Risks of Cesearean Section

[Rochwen]

Every book tells you a c/s is 4 times more 'dangerous' than a vaginal birth but I never know what they mean by that.

So, what exactely are the risks, side effects and long-term problems of a c/s for mother and child? Also, surely a planned c/s will be safer than an emergency one?

Oh, and just how likely is it to get a urinary infection because of the catheter?

Thanks,

Rochwen

Rochwen, there are a few good reasons to go for trial of labour. You can try labour for a short time, and if it's not going well, give up right away. It isn't an "all or nothing" deal - you don't have to choose between an elective section and 36 hours of hell.

I had an elective section with DS1, which involved pretty much exactly the sort of resperatory problems for DS1 that Marina describes. He was 39.5 weeks, healthy and fine, but (we think) they didn't suction out enough of the fluid. He was in SCBU for 30+ hours. I didn't get to hold my baby until he was over a day old. We had problems with breastfeeding as a result. I still get quite upset about how wrong his first few days were, as a result. (Section was because he was footling breech.)

With DS2, I had a sort of trial of labour - I had lots of prelabour, my waters broke, his head wouldn't engage, and I wasn't even effaced, so we went for a very relaxed "emergency" section. I think the prelabour stuff sorted out his lungs, he was fully cooked, and the hormones were all good, so he fed very well. I knew what was coming, so the section went very well. Because of the hormones, my milk came in faster.

So there is a sort of third way - you can wait and see. If labour starts, and you aren't dilating, go for a section. If your waters break, and nothing is happening, go for a section. But who knows, maybe labour will be ok. You can opt out of induction and instrumental birth. You can set targets as you go on. It is under your control.

Cockney, I know what you are saying.

The problem is just that I don't trust the medical system here. I don't trust them to respond to my needs and wishes. I don't trust them to give me a c/s after I've 'had enough' of my 'trial'. I'm worried they are going to let me wait (e.g. because the midwife is too busy to notice, the theatre is occupied with another delivery etc) until it's too late and I will end up with a dreadful instrumental delivery or a very rushed emergency c/s. I am worried it will be 36 hours of hell. I just don't trust our hospital.

Unfortunately I believe that, in my case, a planned c/s is the only degree of control I can get, and I really want to avoid a butched vaginal delivery at all costs. Perhaps my circle of friends has been really unlucky but my friends who had a vd seem to have had more problems than the ones with a c/s, emergency or planned.

Oh Rochwen, and I thought I was alone in my cinical view of the NHS. I totally agree with you. When I read NQC's post I thought to myself "My, you have a lot of faith in the system". A faith I most certainly don't have.

I asked for an elective section largely because I don't trust the NHS to make the decisions I would want them to make... and because it guarantees a team of doctors will be in the room.

I went to Quenn Charlotte, and my experience in theatre was very good. I assure you I don't often praise the NHS, but I would reccommend QC any day.

Well, I have a lot of faith in the system because I have had a reasonable experience, generally with the NHS. I always had my own midwife, though, which helped loads - even though home water births are her area of expertise (and what I actually wanted, both times!), she was a great help with both my sections.

It really helps having someone medically savvy along, who knows you, your situation, and your preferences, and who can help make sure you get what you want. I think some partners can maybe fill this role, but not many.

An elective section still doesn't necessarily get done at the scheduled time - mine ran hours and hours late. My elective section was much more rushed (and disastrous!) than my "emergency" one.

NQC, afraid my experience of trial of labour wasn't quite as "relaxed" as yours. IME once I was in Labour ward I wasn't particularly treated any differently from anyone else, except that they did highlight my problem on the main ward board (ie staff would have known what to look for). But nevertheless there was no way that I had control of the decision to go for a c/s:- it was made once the staff thought that the baby was in distress (and yes, it was after 36 hours!).

Also for both my births there was no consultant physically present - all the consultations were done between the registrar and consultant by phone, so I didn't even have the opportunity to give input into the discussion.

I think that if you would be unhappy/distressed by an emergency c/s under these circumstances then you should make that point forcibly, as this will affect bonding etc post-birth. For myself it wasn't an issue - I was totally euphoric, presumably due to at least 12 hours of gas and air!

NQC - did you get a dedicated NHS midwife?

No, I had an independent midwife. The NHS should provide dedicated ones, but I don't think it does.