Elective Csection

[FrostyPopThePenguinLord]

Hi all,
Fairly new to this posting business but have been lurking for a while so please excuse me if I make any horrendous whoopsies or offend anyone, I can assure you it's not intentional.
Fiancé and I are in the process of trying to get me knocked up, so I thought it was high time I asked others about their experiences.
In the bluntest possible terms I do not want to give birth naturally, it's not a case of 'too posh to push' (good grief I hate that expression), but equally I would not say I'm deeply anxious about childbirth as a process or have huge fears over it to feel that I need psychological help.
However my decision to procreate has largely depended on wether I would be allowed an elective section or not, I've even emailed the maternity department at my local hospital to ask their stance on maternal requests.
My conclusion has been reached by what I hope is my (as far as possible) rational evaluation of the pros and cons of each method of delivery and my overall feelings.
Without going into the nitty gritty of stats and source material etc, which I have looked at fairly extensively, my overwhelming feeling is that I would much rather be cut open under controlled circumstances with highly trained medical professionals in the actual room they could save my life in if it all went tits up, whilst already being numb below the waist!
I know it doesn't always progress smoothly like that and there is always the possibility of complications, but so does vaginal birth and if asked to choose between the two sets of circumstances where I might be in danger I would much rather be already in there and ready to go.
The complications I've heard of with vaginal birth fill me with horror and quite frankly make me want to join a convent.
I've been quite careful to look at a balance of positive and negative experiences on both sides, but I have read things and heard things (I'm at that ages where all my friends are having babies) that sound pretty shit if I'm honest.
Episiotomy...my mum said she didn't even notice them cutting her with me.....I never want to be in so much pain that I can't feel my whatsit being cut with no local....nope not going to happen...
same goes for tearing...id rather a million people gave me shit for being 'too posh to push' than facing even the possibility that I could rip from stem to stern....that sounds like a nightmare.
Forceps...no...just no.
And after all that effort like 1 in 4 women to be told I might need a section anyway....sod that.
Why would I want to push my body and my baby to the point where they have to potentially operate so fast I can't even be conscious because we are in so much danger, I'd rather already be in there.
My mum tells me there is no need to be quite so aggressive about what I want and I'll only get people's backs up. I genuinely don't want to be pushy and awful about it but from what I've read over several years now it seems to be a massive battle from start to finish to get what I deem to be a perfectly valid choice which I have reasoned through in a balanced and adult manner, not a last minute panic.
The majority I've read seem to either think you need to be phobic in some way, have had awful previous experiences or medical reasons.
Medical science has come such a way that I think that c section should be as valid a choice as a water birth or home birth (sorry guys you lost me there, you want to be miles away from the big clean building with the people who save lives and the medicine that makes it not hurt??).
I can't understand why there has to seemingly be something wrong with me in order to justify a choice I want to make about my medical care.
Also all the judgement is completely insane, I have nothing but respect for people who can give birth totally naturally with no pain relief etc....One of my best friends did with both her babies and they were huge and she had a wonderful experience, another friend had 52 hours of labour and forceps as well as more stitches than she wanted to think about, my mother gives birth as easily as a dairy cow and loves being pregnant.... I think you are totally nuts and incredibly brave, those things are not mutually exclusive!! But I would never look down on them or belittle them for their choice in childbirth just because they don't fit my worldview.
I would love to hear from people who had a truly elective section with no medical need and their reasons if they don't mind sharing, I know I'm not alone but it seems to be quite difficult to find people who have decided it is the best choice for them, not because they have had previous trauma or medical issues but just for the simple fact that they think traditional birth is not for them for whatever reason
Thanks guys
X

[hazeyjane]

An emergency and elective section are two completely different beasts. I'm sorry you had a rough time but I don't think it's particularly useful to compare the two situations.

With regards to an emergency section v elective section, and breathing difficulties - actually an elective has risks of breathing difficulties due to the fact that a) the baby is born slightly earlier than term, and b) that the baby has not benefitted from labour starting. Obviously the added element of a baby not having been squeezed through vaginal birth, thus helping the lung clearing procedure, is the same in both electives and emergency.

My ds was an elective, and yet was born grunting unable to breathe properly or suckle, and spent 2 days in NICU and a further 6 in SCBU, on cpap, being tube fed. This was, in part, due to the nature of his delivery.

[TurquoiseDress]

Hi OP

I can completely relate to some of the things that you wrote in your first post. For me, I had my first child via ELCS and got it for maternal request.
There was no medical indication for me to need an ELCS.
For as long as I could remember, I always felt that a CS would be the right thing for me.

I was surprised at how fairly quick and easy the process was (at a London teaching hospital) and I had gone into it expecting to have to battle for what I wanted. I was 36 weeks by the time I met with the first consultant- after talking through my reasons etc, the diary was opened and I was booked in for 39 weeks.

Then I had to see a second consultant, more as a formality. Also, I had to agree to been seen by a consultant psychiatrist- they seemed slightly apologetic when they told me this, perhaps expecting me to question it/not be happy about it. But I just wanted to sort out the ELCS.

Meeting with the psychiatrist was about 10mins, they asked about family/friends' birth experiences, risks/benefits to CS and that was about it. Such a relief when it was all signed off.

Had an ELCS at 39 weeks, all went well & we were home less than 48 hours earlier. It was the right birth for me and my baby.
Never had to justify my decision to anyone else as I never told anyone else (apart from husband), just told people I'd had a CS due to breech baby. They mostly just looked at me with sympathy.

You need to do whatever feels right for you and your baby, after all you will be the one who has to live with whatever consequences may arise after the birth.

I had no regrets.
Good luck with everything.

[habibihabibi]

I elected CS for both of my deliveries .
Like you OP I wouldn't have had any children if I'd had to give birth naturally .
We paid though, I wouldn't have expect the NHS to have funded my operations which essentially not necessary.
It doesn't have to cost an extortionate amount if you only go privately a few consultations in the last trimester and for the delivery .

[welshweasel]

An emergency and elective section are two completely different beasts. I'm sorry you had a rough time but I don't think it's particularly useful to compare the two situations.

[Soontobenewmummy]

Hi OP, sorry in advance for long post!I'm 6 days post a complex emergency c section.

You've obviously done lots of research. But I thought I'd offer my thoughts on what the experience meant for my baby.

My baby had a huge amount of mucous in her body which didn't get cleared out like it would if she had come vaginally. It meant she needed help to get breathing which was terrifying to hear listening as I lay on the operating table. (Just because it's performed as an emergency doesn't necessarily mean you get put to sleep - I didn't).

She was traumatised by the delivery and wouldn't latch for 3 days . The SCBU doctors gave her formula at about 14 hours without my knowledge as I was separated from her as they removed the bakri balloon, catheter and drain from my body. I lost 2.8l of blood and needed a transfusion immediately after surgery - I didn't get to hold my baby for around 3 hours and I'm confident this is one reason she struggled to latch.

Because she struggled to feed they decided to put her on antibiotics just in case it was a sign of infection - this meant nine attempts to get a cannula in her little body and the antibiotics made her very sleepy, making it harder again to establish feeding. Watching her in SCBU intubated and with her cannula in was very hard even though she was only in a few hours.

She failed her first two hearing tests, almost certainly because of the method of delivery and that added to the stress and worry of the difficult first few days. I found being in hospital for 4 days extremely stressful, despite the fantastic midwives.

Ultimately my baby would not have arrived naturally as she engaged in the wrong position. The NHS team were incredible . But this is not the start to life I would have hoped for my baby. If you'd told me at the start that it would have ended in a section, I would still have gone through the long induction process and 13 hour active labour if there was even a small chance I could have delivered naturally.

Sorry for the essay - it's all still very raw for me but I hope my experience can be useful in some way. All the very best in whatever way forward you decide is right for you.

[Blueskyrain]

I'm having a planned CS for very similar reasons to yours.
With me, I have a lot of anxiety and fear around pregnancy, so they are fine with it from a MH perspective, rather than it being just because I have a preference, but the guidance does say that it is up to you which method you go for. If you want a CS, then you need to say this at the beggining, and may have to jump through a few hoops, but I believe that you should get it in the end.

Should is about as good as you are going to get though. You could go into labour suddenly and not have time for a CS, there could be other reasons why you can't have one last minute, or you could find the NHS stamps its feet.

I'd say you'd need to accept that there is the possiblity it wouldn't happen - even if you went private.

[Cuppaqueen]

The NICE guidelines are definitely worth a read in full, and include a comparison of the risks of planned VB versus planned C-section for women without previous CS. See Appendix C - www.nice.org.uk/guidance/cg132/chapter/Appendix-C-Planned-CS-compared-with-planned-vaginal-birth

It's not right to say one is more risky than the other: the risks are different and vary with each person. With CS you have a lower risk of injury to vagina and perineum, obviously, and of pp haemorrhage, but slightly higher risk of any haemorrhage being so severe as to lead to hysterectomy. You also 'risk' a longer hospital stay, although I personally think that's a benefit so you and baby can be monitored. With VB, you have a 1 in 4 chance of EMCS which carries the most risk of all. With CS, main risk for the baby is slightly higher chance of NICU admission but set against that, no chance of the cord being round the neck/ getting stuck and distressed etc.

In addition, research suggests the older you are, the more chance of intervention (induction/ epidural/ forceps etc) and therefore of painful complications. In my opinion, if you've read and understand the risks, you should be able to make an informed choice and most NHS trusts will facilitate that. Saying it costs more money is a generalisation: planned CS costs less than emergency CS, and in any case since when are we saying access to NHS facilities is purely about cost? That risks going down the 'you smoke/drink therefore cost the NHS more and shouldn't have this operation' route. Women shouldn't have to endure the pain and potential trauma of vaginal birth unless they want to. It's 2017 FGS.

I am having a planned CS for my first baby, OP, for many of the same reasons as you. I feel based on my age, size of babies in my/ DH family, and my attitude to risk and pain, that it is the best choice for me and our son. Luckily I am abroad so no fighting the NHS but if I were here, I would be the most determined advocate of maternal right to choose you can find. You go for it, OP!

(And those ladies who want a vaginal birth, hey, no judgment here. Each to their own.)

[totallyrandom]

I second what hazeyjane has said.
I have had 3 vaginal births, 1 completely natural, 1 induced, 1 waters broken and had "only" gas and air as pain relief in all 3. I did have stitches for first or second degree tears with all 3 which healed quickly. I then had a c-section for malpositioning (breech). I found the c-section more painful than any of my vaginal births. I would choose the pain of vaginal birth over 3 days of post abdominal surgery pain any day! Our bodies are meant to deliver naturally in most circumstances and most people do recover quickly. The risks in a c-section are actually much higher for the mother (or so I was told by the doctor) and about equal for the baby.

Like hazeyjane, I went into a c-section quite uninformed and was shocked by not being able to move/turn/get in and out of bed. I had an uncomplicated c-section and any doctor would tell you I recovered very well and after 2 weeks was able to do most things.
I realised afterwards that I had some underlying false presumptions about c-sections such as 1) the NHS doesn't want to allow elective c-sections due to cost cutting- actually most doctors want what is best for their patients which includes the mother so will typically advise a natural delivery 2) most midwives are a bit hippy so want you to try natural first - again, the medical evidence and research shows that in most circumstances natural is better for mother and baby 3) many celebrities are having c-sections so it can't be that bad/might be the better option - still not sure why that is the case, but perhaps to do with age of many celebrities.

Having said all of the above, I believe in a mother's choice so if that really is what you want, go for it (as long as you do your research carefully, including impact on future pregnancies such as risk of attachment to old c-section scar, low lying placenta etc).

[hazeyjane]

You are obviously 100% set on a c-section, so good luck with persuading the professionals.

One thing I would say is that whilst giving birth vaginally can be unpredictable for mother and baby, so can sections - not just the things that can go wrong for the mother, the effect on the baby and but also your reaction to it. I was completely unprepared for just how traumatic I found the whole thing, and I think one of the things I found traumatic was that whilst I had read all the various out comes, I had convinced myself it would be better than my vaginal births, also there were some side effects that I had definitely not read beforehand. Plus I had not quite expected the recovery to be as bad as it was.

So good luck with getting pregnant, good luck with the birth when you are and be kind to yourself afterwards.

[FrostyPopThePenguinLord]

Tearingoutmyhair, this said so many things better than I have put them, thank you.
It's not that I object to natural childbirth, more I resent the idea that I have to do it that way just because that's what I'm 'designed for'...I call bullshit on so many levels....if we were that well designed for it then why would we suffer so much when other members of the animal kingdom give birth with relative ease. The scientific answer is along the lines of babies heads got bigger whilst pelvis size remained largely the same because our bipedal stance and method of walking restricts the size the pelvis can be without interfering with movement, women walk differently to men anyway...as a consequence we suffer more pain and complications etc etc.
I don't see any problem with fully embracing how far our medical practices have come and using them to my advantage, I'm fairly sure 99% of you wouldn't refuse antibiotics for an infection or a hip replacement....you could suffer through without them and take your chances with the infection or pain, but why would you when it can be treated and fixed with modern advancements. Im lucky enough to live in a time where a csection (whilst major abdominal surgery) is one of the safest and most routinely done procedures there is, and I intend to make the most of it.

[MrsBlennerhassett]

i had a natural birth. It was sold to me as being so much easier than a c section and better for the baby. It was awful. Awful. There was no way of knowing it was going to be like that tho my friend was only in labour three hours and was in and out the same day.
If i ever have another child i will be pushing for a c section.
Is there any way you can save to go private? I think you can use NHS for all the check ups to a certain point then just go private right at the end?

[Tearingoutmyhair]

"Vaginas are designed for childbirth" is a foolish assertion. Nature is not a sentient entity that has any "end" or "means" in mind. Things happen, and the evolutionary process continues in response to an enormous variety of basic and complex environmental factors. Sometimes this results in the most incredible feats of precision and harmony and sometimes - as in the case of the pregnancies and births of humans and guinea pigs - in rather a third rate, ramshackle piece of engineering.

The peculiar rosetinting of the imperfect nitty gritty of life is strangely largely restricted to obstetrics. We don't seem so keen to fetishise other painful and dangerous but oft-necessary features of humanity.

The reality is that until the wonderful advances of more recent centuries that have rendered both vaginal and caesarian births overwhelmingly safe in the developed world, one went into childbirth with a bloody enormous risk that either mother or baby or both would not make it out the other side.

In order for a population to be sustained, the "requirement" (so to speak) is that two infants are born to each mother. Obviously several decades of fertile life presents the opportunity for rather more than two pregnancies, so for the overwhelming bulk of human existence, the population was kept in check by nature's rather unfortunate habit of bumping people off exceedingly young.

I understand the "trust in your body" mentality and it is not without value, but having arrived chiefly as a reaction against misogynistic and paternalistic obstetric practices of yore (not that they've entirely gone away) inevitably the pendulum has swung a little too far in the other direction. Women are urged to trust in the "wisdom" of what is ultimately a chaotic and totally amoral bodily process designed merely to propagate the species, and are so often left with feelings of guilt and inadequacy when they end up being one of the sizeable minority for whom the "body" turned out to have rather less noble ideas.

It's a complicated area, because the issue of the public purse - while hugely less pressing in the moral sense - cannot be disregarded altogether.

But your preference is entirely valid, and IMO should be respected, and I wish you the very best of luck in the months to come.

[Imstickingwiththisone]

What your hospital has said is promising OP. You would have to demonstrate that you've weighed up the pros and cons of all eventualities and that you are certain about your choice, which you shouldn't have a problem doing. I had to fight for my upcoming ELCS and feel I have good cause to (traumatic first birth and damaged pelvic floor which I want to avoid worsening with an instrumental delivery). I was really worried about giving birth naturally but still managed to feel guilty about my decision as I had to argue it with the experts who said that I didn't need one. Even now I worry I'm being judged but would absolutely shit myself if ELcS was cancelled. Good luck OP

[mimiholls]

You are more than capable of making your own decision having gone through the risks and benefits of both options so I wouldn't bother listening to anecdotal experiences, there are good and bad on both sides. It just could be a battle on the nhs but the correspondence from your hospital sounds positive. Good luck with whatever you decide.

[SanityAssassin]

OP I felt exactly like you and had an ELCS on the NHS for maternal request. First child and no medical reasons this was also before the new NICE guidelines and I did have to fight for it. Also had second ELCS but that was easy to get as had a previous.

I had good quick recoveries with both.

[FrostyPopThePenguinLord]

Mimi, yes I asked their stance on elective section and they said obviously they like to encourage natural birth but if I can show an understanding of risks etc then they aim to give mothers the birth they want.
I'm not a total idiot, I know surgery is painful and recovery can be crappy, I've had abdominal surgery before (appendix) and it's not the most fun I've ever had, but I was fine and moving the day after surgery, obviously it's a different procedure and I may not recover the same way plus looking after a baby, but I could be equally knocked down by traditional birth, there are no certainties with child birth is the thing I have learned and it's about making the decision that you can feel happy with....I just made a more awkward decision x

[mimiholls]

Op have the hospital told you in writing that they allow cs on maternal request? If so that sounds pretty positive...

[mimiholls]

Sorry but the NICE guidelines don't mean anything, hospitals are not required to follow them. You can ask to see another consultant if one refuses but the next one can also say no and the next one can also say no until you're out of time. I do know people who have had section simply for maternal request but this was in 2011 and 2012 when the guidelines were first brought out. Since they've now been out a while and more people are asking about it, many hospitals have now put a more concrete policy in place e.g. in my area everyone gets a letter at their booking appointment stating that they do not allow c section on maternal request and I know a couple of people who have been refused even when they pushed for it. It does depend on your hospital and what area you're in. I am not saying it's not possible but there is absolutely no guarantee. Mental health reasons are different and they would be obliged to address that the same as physical health reasons. Look into private health insurance policies that cover elcs. There are a few threads on here about it.

[user1471441738]

NICE guidance since 2011 is that wanting one IS a good enough reason to get one.

You may have to jump through some hoops and change consultant etc but you should be able to get what you want.

You shouldn't have to go private
www.nice.org.uk/guidance/cg132/chapter/Key-priorities-for-implementation

[janinlondon]

As above - you can get an ELCS on the NHS. Set out your medical reasoning and costings, based on original pubmed articles (not press reports or stories about people your aunt's cousin knows), with a list of references. If possible choose a hospital based on the consultants' published c section stance. Do the work, present well, and you will be given the section.

[Jackiebrambles]

I’ve had two c-sections – the firs t was an emergency one, and the second elective.

I decided once I’d already had a section for my first baby that I didn’t want to risk going through labour (again) to risk the chance of another EMCS. I also didn’t want pelvic floor damage AND a c-section scar (as I already have of course!). The midwives/consultants did try to convince me to have a VBAC but ultimately happily signed off my ELCS.

However, my circumstances were different to yours of course.
My friend felt the same way as you when she was first pregnant, and talked to her midwife from the very beginning about this. They sent her for counselling and would not sign off a c-section until she had done this. She was prepared to go private if necessary.

In the end her baby was breech so she had to have a section anyway!

So really I think you need to just wait until you have got pregnant and start the discussion with your midwives at the earliest possible time.

You should be aware though, that even with my ELCS, I was not ‘booked in’ for my operation until I was 36 weeks pregnant.

They just don’t sign you up for the c-section any earlier than that. So you need to be bear this in mind, you won’t know for 100% sure that you are having a section unless you pay for private.

[neonrainbow]

I thought the same as you but for me it was fear of the unknown. However once i was pregnant a midwife led birth started to sound good. But then i found out for a couple of reasons that it would be a highly medicalised birth so my choice was about induction/epidural vs c sec. My body had other ideas and my waters broke and i went into labour 10 weeks early so agreed to try naturally. Things went wrong and a general anaesthetic emcs later and you realise that this stuff can't be planned and that the vast majority of women have a normal uncomplicated natural delivery and that really is better for the baby. You can't plan it and there's really no point stressing about it.

Also, having had a section i was absolutely crazy to ever think, however briefly that it would be the easier way to give birth. The recovery has been physically and mentally very hard and medically speaking my recovery has been relatively straightforward. I couldn't do anything at all for myself the first few days and couldn't walk any distances for 5 days. You'd be absolutely crazy to choose it over a natural birth.

[welshweasel]

I totally understand where you are coming from. I felt similarly. If someone could have absolutely guaranteed me a normal vaginal delivery if have gone for that. But obviously that's impossible. For me, an elective section, whilst more risky than a nvd, was the best compromise. I requested a section at my booking in appointment. I saw the consultant at 20 weeks, and had the section agreed within minutes. As it was, I needed one at 35 weeks for medical reasons but already had a date booked at 38+6 by that point. The birth was incredible. I watched it all and we have photos of the entire process. I recovered quickly, was having lunch in the pub day 4 and driving day 10. You absolutely can get a maternal request section on the NHS. You may have a harder time that I did getting it agreed to but if you are firm from the start and do your research you should be fine. If the consultant refuses your request, they should refer you on to someone else. Most hospital have at least one consultant who is more 'section happy' than others.

[Blahblahblahyadayadayada]

Go privately. Sort out your insurance etc before you fall pregnant.

[waitingforsomething]

If this is something you want so badly, even though you have no mental health, physical health, prior bad experiences or anxiety reasons to have an Elective C-section you should consider saving the money and pay privately. The NHS is on it's knees and a C-section is very expensive - your body is designed to give birth, if you have complications that pose a risk to you or your baby then they will perform an emergency C-section and you and baby will be safe.

C sections are performed for lots of reasons - they are not an easy option. You will have a scar, your recovery takes longer in most cases. I know two people that have had serious complications from C-sections unfortunately. Neither way of giving birth is easy, both pose small risks but an Elective C section is not the easy way for you .