Interesting article in the guardian about obstetricians going for elective c-sections

[FairyMum]

www.guardian.co.uk/society/2008/jul/11/nhs.health1

This is interesting. My neighbour is an obstetrician who was very adament that her DD
should have an elective c-section. I also have two friedns who are GPs who both had elective c-sections privately and
say they would not even entertain the idea of a vaginal birth.

So good to see a rational discussion about elective c-sections.

Sorry to interupt - but I have a few questions which I know if I posted elsewhere would get shot down in flames immediately!

I'm currently 5 months pregnant with my first child and have always wanted to choose a C-section.

How do you go about this?
How likely are you to be granted it by the NHS?
If you choose to go private what are the approximate costs?
Where can you get it done privately?

I'd be so grateful if someone could answer some of these questions for me!

Thanks

Spongecake, very sorry to hear of your DS's injury that must have been very distressing for you.

What are the chances of this type of injury resulting from an elective CS compared to an emergency though?

An elective caesarian is a planned, controlled event where the surgeon is not rushing, there is no panic and they are not fighting against time to get the baby out very quickly, unlike an emergency, which seems a more likely environment for injuries such as Spongecake's DS suffered.

This is why when people quote CS statistics it is a case of "is this regarding elective, emergency or both"? The two types of CS are performed under very different conditions so the outcomes re injuries to baby and mother) should not be lumped into one lot of "CS" statistics IMO.

I would be more surprised to hear if someone's baby/bladder got nicked during an elective CS than an emergency CS. Perhaps it would be useful to see a set of statistics comparing elective V emergency CS.

just posting late in the day to say I also suspect that some of the risks of VB are internalised by mothers rather than paid for by the NHS (sexual dysfunction, incontinence) and therefore because they are not recorded, they are not brought into the equation in this sort of discussion.

Obviously not every VB ends up with those problems but my sister ended up with infected episotomy and had a horrendous time for several months after her VB. The ongoing problems for her are not caught by any statistics whereas problems post CS are quite likely to be more acute than chronic so the NHS will know about them.

Glad this has been a moderate discussion btw.

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ds 1 -11 days late, induced, 27 hrs, epidural ds distressed, episiotomy, ventouse, tore, repaired with stitches. 9lb 1oz (I'm 5'2) Severe PND after. No bonding with the baby for months.

ds 2 -various growth scans as he was big from 20 weeks. Spontaneous labour, epidural, got stuck, (they knew he was stuck at 10pm but wanted me to push, he was finally delivered by forceps at 2.24 am) forceps, 3rd degree tear. Baby was 9lb 15 1/2oz.

I have had various problems since delivering my second ds, incontinence (bowel and bladder) a feeling all is going to fall out of my bits. I have been seen by the hospital and had various tests but nothing is actually wrong they think it is just muscle weakness.

I would like a third but have been told there is no medical reason why I could have a c-section so I will not be having a 3rd as I cannot have a natural birth again as I am very frightened as to what could happen. I was told 'well, you could choose to have an elective c-section..' but I was left feeling that they could choose to not let me have one and I couldn't take that chance. We are now waiting for a couple of years to make the final decision but dh has said that he finds it traumatic not knowing what is happening to me and we have two other children to take into account that he doesn?t want a third. I am finding it hard we are making a decision on having more children based on what delivery we would be allowed. I have a feeling that when I am older not having a 3rd child will be a huge regret.

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Thanks onestone.. It was the consultant that said that about a possible c-section last Tues. I just don?t trust them at all. I can imagine they would say yes, then change their minds at the last min and there would be nothing I could do about it.

I remember at the point of ds 2 getting stuck I said to the consultant I was not happy about forceps, he asked why and I said because of possible tissue damage and he said all would be fine and I was left with a 3rd degree tear. I spoke to one of the midwives the day after and I said it did seem to be a cure rather than prevention attitude they had and she agreed. I always though a c-section would have been better for me as had had a previous instrumental delivery and I was very traumatised by my first birth and I was also terrified of having another large baby. They regularly scanned me to monitor ds 2's growth and even said they would induce me at 39 weeks to prevent him getting too large but they changed their minds at 36 weeks when he was measuring 40 weeks. I was terrified. I was told I would be fine as I had already delivered a 9lb baby and that my pelvis could deliver a 12lb baby! It turns out they were wrong and I am now left with the damage caused by my second delivery.

I never knew I request a c-section...

But after all this I would never trust they would let me have one anyway.

Muppetgirl, that is shocking, if anyone who has had a previous vb should be allowed a cs it is you. Lots of women have cs after a third degree tear, let alone PND, two instrumentals. If you seriously want to have a third baby then I am absolutely certain that you could have a cs on the NHS without two much hassle at all.

onestonetogo, lots of people have uncomplicated instrumental births. Whilst they are not as 'nice' as normal births, many women who have 'lift out' deliveries heal very well physically and emotionally. (a lift out is when the mum is knackered, has pushed the head down so low that it comes quickly and easily with a ventouse or forceps). It is far safer for women to have a simple lift out especially if they are likely to have any more children as the risks of multiple cs are not to be underestimated.

baby elephant, it wasn't a panic and and emergency. they knew they had to do it as 5 days of inducing didn't work, (had to be induced as had obstetric cholestasis which according to mw meant my baby would be stillborn-have since discovered this was a theory in the 70's with no fact basis) so it was all very organised and no rush at all. it was a slip of the knife by the surgeon to cut my ds during surgery-she was explaining to the student what she was doing at the time.

Haven't read the whole thread, but I'm the obstetrician that had a home birth. Most of my colleagues have had vaginal deliveries and of those that didn't all but one had a Caesarean for medical reasons.
Nature will often get it right and the arguments earlier in the thread for as little intervention as possible are good, but of course nature doesn't always get it right (otherwise I'd be out of a job!) and for some that medical intervention, be it pain relief, instrumental delivery or emergency Caesarean can be a god-send, and as someone else pointed out, the difference between life and death for mother or baby. It's also sometimes appropriate to offer these options on psychological grounds as evidenced in some of the testimonies here from people highly traumatised by their birth experience.
The balance of power has definitely swung in favour of midwives but this has not necessarily been a bad thing and in most units I've worked in (with the exception of the large 'prestigious' London teaching hospital) the relationship between midwives and obstetricians has generally been respectful of each other's role which can only be for the benefit of women.
In response to OP, yes- after 14 years in the speciality there are things I know that you don't (would be something very wrong if there wasn't!!) but it didn't steer me away from 2 vaginal deliveries.

i'd probably have a repeat csection if i'd already had one.

but after having had involutary major surgeries to repair my knee joints after a skiing accident, i can't see myself signing up for a big abdominal surgery like csection unless absolutely necessary.

i had a forceps delivery with DD1, and it was only after coming to MN that i realised i probably got VERY lucky with the consultant who performed mine, well, when the midwife went to get her she did say, 'I'm glad it's only 4PM, because Mrs. X is very senior and really good . . .'

yes, it's not a pleasant recovery, but luckily i had no long-term ill effects and gave birth to DD2 with only a graze, which i actually found more painful (road rash on your vulva, OUCH!)

it's just too bad that so many first-time mums have such poor treatment or the maternity care is so overstretched they feel better off going for an elective csection (conditions like breech position, placenta previa and the like excepted, of course).

Oops! Sorry- I guess I was replying to the journalist and not the OP.

popstar - thanks for posting, that's very interesting.

Could you answer a question? I have a bit of a bee in my bonnet about the OB that treated me when I had DD1. I was treated without my consent and then lied to about it, so I don't have a great opinion him, although I obviously don't think that that's a universal experience. But I was wondering if he (and the unit) would ever find out about the after effects of his treatment? It occurs to me that most doctors will treat a patient and then have complete feedback on how that patient reacted to the treatment. If a surgeon does an operation and the patient develops painful scarring and life-changing side effects then that surgeon is going to know about them and will use them to evaluate their performance. If a lot of patients end up with those problems then the hospital will take a good hard look at the practices of that doctor, right?

But it seems to me that OBs usually don't ever find out how badly the women that they treat are effected by an instrumental delivery. Is that right? I posted early that I noticed that we had ticked the boxes of VB, live baby and live Mum and presumably were therefore considered a great success for him. I struggled to get any GP to take me seriously and in fact it was only when we moved into a different health authority that I was referred to a specialist, but I got the impression that even if I hadn't moved that he would never have been notified.

If I wasn't so ashamed of my complete lack of sex life, then I would be really fighting about this and spear-heading a campaign to get the results of difficult deliveries out in the open and taken seriously. There are so many stories on here of women with dreadful tears and scarring problems, and a universal problem seems to be getting the GP to realise that it isn't acceptable to have such problems and that it's not all in our heads.

and i was responding to 'Onestonetogo on Sat 19-Jul-08 13:32:15' .

not all forceps deliveries result in brain damage or are needed for shoulder disocia or the like.

my baby was OP and had her hand up cupping her head above her ear.

i got to 10cm no bother and apparently pushed her fairly well. she just needed a bit of help getting out and i pushed whilst the consultant pulled.

she breathed straightaway and didn't have any trauma after the birth - the marks on her face were pretty light and healed up in about 10 days.

'There are so many stories on here of women with dreadful tears and scarring problems, and a universal problem seems to be getting the GP to realise that it isn't acceptable to have such problems and that it's not all in our heads. '

How shocking and sad!

Go redcardigan

I have had 2 cs - one emergency and the second elective because ds was footling breech.

Both times, I have had nothing but pity from those around me, much to my annoyance. Had I not had one first time round, due to a placental abruption, both me and dd would have been in serious trouble.

Like Redcardigan says - women need to realise that a medical emergency may necessitate a cs, and if so, in no way have you failed. I was made to feel like I had failed, because I hadn't given birth "naturally". Sure it wasn't the way I would have chosen, but equally, I'm here, dd is here and so is ds, so what more could I want?

Oh, I've had some real corkers. The GP who did my 6 week check up told me that all I needed to do is to have lots of sex to stretch me out again (this is when I couldn't even sit down properly). Then I was told by the next GP that I did have a problem scar, but there was no point in doing anything about it, as I would just have another child and ruin the results of the repair. Yet another GP told me that I should be grateful that I wasn't doubly incontinent like her SIL and that she had had 3 C sections.

The worst experience was probably the first GYN that I saw though. I was determined that the consultation would be a success, and so I did everything that he wanted at the examination. I had used yoga breathing and hynobirthing techniques during labour, and practiced my "release" with my pelvic floor, so I did all of those so that he could give me an internal. It was very painful though, and I told him so. Unfortunately, he interpreted the lack of clenching and screaming as a lack of pain and told me that as he could insert a finger into my vagina "in the relaxed environment of the examination room" (direct quote) that my problems were just that I was very tense with my husband. When I pointed out that I had pain on sitting or standing for any length of time too, and wasn't scared of a chair, he told me that it was because I had a mild case of thrush.

Finally I saw a GYN that confirmed that I had a problem with capacity and a long stiff scar (and an external skin tag and skin bridge over my vagina). I'm not a good candidate for surgery in her opinion though, so even though hormone cream, and dilators have helped, I don't suppose I'll ever get a proper working vagina back.

I have bored everyone on another thread about my fear of giving birth again, given that my trust in the medical profession is at rock bottom, but I'm sure you can imagine why.

Ok, so it's down to choice and advice from the proffs. Up until today I was addamant for a natural VB at the local MLU.
I nearly fell over at my booking app 7wks ago when after going through my previous with ds1, the very lovely exp mw asked if I was going ec and perhaps I should consider!
I went natural in the big hosp last time. After 1 hour labour was ready to push and i pushed!!! Buht he was stuck firm and needed vontuse and forceps!! I needed episiotomy without a local then tore much much further!
Ater 2 hours pushing and pulling baby arrived with cord round his neck and needed a lot of help to get going! Thank God I hadn't had the drugs it would not of helped him get his breathing going! I can say he is a very healthy 7 yr old and only I know why he has a funny lump on his head! My bum didn't fall off last time and partner doesn't care what my fanny looks like it still feels good!
MW says she will support my choice whichever I make.
Talk to the ob!
MMMMM think I might go EC now I read all this. For babys safety and my own.....
DS1 was back to back was my resolve and it shouldn't happen next time was what I was told when I was being stiched up!
Reading this thread has scared me more than the nightmares from my own last exp!

Only read up to page 5 but wanted to post.

I requested an elective section at term when I was 30 weeks preg with dd. My consultant recommended vaginal dlivery as she had had three vb herself but agreed to an elective section if that was my wish. I had an em. section at 32 weeks for pre-ecmpsia and HELLP syndrome with significsnt complications relating to my wound.

I requested elective section because I'm a paeds Spr. I had seen horrid vbs from the "wrong end" and I really wanted to avoid traumatic vb for me and for my baby. Despite my wound probs I would definiely elect for a section again and recent research published in Archives of Disease in Childhood suggests that elective section at term is as safe as vaginal delivery for the bay.

This thread title caught my eye when I was looking up something else. I've read a lot of the posts here and for first time I'm posting a message as the whole topic has just made me think (even more) about my emerg c-section 2yrs ago.

Rather naively I had assumed that after a great and problem-free first pregnancy, all would be well and 'normal' with the actual birth. I was fit and healthy.

After induction and 9hrs labour/epidural I had to have an emerg c-sect under GA and it was pretty terrifying and completely not how I'd imagined my experience would be.

I did wake up an hour later and held my DS(who was delivered safely) but then had massive PPH and crashed-which I can remember in glorious technicolour detail - and had more surgery which resulted in a life-saving hysterectomy.

Waking up in ITC hours later was pretty shocking. And the aftermath incredibly traumatic, still, of course.

I had to have surgery on my throat a few months later as I had suffered damage from the intubation.

There is no real explanation as to why I haemorrhaged. There was nothing to indicate this would happen. I had no condition.
So would it have happened if I'd had an Elect C-section or even a VB? Was my uterus just one that would not contract no matter what? Would I have just had PPH anyway? I'll never know as I won't be getting the chance to try a different method.

But supposing I had experienced everything without having to have a hysterectomy and was able to have another child, I'm sure I would be terrifed of having surgery (as I was with my throat op)and would find it difficult to opt for it. It would be difficult for me to believe that everything would go OK as that's what I thought and was told last time. Even if it was elect and a calm room.

Sometimes-and luckily very very rarely-things just go wrong and doctors don't have a crystal ball.We know there were no errors with my labour so sometimes things just happen.

We are currently TTC our first- i have read this thread and had a discussion with a close relative and i am pretty certain i would like a selective C-section. I am young and (relatively!) healthy however, every female in my family (dating back to grandmother!) has had difficult traumatic births for both mother and child. I am really quite concerned about this as i do believe in the genes! Would i have any chance at all at getting what i wanted as i myself (obviously) have not previously had a difficult birth.

Maristela I am so sorry about your experiences and am sorry i do not have any answers.

Crunchynutter, I think it really needs to be a clear and present phobia to be taken seriously by the relevant people. Start working on your GP as soon as you get a BFP!(Good luck with that too btw)

'I am young and (relatively!) healthy however, every female in my family (dating back to grandmother!) has had difficult traumatic births for both mother and child. I am really quite concerned about this as i do believe in the genes!'

It's NOT.

EVERY single female in my family on both sides besides my paternal grandmother had csections.

I had two VBs. My sister had one csection (footling breech) and one VBAC.