Let's talk elective cesarian please.

[wb]

Am starting to think about conceiving dc3 and one of the big question-marks over the whole idea (at least for me) is how the baby is going to come out.

Briefly, both ds1 and ds2 were OP babies - ds2 did turn during labor but was very big. Anyway, although both were vaginal births, on both occasions they became distressed during 'pushing' and were delivered using forceps. I have no argument with this, and found neither birth particularly traumatic, but the residual damage/scarring to my pelvic floor is considerable and I really don't want a third forceps delivery for this reason (although of course if I found myself in the same position again I'd agree straight away cause would want them out safely asap).

So anyway, if I do go for no. 3, do you think I should consider asking for a c-section? And who could I discuss this with? I have to admit I'm not keen at all on the idea but neither am I keen on, say, incontinence, or more scar tissue.

With ds2 by the way I had a 1-1 midwife who was really great at keeping me mobile etc so I don't think there is anything more I could have done to avoid the forceps.

Youu can talk to the consultant about having an elective c-section. If you are very clear about the reasons and the distress that further complications from a forceps will cause they should be absolutely fine about it. Mine were elective c-sections due to previous problems and I have never regretted it. Elective are far safer and less stressful than emergency and it sounds to me like you have an excellent reason for wanting one. And stick to your guns if one consultant can't help you, ask another one. It would be a shame if this stopped you from adding another member to your family.

Thanks BB. Out of interest how/where do you get a consultant? Don't think I saw one for pregnancies 1 and 2.

Someone else might know whether we automatically have the right to be referred for an appointment. If you are only seeing midwives they will pressure for natural delivery but they lack the medical expertise that your situation warrants and may just make you feel more confused and upset by the whole situation.

I would ask your GP to refer you to one, you could kill two birds with one stone and ask for a consultant who can address the damage left by the forcep deliveries and from there discuss your concerns and ask him/her to advise and refer to an obstetrician. They may even be able to repair some of the damage.

With my first pregnancy I actually saw an obstetrician for one private appointment and then as he was so good asked where he practiced NHS and went to that NHS hospital via him. I was then placed on his team. However I had very complicated pregnancies which is why I was forever seeing consultants so try my first suggestion.

Does all that make sense, I do ramble.

From memory with DD and DS's pregnancies I didn't see a consultant either but I had the name of one on my notes. This time round I saw the consultant at 12wk scan as DS ended up being an EMCS.
When you have your booking in appointment with the MW start mentioning it then that you would like to speak to a consultant regarding delivery and you will get a meeting with one then its upto you to put the case forward of why you would like a CS, totally agree with BB if that consultant isn't responsive then ask to speak to another consultant until they take you seriously.

wb, your care will normally be midwife-led unless you are in a specific high-risk group, when it will be consultant-led. For example mums with previous sections will be automatically under consultant-led care. You may not be able to get referred on the nhs if you are not high risk, but maybe you need to speak to your GP/midwife about possibilities and /or if you feel strongly enough about it, going private.

The only thing I would say is that a c-section is not the easy option it is sometimes depicted to be. There will also be scar tissue, you may end up with a typical "caesarean overhang" on your scar (not pretty), you may take up to 6 weeks to be properly mobile, you won't be able to left your other dc's for quite some time afterwards, you have a higher risk of infection and the risk of death during a section is about 6 x higher than than during a vaginal delivery.

It's not that I'm trying to put you off, I just want to point out some of the less attractive points of having a section. Your doctor will go through all this with you anyhow.

Look up as much information as you can on c-sections and then if you decide that is still what you want to do, you can go to your doctor/midwife armed with all the facts and aurgements and be sure of what you want in your own mind.

sorry, "lift your other dc's" not "left" them... Its late....

I would agree with the advice to speak to a consultant and ask them to advise you about the damage to your pelvic floor, and what they would advise for the 3rd delivery.

I would do that rather than go in asking for a section if you arent sure that is what you want, IYSWIM.

If you dont usually see a consultant during pregnancy then just tell the midwife that you want to, you will be nominally under the care of a consultant even if you never actually see them.

Thanks everyone. I don't actually want a c-section - for all the reasons that KnackeredOldHag outlines above - what I really want is a quick, straightforward delivery with no intervention or tearing - doesn't everybody? But am not sure that my body could cope with forceps/tearing again, so yes, I need to talk things over with a (hopefully) sympathetic obs/gyn.

wb I can empathise, I had a forces delivery with DD then emcs (well they call it a crash section as it was straight to a General anaesthetic I wasn't in labour but had a pain). This time (not due til May so long way off) I would dearly love to look into a crystal ball and see what type of delivery this baby would be and whether I would need forceps/ emcs etc. Its a lot to think about and weigh up, personally for me I have thought about it long and hard and am opting for an elective section this time round.

Good luck

Knackered- is it true? Does a c section really carry a 6 xtimes greater risk than vaginal birth? I'm booked in for 10 days time and now I'm scared.

knackered are your stats based on an emergency CS or elective? Or does it not affect the stats?

Nesta don't panic, I am sure there is good reason if you are booked in for a cs to be having one.

Statistically c-sections have higher mortality rates, but most of them are done when there are already serious problems, especially in an emergency situation. Surely far less dangerous if they are scheduled. Don't worry nestafiesta!

Hi WB.
I had an ECS due to medical reasons - it was my only option after previous ops on scar tissue from my first birth (also forceps and OP baby). It was a lovely, cathartic experience, and the risks of infection and complications are far less than with emergency sections.

I would think with your previous trauma you have a fair chance of a C/S. You can also sometimes pay a fee of a few hundred pounds to a consultant at the hospital where you are receiving NHS treatment to perform you a C/S if you wish, if you haven't otherwise been scheduled for one / if they don't agree.

If you choose to brave it however, you can find the birth stretches out the previous scar tissue making you more comfortable down there, but it's an unknown isn't it? I know how worrying that can be. Good luck TTC

brightredballoon those stats are based on elective cs. Risk of death with emcs vs vaginal birth rises to 9x. Obviously though this is comparing an uncomplicated vaginal birth vs uncomplicated c-section and there are many cases where c-section is life-saving.

Nesta as redballoon says, I'm sure if you are booked in for cs there is a good reason for it. The risks can only really be compared if looking at uncomplicated vaginal birth vs cs.

CS is often thought of as being the "easy" option and it is not. If there is no good reason to have one, vaginal birth is preferable from a safety perspective. In cases where there is a good reason to have one, it can be life-saving. This is why medics always needs to weigh up risks/benefits of major intervention such as cs.

I should also add, I had 2 elcs. The first because ds1 was transverse. If I had gone into labour, both my and his lifes may have been put at risk. With ds2 I opted for a repeat cs because I have strep B infection which I wasn't convinced the hospital would give antibiotics for during birth and I also had >1 risk factor for uterine rupture with a VBAC. In the end I was glad I had a repeat section with ds2 as the surgeon commented that the damage to my uterine wall was so great from my first section, the wall was very thin at the point of the scar tissue.

It's always a difficult call to make but it should be remembered that a cs is still major surgery and should not be entered into lightly.

Thanks all, I have plenty of food for thoughtThanks all. Lobster I never considered that the scar tissue might stretch - it just feels so solid that I imagine nothing could shift it.

The risk of death is not six times more likely with an elcs, maybe twice at a push. A baby is safer, after 39 weeks, with an elcs.

I've had four sections, 2 emergency (one GA) and two elective.

Agree posieparker - I've had two elective sections (family history big babies and problems, DC1 over 4 kg and odd position etc etc). All surgery carries a risk and you certainly have to weigh that up - but the maternal risk of an elective section is certainly not 'six times' higher - if you think about it the (often criticised) rise in the proportion of sections in the past 20 years would have led to a huge rise in maternal deaths if that were true! Scar tissue seems to depend on the skill of the surgeon - a good ob-gyny on my second one left me with practically no scar at all - but you can't rely on that. Good luck with your decision.

Okay, was interested so looked up this Canadian survey

www.cmaj.ca/cgi/content/abstract/176/4/455

Note that there is an increased risk of cardiac arrest in the mother with an elective section - there are indeed risks and you have to weigh them up. Note also difference in in-hospital actual maternal mortality non-significant.

Obviously there will be other surveys out there. Obviously there will be slight differences in end results.

Message withdrawn

Knackered- what is your source? I asked my midwife and she said no way was the C-section risk of death 6x that of a vaginal birth (or 9x in an emergency as you have pointed out). I've already had an EMCS and my next one is elective. I am very slightly calmer about the elective than I was about the EMCS, but your info is very alarming and I'd be interested to know your sources.

Everybody else- thanks for trying to calm me down! 7 days to go!xx

Just double checked. The official NICE guidelines state a little under 5 x greater risk www.nice.org.uk/nicemedia/pdf/CG013fullguideline.pdf.

However, as I stated previously, you need to bare in mind they don't usually do elcs without having a medical reason to do so. In those cases the risks of having a caesarean are weighed up against the risks of having a vaginal birth (which will not be uncomplicated if cs is recommended in the first place). In other words, if you have been recommended to have a cs for medical reasons, there is probably a good reason. If not, don't take the decision to have a cs lightly and if you read around on the subject, weigh up the risks/downsides you are willing to take and still opt for a cs, at least you are doing so from the stand-point of being fully informed.

Message withdrawn

As stated in my original post, I am just pointing out that the decision to go for a c-section is not one to take lightly. You need to consider that as with any medical treatment/procedure there are certain risks associated with it. Also as with any medical procedure you need to weigh up the risk/benefit ratio.

If risks outweigh benefits, it is better to go for a vaginal birth. If benefits outweigh risks, go for a c-section. This is something only you yourself can decide in consultation with your medical team. Everybody's situation will be different as well.

All I am saying is that before making a decision you need to go into that dsecision with all the information on both the upsides and downsides of both cases and to realise that c-section is not the "easy" option it is often portrayed to be.

As I also said in my original post, this was not information given to try and put anyone off, but to point out that there are some less preferable sides to having a c-section.

Nesta, I would also like to add that the risks/benefits of c-section vs. VBAC are different to c-section vs. normal vaginal delivery. In this case, some people (myself included) beside that the option of a VBAC presents risks they are unwilling to take and c-section still becomes preferable. As I say, it comes down to individual circumstances. I wish you luck with your birth. My intention was not to scare you. I thought I had brought that across in my post of 10-Nov-09 01:47:37, but clearly not.