C sections and requesting (midwifes on here can you help!)

[Summersunx]

Hi there, I'm 39 weeks and 4 days baby hasn't arrived yet and I'm just wondering if I go over 40 weeks can i request a c section instead of going way over and having inductions etc.

Many thanks

Elective section and emergency section statistics tend to be lumped together, and obviously for emergencies, things are already going wrong.

OP, you do not have to accept anything offered to you (it is an offer, not a demand, but may be worded more as the latter), so if you don't want to be poked and prodded, just say no. Indeed, it can be a pretty horrible experience (thinking back at being jabbed in the cervix in Triage...). Equally, you don't have to be induced, and if it gets that far, you can always opt for a CS as an alternative if they want the baby out asap. I personally wasn't poked and prodded after my sections - to be honest you are treated as though there is nothing wrong with you so make sure you take the painkillers regularly after surgery!

If you are able to speak to your midwife tomorrow that would be great, so you can consider your options and put your mind at rest.

Let me quote you so you can better understand what I'm referring to.
I didn't comment on @Peonyyyy 's post so don't know why you're not focusing on what I was saying.

You said " a planned c section is actually statistically the safest way to give birth for both mother and baby."

To which I said that this is incorrect.
Maybe just a quick 'ah sorry, had my facts wrong/ will go check my sources " rather than making a completely different point.

Honestly I don’t think it’s an advertised fact that it makes future pregnancies high risk. In what way does it? (Panicking slightly now..!)

Midwife here. Yes, cesarean sections do make subsequent pregnancies not high risk but you will definately move out of the low risk group. A previous CS makes you at higher risk of

1. placenta previa
2. Placenta acreta (very rare though)
3. Uterine abruption.
4. Adhesions
5. Subsequent Preterm birth

Babies are at an increased risk of having breathing issues following CS birth

I would support a woman to make any decision regarding type of birth. However, it does seem on mumsnet - vaginally birth is generally written about negatively. In my experience, I have supported hundreds and hundreds of women give birth vaginally . Yes, some women have had horrible traumatic births, but the majority ime have been lovely!

Yes, CS are quick, controlled and you are facing less of the unknown but they are a major surgical procedure. Things can go wrong with them and they can turn horribly traumatic too.

Get as much information together as you can, weigh up the risks and make an informed choice. Your midwife and obstetric team will suppprt you on your decision - whatever you decide.

No experience scheduling ELCS, but just wanted to add you can turn down inductions if you're not comfortable with them. I turned down one for my second after doing extensive research on the pros and cons in my scenario. Would encourage you to chat through with your midwife in what cases they'd recommend an induction and why. You can then ask for the evidence surrounding it for your particular case, and what the risks of moving ahead or declining it are. Plus you can ask for the hospital's own stats on how many inductions end up in emergency sections.

Your Bishop Score would also indicate how likely an induction is to be successful - this looks at how dilated you are, etc., and gives a score out of 10. The higher the score, the more likely induction will go quickly for you.

Best of luck with your delivery, however you choose to do it!

You said " a planned c section is actually statistically the safest way to give birth for both mother and baby."

I didn’t say that at all.

OP I think you want a c section because you’re fed up of waiting for baby. I get it.

i went for VBAC second time and almost called for a c section when I was feeling fed up of waiting!!

I had two inductions. I wanted to refuse the drip and go straight to section if needed as that's where I'd heard things get difficult and the risks of intervention increase.

Actually both of my inductions were OK, I didn't need the drip and birthed vaginally.

I would give the pessary a go it might be all you need to get you going.

Actually there is evidence that maternal request c sections (that is, c sections that are not being carried out due to health risks with mum or baby) have lower complication rates than vaginal births. The issue is that most places don't differentiate in their statistic recording between maternal request sections for low risk pregnancies and planned sections where either mum, baby or both have increased risk factors (resulting in the need for a section in the first place). It stands to reason that mums and babies who may be unwell in the first place may be more likely to suffer adverse affects, but for healthy mums with low-risk pregnancies, the evidence out there about maternal request sections shows that they may be actually safer than vaginal births.

www.cmaj.ca/content/193/18/E634

amp.theguardian.com/lifeandstyle/2022/feb/13/caesareans-or-vaginal-births-should-mothers-or-medics-have-the-final-say

The data shocked the study’s head author, Darine El-Chaâr, a perinatal researcher at the Ottawa hospital. In the planned vaginal birth group, there was a higher percentage of negative outcomes compared with the MRC group, driven by serious vaginal tears and babies admitted to intensive care. “I myself am challenged by the data,” she says, underlining that she believes vaginal birth is natural. “I wanted it to be the other way around.”

A bit off topic but I felt it was interesting.

Is there any particular reason why you need to have your baby at 40 weeks? I wouldn't like to go to 42 weeks but waiting until 41 weeks is fine. (41 weeks would be your due date in France.)

If you hold out until 41 weeks you're very likely to go into labour spontaneously.

Having had one failed induction leading to an emergency C-section and one spontaneous labour resulting in a straightforward vaginal birth, I would try for the vaginal birth every day of the week and twice on Sundays. I declined an ELCS and opted to try for a VBAC the second time because I found the recovery from a C-section very rough. Although my C-section was technically an emergency (in that it was unplanned), it was carried out in very calm conditions and it was beautifully done from a surgical point of view. I healed beautifully and my scar is tiny. So the only difference between that and an ELCS is that if I'd had an ELCS I wouldn't have laboured beforehand. Whilst I'm sure that does make a difference, I was definitely in a lot more pain in the days and even weeks after my C-section than I was during labour.

If I had to do it again I would still choose induction over an ELCS.

I had two vaginal births, one at exactly 40 weeks and the second at 41+ the day before I was due to be induced. Is it your first pregnancy? Anecdotally the people who I know who had difficult inductions that resulted in a c section anyway were on their first pregnancy and I suppose their body was really not ready to go. I had the feeling with my second one that if it did get to induction I'd be ok as I'd had all the signs of labour for ages just no baby! And I do know friends who had the induction first time round and laboured with no problems. I'm sorry I have no idea on the logistics of requesting one this late, but if that's what you want a huge proportion of people who give birth have planned c sections with no problems so I wouldn't worry about that part of the decision making.

Yes, I know this, of course. It would be great if the medical studies that signify that once you’ve had a c section any subsequent pregnancy is automatically high risk could be shared, So far no evidence has been provided for this statement, and another midwife has stated that it’s not true. It would be good to know the facts so that posters can make informed decisions about their birth choices.

Coldandunderablanket provided a very helpful summary yesterday at 18:26. My understanding as a non-medical professional is that C-Sections increase your risk of a few really nasty complications in future pregnancies. So although ´automatically high risk’ seems to be the wrong wording, C-Sections do increase risk in subsequent pregnancies.

@doodleschnoodle also provided a very helpful summary, including links, which has differing information.

I don’t care either way who is “right”, but I do think it’s helpful for women to have the correct information so that they can make the choices they think are best for them. Sweeping statements (“A caesarean section is a huge operation that automatically makes any future pregnancies high risk... “) not backed by facts are no use to anyone, and may unnecessarily frighten women away from requesting C sections when that might actually be the best choice for them. You said that midwives read medical studies and I merely said it would helpful to share the study that indicated that C sections automatically made subsequent pregnancies high risk.

Doodleschnoodle’s link answers a different question - complications during birth/postpartum for that birth for maternal request C-Sections vs all vaginal births. Zimunya’s point was about risk in subsequent pregnancies due to the scars created by all C-section surgeries. It’s not the same point and women in different situations will want to put more or less weight on both points depending on their future plans.

Quote: “Zimunya’s point was about risk in subsequent pregnancies due to the scars created by all C-section surgeries.”

Absolutely not. Zimunya’s point was that it was unfair and unethical for midwives to peddle a false narrative.

You’re 100% correct that Doodleschnoodle’s link answers a different question..I mentioned it because it provided links to the information that was being given, as opposed to making a statement (subsequently debunked) with no evidence.

I meant coldandunderablanket’s point, not yours, sorry.

So had midwife today she did a sweep as I'm now 40+1 weeks she said she couldn't get into cervix as it was only slightly open and the other part was fully closed not sure what she meant by this...I do regret having the sweep has made me quite sore and I have a little tear mark on the skin below vaginal entrance. I've told midwife I do not want anymore sweeps or inductions I just want baby out safe and would like a c section if it comes to the stage of induction she said she would speak to hospital for advice. I just can't wait any longer can i phone hospital myself and tell them how i feel I've also noticed a funny smell down below since the sweep :-/

I would definitely phone them. You must be allowed to choose how you want things to go, as far as is possible.

A huge operation that I was able to stroll around the supermarket, carry newborn in a sling, go out for lunch and potter round the house happily and pain free within a few days?

No, my experience is not universal, but I've honestly had worse periods, and I have an embarrassingly pathetic pain tolerance level. I kept assuming that the pain would start, and save for a bit when first getting up and down for a few days, it never came.

An elective c section IS statistically the safest way to give birth for both mother and baby. An elective is very different to an emergency one, and the stats are lumped together which makes it look worse.

subsequent pregnancies are still low risk after a c section (unless something went wrong last time and has left a problem).

@doodleschnoodle is correct.

@Coldandunderablanket are those risks you are quoting if you attempt a VBAC? Or are you saying these things MIGHT occur if there has been issues after the c section or if something went wrong during it? Because this is not correct - I have had one planned c section and I am still classed as low risk in this pregnancy. So unless my trust has got it completely wrong, this isn’t true.

NHS guidelines are biased towards vaginal births because it’s seen as the ‘normal’ way to give birth and is cheaper. However as so many ‘normal’ births end up with long stays in hospital, interventions and an emergency c sections in the end I wonder if it really does save any money in the long run!

I’ll leave aside the infighting of section v not etc.
I would prepare myself at this stage that an ELCS may not have a space/date for you any time soon.

Our hospital has a theatre for ELCS and currently there wouldn’t be a date for me to offer you for about 10 days.

You can have the option for induction, monitoring or transfer to another hospital (not close) but I can’t give you an ELCS date we don’t have.

Is it waiting? Fear of examination? Pain? Past trauma that’s worrying you? I think your comments about being messed about with are something to explore? What are your thoughts around each intervention/type of exam? Worth exploring with the midwife.

Midwife if I'm honest is not the best she dosnt listen to me and my views she hasn't even gone through the birth plan which she did say she would but it's never happened. I feel like these last week's of pregnancy have gone too fast and with the induction I had a sweep the other day cervix was closed she said she managed to move around the cervix her fingers but that was it. I said I don't want anything else like inductions or 48hr sweeps I don't want to go over 41 weeks either I just want my baby out safely now il be 41 weeks on Monday and she's booked me in for appointment on Tuesday to see her again. I contacted her yesterday and left a msg she dosnt reply back.

She doesn't sound great. Have you tried calling the hospital directly? There's a good chance you will go into labour soon.

Hi no I havnt phoned hospital is it worth a try I just presumed that the midwife could only put anything across to them about me not wanting inductions etc. Midwife dosnt update the app regulary so when I go on to check what babies heart beat was and how far down he is etc it's not on there. I msg her she dosnt reply sometimes she does can take it untill the next day plus we only seem to have one midwife at the practice and she only does certain days it dosnt actually say there is any other midwife at the practice too.