or no risk of injury from the incision.

The greatest risks with a VB with complication are neurological problems for the baby due to the use of forceps and brain damage due to lack of oxygen during delivery. I chose to avoid these risks by having an ELCS and accept the risk of bleeding and infections for myself instead, so I find it very weird that people would think that ELCS is a selfish option on behalf of the mother. Coincidentally I found out after I had given birth that my doctor had been against ELCS until his wife gave birth, of course under the care of another physician, things went horribly wrong, the decision to go to EMCS was taken too late and the baby suffered severe brain damage as a result. His own experiences as a father led him to change his views about the options he offered to his patients.

From what I had read about CS and bf the main problem is that the start of natural labour also stimulates the production of milk and as CS by-passes the start of natural labout the body may have some delay in producing the milk (this is what the 30% statistic referred to). I would imagine that with the really low overall initial bf uptakes and tiny number so of women continuing to bf it must be impossible to see the wood for the trees as to why bf doesn't work out and any role CS might play in this relationship. I would imagine initial difficulties with milk production may be easier to monitor.

Princess it's interesting how people perceive things differently! If my MW had made that comment I would have made an official complaint against her! While I understand the need to keep pregnant women calm about birth since going back and not having to give birth by one method or another is not an option, this patronising attitude of misinformation is frankly insulting. I am pregnant, not stupid, the end result of all pregnancies is not a healthy, happy baby. Sadly some births go wrong and I would rather have all the information at my disposal to make an informed choice about my birth, my health and the health of my baby than have someone pat me on the head and promise me something that cannot possibly be true.

Booboo - are you only having one child?

The risks for a first c/s are mostly with the mother (if it is done at 39 weeks or beyond).

However, you transfer some risks (of abnormal placental implantation in particular) to the baby you carry in the next pregnancy, and even more if you carry on to have another baby after that. here

Genns - midwives in the UK and in all countries where they are employed and called 'midwives' rather than 'obstetric nurses' care for women from across the risk spectrum. They are only usually the lead professionals however, in cases of normal/low risk births.

"No-one chooses a high a intervention birth."

But in choosing to give birth in an obstetric led setting you are choosing to greatly increase your chances of having a complicated birth needing medical input. Doubling it more or less (when compared to giving birth in a low tech, midwife led setting).

"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."

I agree. When you have a planned c/s you disrupt the normal hormonal physiology of pregnancy, birth and the postnatal period in a fairly significant way. Given that lactation is governed by hormonal physiology it stands to reason that there must be some subtle or maybe not so subtle disruption of the process, hopefully mostly compensated for with sensitive and skilled postnatal care.

Mini I have one DD and I am currently pregnant. As far as I know the risks increase significantly by the 4th CS.

The research you quote is from a really older population (1968-89 cohort) who would have had the old style CS (the longitudinal incision) that is associated with a lot more complications and is very rarely used today. Given the change in the type of CS now performed the extrapolation to the 4% stillbirth rate is nothing short of silly - it's astounding how some studies are such poor quality and still see the light of the day.

"But in choosing to give birth in an obstetric led setting you are choosing to greatly increase your chances of having a complicated birth needing medical imput. Doubling it more or less" Now there is statement in need of evidence based medicine if there ever was one. Could you link to the studies that show this please? And also account for how you sort out the chicken and egg effect here, namely that births that are in any way expected to be problematic will be routed to a hospital setting in the first place. To really study this claim you would need a control group of high and medium risk pregnancies taking place in a low-tech midwife led setting - but that is clearly unethical!

But Boo - we know there's a significant increase in abnormal placentation in pregnancies following c/s. Are you saying these risks don't increase the chance of stillbirth and major complications?

I'm not sure when LSCS became the norm, do you? Given that the c/s rate has more than quadrupled in the past 30 years, I suspect that the largest proportion of c/s included in the study would not have been classical incisions.

However, if you have a link to a more recent study looking at outcomes for c/s I'd be interested to read it.

"Now there is statement in need of evidence based medicine if there ever was one. Could you link to the studies that show this please?"

The 2011 Place of Birth Study here here

This study examined outcomes for 65000 women deemed 'low risk' at the start of labour, by planned (not actual) place of birth.

"And also account for how you sort out the chicken and egg effect here, namely that births that are in any way expected to be problematic will be routed to a hospital setting in the first place."

By only including healthy mothers deemed low risk at the start of labour.

"To really study this claim you would need a control group of high and medium risk pregnancies taking place in a low-tech midwife led setting - but that is clearly unethical!"

The study was only looking at outcomes for healthy women (like the OP perhaps?).

Booboostoo - I had a very low risk pregnancy with the baby in perfect health in the right position, good size, full term, no health complications on my part (aside from some high blood pressure). OP made it seem like she has a low risk pregnancy that will allow her to make a choice that could go either way depending on what she feels is best for her individual situation. Obviously you would not be saying that to a woman with a high risk pregnancy or fetal complications. ;)

I had ELCS with twins at 37 weeks, it was a wonderful experience, the recovery was an absolute doddle compared to the 17 operations I have had on my legs and hips. I would do it again in a heartbeat. Babies came out screaming with apgar scores of 9.

Some of my friends who had natural births have some horrible stories, so for me, an ELCS was the right choice.

I had VB 1st time (hell on earth, search for my old threads/posts if you want the facts) 2nd time had a blissful ELCS - recovery was easier, less painful, breastfeeding was established more easily. I fought for my ELCS 2nd time round as my 1st experience taught me that you cannot predict how a VB will go. I saw the choice as:

VB = roll the dice as to how long/short, painful/painless, complicated/ straightforward, damaging/ damage free it will be. You can get hold of some stats - check whether they roll 1st time births into subsequent births. The outcomes for 1st timers are substantially worse than those for subsequent births. You could get lucky. No-one will be able to guarantee that though.

ELCS = I could understand exactly what the birth process was going to be like and had copious statistics to understand the risk/s to me and my baby. Both consultants I saw agreed that CS is the safest mode of delivery for baby as they is almost guaranteed no chance of brain-damage due to oxygen deprivation. There are risks to the baby regarding respitory issues but these are low when delivered at 39 weeks.

Again anectodal but there seems to be a suggestion that having a vaginal birth makes a woman much more orgasmic ( after healing of course).

Almost as if a vaginal birth transforms the vagina and nerves. My sexual satisfaction has skyrocketed after giving birth, and many of my friends have experienced the same- but not those that have had CS.

If this is a result of VB it's not something I would want to have missed!!

Hi everyone

I am really sorry if my musings about people having CS' possibly being the "type" not to BF offended anyone. It was me guessing as to why BF might not be initated after a CS when the studies seem to show that if it is, BFing can be as successful as in other modes if delivery. I'm definitely not trying to be goady, although of course there are some responses that resonate more
with me that others. For the record I would plan to BF for 6 months if possible but I'm not going to beat myself up about it if there are problems. I don't know what it's like in the UK but here the "breast is best" message (which I think is correct) can be aggressively pushed which I'vr noticed can be really upsetting for mothers struggling with BFing.

As for there being a "type" re laboir - if course outcomes can change but I definitely think the type of person you are can affect the labour you have. One of my best friends is a naturopath, v anti traditional medicine, birthed in a pool at a midwife led birthing centre. She would never dream of considering an ELCS or of paying for a private ob. Thesw choices don't determine what birth she might have in the future but they do influence it I think.

mini I think you asked why I would choose an ob when midwife led care is statistially more likely to result in fewer interventions. There are a few reasons - I don't lije how the NZ system is set up so that midwives are financially incentivised not to hand over care - although I am sure most are great it affects my trust in the system; the birthing centre doesn't offer epidurals, andd more worryingly for me, can't deal with complications, so if I did need medical attention i would need to be put in an ambulance and sent to hospital. This for me is an unacceptable risk. And I'm obviously not ant intervention so that's not really a problem for me.

Sorry for typos, stupid phone! !

gennz I have to admit that I find your approach to all this quite amusing.
As others have said birth is only the beginning and for many quite a small part of actually being a parent.

Our lives are transformed when we have children, they become chaotic, previous plans seem unrealistic, having a child will turn your life upside down.
While I admire your fastidious and meticulous approach , don't be surprised if events surrounding the plans for your birth and indeed the bigger challenges of being a mother cause your plans to be chucked out of the window. Good luck with whatever you decide- strict plans are fine as long as they are weakly adhered to.

To be honest deep I find that post a bit patronising. This thread is about birth options - not about parenthood - and trust me I've made no strict plans about how I plan to look after or bring up my children because I realise I haven't done it before and I will learn on the job.

This thread is about whether I should choose an ELCS as it's an option open to me. Why is that amusing? Imagine the if I went on a thread about asking for advice on a homebirth and said "I find this so amuaing, I think you'll find your plans will go out the window when you go into labour and need a hospital!" I think I'd be seen as pretty rude.

Not at all patronising, but when you look back in two years time you may understand my view a litttle more.
Many first time mothers focus on the birth to the exclusion of much else.

How would you know what I am focusing on given this is a thread about ELCS amd my plans about parenting haven't been discussed at all.

Good luck with your birth I hope you find the medical management you are looking for.

My first child was born by emergency Caesarian , awful experience however obviously glad to have a healthy baby. Weeks of recovery, etc.

Second elective Caesarian, brilliant experience, up out of bed after a few hours, home the next day, I even forgot to take any painkillers after I got home. Felt back to normal after 2 weeks.

Obviously just mynexperience

Thanks Twilight Would you have a third?

Thanks deep I'm sure I will.

I think it's a bit unfair to assume parenting styles based on exploring all birth choices. Many health systems are unlike the NHS in terms of choice so women have a different antenatal/birth choice/postnatal culture. Exploring options and seeking advice on mn seems pretty sensible.

As a first timer I was totally focused on the birth and the immediate newborn stage, it's hard not to when you've never done it before! Same as focusing on the perfect buggy/cot/nursery as though the baby gives two hoots about that . It's the same as brand new parents inventing parenthood (of the 'no no my baby does the biggest poos ever' variety) and sleep deprivation.

Third time around I keep forgetting my due date and how far along I am and this bubs will be lucky to get some new vests...

Genz....the planning of my delivery was huge to me ....I understand where you were coming from.
I was pro surgical intervention all the way ....just my choice
Certainly relaxed when it was all booked in.

gennz,

Im really glad i found this thread as i am weighing up the same choices. And this is my second child, so im aware that the birth is only one day - but i still have to make the decision.

For my first i really wanted a natural birth. I went to birth classes ran by a doula, i bought an epi-no and loads of books on calm birth. I thought i was prepared for the pain and i was looking forward to the challenge. I was perhaps guilty of what deepinthewoods indentified as obsessing about the birth and neglecting to mentally prepare for the baby.

Then infound out baby was breech and i tried absolutely everything to get him to turn and avaoid an ELCS.

In the end, the ELCS was a really famtastic experience (i dont live in the UK, i think we might be neighbours). I told the staff i was nervous about needles and they were all kind and reassuring. Everyone in the room was relaxed, friendly and chatty (i went to a public hospital so there were a few juniors and students in the room). The anesthetist took great photos (not that anyone wants to see most of them). Afterwards baby was passed to me quickly and came into recovery where we started bfing.

I stayed for three days and was never really in pain. I was a bit slow for the first couple of weeks but recovered easily enough and have no bladder or scar issues. Actually having a baby that fed every couple of hours and took 40-60 mins to feed was more limiting than the recovery from the ELCS. And the pain of shredded nipples and x2 bouts of mastitis was far, far more painful.

Now i am pregnant again i can choose an ELCS or attempt a VBAC. If i could guarantee myself your option 1 i would go for a VBAC but seeing as my ELCS was such a positive experience i am reluctant to gamble it and end up with option 3 or 4. This time i will be at a different public hospital and will stay for 4 days if i have an ELCS (glad im not in the UK).

. I think i am leaning towards the ELCS as i am sure this will be my last child. Good luck with your decision.

Thanks Essel! When are you due? We might end up being neighbours in hospital! My understand with a CS is that assuming the baby is alright afetr 24 hours you can transfer to Birthcare or even home?

The things will being sore afterwards & not having much mobility is that I've kind of anticipated not really leaving the house (or at least not going very far) for at least 2 if not 4 weeks afterwards. I am lucky in that I have a lot of family support (the challenge will be chucking them out!!) I am definitely (rightly or wrongly) more worried about mastitis than a CS scar, mastitis sounds so painful, poor you.

P.S. Thank you everyone who has responded so far, all your comments have been massively helpful.