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!!))

Thanks Emma!

I am leaning towards attempting VB, I'm pretty active too and the baby will be born in early summer here. I swim regularly and if a CS wound got infected and prevented me swimming all summer I would be seriously hot and grumpy! Hopefully the lochia won't go on too long.

I don't know how much of successful/straightforward VBs are hereditary, but my mum & my sister both had straightforward VBs (4 for mum, 2 for sister) and both have similar body types to me (the pear-shaped hips might yet be useful for something!). Hopefully this counts for something.

I'm not ideologically wedded to a VB and if there are risks or scans reveal a big baby (unlikely as DH and I are both small mbbut my dad is 6'3 so you never know!) I'm happy to go ELCS but at this stage VB looks like the best option crosses fingers

Both mum and DSis had episiotomies and were very laissez faire about them, I am more scared of tearing tbh - probably feeds into my control freakery.

BeyondRepair Sat 26-Apr-14 14:34:06
There is no way to record a womans experience in birth, or after.

there is no joined up thinking or place to put all information in one place.

for instance a lady with bladder issues, eventually plucks up courage to go to docs...does that info ever get put anywhere back to hospital? no!

Many women suffer in silence.

No mini I mean the brigade who refuse to accept that often labour, no matter what you do before and during will simply be dangerous and life threatening and no matter how many floors you scrubbed before, no matter how mobile you were, no matter how this that and the other you were ...that baby would have still got stuck, come out wrong, the nail sliced the vag on the way out, chin got stuck, and so on.

Some posters on here seem to think problems only occur because the mum did or didn't do something ot they didn't get good care.

Labour and birth is un predictable.

Right. First things first. I am having an ELCS. By choice.

However I think you are off the mark with a lot of comments you've made on this thread.

I do feel that MN is largely a fairly openminded forum with regard to the subject. If anything I actually think it is more pro-ELCS than not. I often see a lot of posts and a lot of threads about how wonderful their ELCS was and how awful their VB was. The thing I worry about those posts is the strength of them - they are very compelling in the sense that they are emotive and play on already existing fears and as such are therefore more powerful than the opposite argument in response. And they are still personal and anecdotal and don't reflect someones underlying health or circumstances and how this relate to others. They are no more unbiased than the opposite argument.

I think its far too easy to get sucked into this emotive debate rather than encouraging people to look closely at their own fears, priorities, concerns, health, age, other risk factors and trying to offer the pros and cons of both. They are different for everyone. And trying to do so without projecting your own feelings too much. You can never be totally impartial, but I do think its important to get others to ask themselves questions or to question what they know so they can make decisions based on information rather than pure emotions.

And both sides of the debate can be equally guilty of doing this.

There clearly IS evidence out there, that suggests that where you give birth has an effect on the experience you have. But I do think its important to say this isn't not only psychically but also mentally. Neglecting this information, isn't helpful to anyone. If we ignore it, then we loose the opportunity to ask questions that could lead to better care for everyone. And sadly, poor care IS contributing to poorer outcomes which is utterly scandalous. I do feel a lot of women could have better experiences with VBs for various reasons. This does mean that women do have a certain amount of ability to exercise choices which can impact them positively and negatively, as care is unfortunately, not as universal nor consistent as it should be. Its only when you present their choices as the only thing that can cause problems that you have an issue. You still might end up with a bad experience whatever you do, because as your rightly point out labour and birth are unpredictable. This also includes outcomes from having an ELCS.

I also think that saying that there is no way to record a woman's experience is a rather defeatist way of thinking of things. There IS now research being done in this area. And in terms of women suffering in silence, I think forums like MN are making women wake up and realise that what has happened to them isn't acceptable and they are feeling more able to talk about it. Things are changing and we need to encourage it, rather than just say "no one is listening" and it can't be quantified or recorded. It can.

For example you CAN record things like an increase in a rise in requests for ELCS or a rise in the number of women reporting bladder problems quite easily. The rise is as important as the actual number of figures as it reflects a number of issues that can be explored further.

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."

Last year 10.7% of births were by planned c/s and 14.7% were emergency cs. Although emergency c/s is associated with poorer outcomes than planned c/s, the vast majority are still uncomplicated.

"(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?)"

Nationally, the hospital with the highest rate of normal birth last year was Birmingham City hospital - 52% of women had no medical input in the birth at all (ie, no induction, no episiotomy, no augmentation, no forceps, no ventouse, no c/s). Nationally 37% of all mothers will have either an instrumental delivery or a c/s (planned and unplanned). This figure is for all mothers - including those with complex medical problems.

The normal birth figure for healthy mothers having their baby outside of an obstetric setting is very much higher than this.

About 3% of women will need surgical repair to the perineum in theatre following a vaginal birth.

You need to address your control freakery, OP.

Why is looking at risk "control freakery"?

Why is the OP criticised when women who might make decisions to reduce their chances of a CS would not be viewed in a similar fashion?

OP calls herself a control freak. I think at some level she knows that trying to make this decision purely from stats & probability & anecdotes & data is not necessarily the route to an outcome she's happy with.

Besides, knowing stats doesn't reduce risk. Knowing them might help her feel happier with the impacts of her own decisions. But the decisions are still just bets with unknown outcomes that she can't control very much.

There's so much about having kids you don't get to control. You need to learn to enjoy the ride, whoever or whatever is driving.

Wow so helpful HolidayCriminal

Knowing stats doesn't reduce risk Errrr no but it may prompt you to behave in a way which does. You may be happy to breeze through life in merry ignorance of risks but it's not how I choose to live my life.

I am 31 weeks pregnant with my first child. I am in the UK and I'm currently trying to persuade my consultant to approve a maternal request ELCS.

Like Gennz I am a self-confessed control freak and her reasoning is my reasoning. Additionally, I believe I have valid physical health concerns about my ability to have the gold standard VB and crucially - how my body will cope with the aftermath. On that basis I have seen two registrars about this, neither of whom has listened to me and botg of whom have effectively tried to bully me into changing my mind. Conversely, the community midwives who I would have previously assumed would be very very pro-VB and anything else would be treason to womankind, don't understand what's wrong with the registrars.

I've also had several surgeries in my life already, although nothing as 'big' as a C section. The most recent one was for a one-in-a-million, only see it in textbooks- never in real life medical condition that made me oddly popular amongst the medical staff involved. I got awesome care.

Conversely, for my pregnancy, I've never seen the same community midwife twice nor any other medical staff. Considering I live in a smallish town of about 30k people I've found this side of the NHS callous and conveyor-belt in style. The midwives have been nice, but considering my medical history, every session I have to repeat it all to them and then watch them google the rare bits. The OBGYN registrars have been worse.

I have fears about VBs - episotomies and tears and so on - like most first timers. Like OP I like to research and educate myself and so I researched things like tears and stitches. I was surprised to find out how minor 1st and 2nd degree tears can be - depending on location and the research did in fact calm me a lot. Sadly my information is anecdata so not worth much clinically. One thing that I'd like to add regarding tears / episiotomies and stitching is this: my MN anecdata of women who'd had 3-4th degree tears and significant stitching reported on average about 3 weeks to recover. This is similar to ELCS anecdata also found on MN. Where wounds became infected or stitches did not dissolve as they should, this time was longer. This is also similar in timeline to CS anecdata.

Next appointment I have is specifically with the consultant and I will probably be bringing my supportive but scared DH. I'm not sure what we will do if we are refused an ELCS (although I've been wondering when I got stuck in the dystopia of the Handmaid's Tale, although that's not the best analogy). It feels like I'm being potentially forced to do something I have no faith in - not in the clinical staff I've seen so far and not in my body's ability to cope - now or in the future. That doesn't feel very nice or like a very enlightened society.

Personally for me, no to elcs. Of the 3 births I have had it was the worst, traumatic, long recovery, complications and ds was born with breathing difficulties. With dd1 I had a 3 day labour, ending in episiotomy, ventouse and 3 rd degree tear, with dd2 I had induction, epidural, 2nd degree tear. But they were definitely better by a million miles than the elcs.

Everyone's experience is different so stats don't really help or tell you what experience you will have.

I had an emergency CS after a 4 day failed induction. No issues with DS but they left a large piece of placenta inside me which meant I could not breast feed and was rushed back to hospital later with bleeding and infection.

With DD I had a wonderful, calm ELCS. No problems with DD and she breast fed easily.

In both cases I recovered really quickly (once the manky placenta had been removed). Friend who had Emergency followed by Elective CSs with her two had a really hard time recovering.

Good luck whatever you decide.

Forgot.

I've read lots of research. Lots of MN and other forums threads on this. I know my body and medical history. I know my husband.

I know that for me an ELCS is the best choice. However, I still have to make that decision and fight to make it happen and that does feel like a terrible responsibility. Part of me hopes my bean just doesn't turn - been breach at every appointment so far - and the decision will be made for me.

If someone could guarantee me 100% no future complications, no stitches, all going swimmingly, I'd jump on it. But in the absence of that guarantee, the least worst option for me is an ELCS, provided I can continue to stick up for myself and get one approved.

Ismara - I understand how you feel.

I had to pay an independent midwife to guarantee a homebirth because of a lack of NHS support.

Many women, not just those wanting elective c/s, don't get the birth they want because of a lack of resources.