elective c-section?

[katzen]

Hi all

Im 28 weeks along at the moment. All going well but now starting to think about labour and my options.

Im concerned that on my mum's side she and my aunts have all ended up with c-sections due to complications.

Im also concerned that I have extremely low blood pressure and blood sugar (fainting a lot) and feel an extended natural labour may not be the safest.

Though I do respect that a c-section is major surgery too- i just feel that I would rather not worry that my baby would be at risk if my blood pressure dipped for a long period as opposed to a c-section.

Any advice on how to approach things if i wanted an elective section?

thanks

you need to speak to your midwife and ask her to refer you to a consultant as it is the consultant that makes the decision.

as for how to approach it - I would read up on all the pro's and cons to both birth methods so that you can enter into the discussion as informed as possible.

If you want it, but there isn't a real medical necessity for having one, then you will have to pay and go privately. Expect it to cost upwards of 10 thousand pounds - no matter how amazing your private health insurance is, it won't cover you if it's elective surgery. If on the other hand you are referred to a consultant in the NHS who thinks you require a C-section for medical reasons (unlikely that family history alone would cut it...pardon the pun) then you would have it done on the NHS.

Hi

Thanks for the info. Also what I am concerned about is that I have had a very bad reaction of general anaesthetic previously (unconscious for several days and breathing problems).

So, worried that in an emergency section I and the baby would be at risk if a general was needed; compared to a spinal block in a planned section.

most 'emergency' CS's are done under epidural anaesthesia or with a spinal block. Doesn't really sound like you've got a good enough case to convince the medical establishment to me. More like a severe case of the willies.

nice of you to judge, i assume you are medically proficient- no, didnt think so

Katzen, if you have medical insurance which will cover you if you needed a section for medical purposes, then I'd say make an appointment with the private consultant of your choice and get his/her opinion - there are a number of 'conditions' in which c section would be covered, including low lying placenta, and, interestingly, malpresentation. And it's down to your consultant to make that call, as to whether he/she thinks you 'might' fall into those categories.

On the NHS you have every right to request the birth YOU want, and your care providers should either take that into account, or reassure you enough that you're happy with your birth plan. And anyone who makes a judgement about your choices is undermining all women and their birth choices and rights.

I too have low blood-sugar and low blood-pressure, and had 2 C-S prescribed by the consultants. They were too worried I would pass out.
My experience, and it's only my experience, has been very good. I hope you get the birth you want.

Yes, I am actually. You won't always get the response you want to hear katzen.

(tightens belt on judgey pants)

Wouldn't you need en epidural then but don't they lower blood pressure making it even worse for you? I have low blood pressure myself (how low is yours?) and am pregnant with my 4th, had all 3 previously naturally.

I was born with part of my pelvis underdeveloped and had surgery to correct it as a child. Plus, my mother had three CSs because of our position and her narrow pelvis.

I'm now 13+4 but as soon as I found out I was pg I was concerned about whether I would be able to give birth naturally and whether the baby and I would be safe. I made sure I highlighted my concerns in my first appointment with my MW and fully explained why I was worried. I am now having a risk assessment with a consultant and feel much better about the whole thing.

I had to push for the consultant but it was so worth it. Whether they decide I should have a CS or natural birth I feel my concerns will be taken on board and examined.

Issues with general anaesthetic are a good reason for them NOT to give you an elective section. If the spinal block fails at any time during surgery their only option is to give you a general as they can't stop the surgery once it's started....
I very much doubt low blood pressure (something that can be controlled by administration of fluids which hospitals are well used to doing with epidurals) or a family 'history' of sections due to complications (unless there is a specific complication which you don't suggest) will be enough to convince them to give you an elective section.
This is not meant to sound harsh... I do think you should make every effort to chat though your concerns with a consultant, for your own piece of mind.

katzen there are consultants out there who will agree to a c section even with no medical reason for tokophobia.
You need to find a sympathetic consultant to discuss your reasons and your fears.

Agree with others that spinal and epidural can lower BP so this doesnt really hold up your argument, whereas a normal delivery does not lower bp necessarily. However low BP can be managed with drugs and fluids.

I had 2 normal deliveries which went very well followed by the worlds worst c section (emergency but done under epidural).

Please think about your choices carefully and I hope you get the birth you want

Katzen, have you considered looking at hypnobirthing to calm your fears? Following a traumatic first labour and delivery I am terrified of giving birth again (am 17 wks preg now though). I have read the Hypnobirthing book and am planning on doing the course. It's by no means a magic answer but has certainly made me feel (from what I know so far) more confident that I can do it.

missismac you should really watch your tone. What do you have against women undergoing elective c-sections? I had one & think it's the best decision i made. Elective c-sections are far less risky than emergency ones.

Scara - Nothing. I think that elective CS's are brilliant for those women who need them in order to give birth safely. From the info that OP has given us it doesn't sound as though she's one of that percentage. It does sound as though she's looking for reassurance that she is though. you're right about my ECS being much less risky than EMCS's too, but vaginal birth (where possible) carries dramatically less risks than both, hence a good Obs needing a valid medical reason to do one on the NHS.

Sorry about tone.

sensible post from pamplem0usse, also labour usually increases BP slightly rather than the opposite.

Pamplemousse, my consultant sent me to see both a neurologist and a cardiologist, and they decided that I should have a C-S under GA because of the low blood pressure and low blood sugar.
And a different consultant took the same decision 18 months later for my second child. I also had an amniocentesis under GA for the same reason.

I too pass out very easily and it's just a mechanical problem, not me being a drama queen.
Basically the vagal artery dilates too much when you feel under stress or in pain, and it makes you pass out.

OP, I think that you should decide what you really want and I hope you find a consultant who listens to you.
For what it's worth, I would have preferred to give birth naturally in good conditions, but it all went very well for both me and my babies.

I do hope you get the birth experience that you want; I asked for an ECS - was told it was 'out of the question', I was not assertive enough to argue but ended up with an EMCS with GA - to be perfectly honest it did not bother me, really easy recovery, but it would have saved the NHS a lot of money and hassle if I could have had the ECS I had requested in the first place.

I requested an ELCS with no medical reason and was refused so asked for a second opinio and got it agreed - Lovely experience and went on to have second by ELCS also. If you want one it is possible to get one but not easy and you need to be prepared to put up a fight. An as Hevster says make sure you get all clued up with pros & cons before you go. Hope you get what you want.

Please don't underestimate how major a surgery caesarean section is. It takes at least 6 weeks to recover. You can't drive, you will struggle to pick up your baby your partner may need to take longer off work to look after you and baby. Most will advise that in total in you life you have no more than 2-3 sections, so think about how many children you want and how far apart you plan to have them (should be at least 1 year to 18 months between sections). There is risk of damage to bladder and bowel.

Nearly all c-sections (even emergency ones) are done under epidural / spinal anaesthetic but I would worry about your previous problems with GA. You need to ensure your team know about this and that you see a consultant anaesthetist in clinic whether a desicion is made for elective section or not. The anaesthetic team need to know about you and make plans either way. Spinal and epidural WILL drop your BP. With give medications to counteract this but it can sometimes drop dramatically and cause problems to baby BEFORE you have sufficient block to do the op. Then GA is needed and it can all be a bit dangerous.

None of this is meant to alarm. If when weighing up all the risks and benefits a caesarean is best then have one. However, don't assume it's the easier option because it isn't.

Go for it and fight for what you want. Be thick skinned and prepared to be asked by everyone 'why' you want the elective.
Really it is not theie business, so go ahead and find a sympathetic consultant.

I have had one EMCS and one ELCS - both recoveries really quick.
Driving almost right away and certainly able to pick up my own baby.

I was back at work one week after the ELCS.

I forgot to say that both my recoveries were very quick. I was up and about within 36 hours and carrying my baby, driving 10 days later.

I know that a lot of people recover really quickly from elcs, but it is not always an easy ride - especially if you have low blood pressure.

Mine is low naturally and very low in pregnancy, always struggle coming round after general anaesthetic and passed out several times during my labour with dd2, due to the epidural.

When I had ds(number 3) I had an elcs due to damage which I had from the previous two births. Drugs were put through the drip to help maintain my bp, but I still felt nauseous/vomited and 'out of it' for most of the procedure and for most of the next day.

The other risk is, of course to your baby. It is rare, but babies born by elcs are more prone to respiratory distress. Ds was born grunting, and with several signs of prematurity (despite the cs being done at 39 weeks. He was in an incubator for the first 48 hours and in SCBU for 8 days. I found recovery from the section hard, I had lost a lot of blood, my whole body ached for weeks and I had an infection in my scar at 5 weeks, which nearly floored me.

I really don't want to be negative, and I know that the majority of women have very positive experiences.

Also, it depends on the hospital, but I had to fight to have a section, despite having had some bad tearing and continence issues, so if you decide you want a section, prepare yourself well.

Low blood pressure won't harm the baby.

There's no reason to think that just because your mother and aunts have needed emergency c-sections that you would. You're different people, different babies and different labours.

As for the GA - the risk of that reaction can run in families. You should ask for a referral to an anaethaetist to discuss this, there is a different type of GA that you can be given that doesn't contain the component that causes the reaction. Like an earlier poster has said most sections even emergencies are done under a spinal. You could ask for an epidural in labour if you're still worried as then the access is there and all they need to do if you did need a section is to top it up.

Good luck

Spinals etc, don't help with low blood pressure, you know this right?

Anyway gone are the days now when you could find a sympathetic consultant who'd do it on the NHS for no medical reason.

Trusts now are judged and receive performance related bonuses for NOT performing c-sections as so many have been done when they were not really necessary, there is a huge drive right now to get the numbers down and cut the risks that come with the op.

People say you have choice to have the birth you want, well yes you do to a certain extent. You don't have the choice to force a consultant to agree to surgery if he does not thinks it's in your best interests, the safest option or necessary.

They made decide for you taking into account the fact the spinals lower your bp further and you are more at risk from a GA having an elcs, it would be safer to have you on fluids and a glucose drip if your sugars fall during a normal birth.