Thinking of an elective c-section (long)

[Lilysmum]

Its early days for me yet (circa 10 weeks) but I am thinking of requesting an elective c-section. I am told that the obstetrician that I have been referred to may be receptive. I feel that it is the right decision for me but am not sure. What do you think?

My reasons are as follows:

*Had bad labour first time around. Anterior presentation (notoriously causes the most painful labours). Also very lengthy labour.
*Had to give birth in a theatre because they thought there was an evens chance they may need to proceed to emergency c/s. In the event I had ventouse, forceps and a whacking great episiotomy
*Episiotomy wound became a bit infected with a strep infection and I experienced soreness for months. The whole labour process gave me some psychological sexual dysfunction problems (i.e. I just didn't want to do it for months and months because I thought something might rupture!)
*My baby although full term was born with some breathing difficulties and spent a short spell in SCBU (I am sure related to foetal distress during the delivery)

• I don't like or trust midwifes and their dominant ideology of 'natural is best'. In fact I HATE them (sorry - few repressed feelings coming out here)... *Lots of near misses have been reported in maternity units in the news recently due to understaffing in midwifery. At least with a planned c/section its medically led planned care *at least 10% of women who give birth vaginally go on to experience either urinary or faecal incontinence...either straight away or in later life (and I know some of them!)

anyway the downsides which put me off are:

coping with a new baby and my (by then) 21 month old when I am not supposed to life

not driving for 6 weeks when I live in the countryside and am dependent upon my car.

Would value peoples advice and comments. Thanks

sorry typo - I meant to say 'when I am not supposed to lift'

I am the big fan of electives round here (!) so I'll get my bit in first. I did lift everything as normal. OK, I didn't move any wardrobes but a kettle and a baby presented no problems. Lifting your toddler might well be more problematic. I drove the minute I felt organised enough to get out of the house. There was certainly nothing on my insurance saying I couldn't. I honestly don't know where this 'six week rule' comes from. No dr mentioned it to me. I recovered quickly and easily. I enjoyed the feeling of being in control of myself and the predictability of c/s birth. It certainly wouldn't suit everyone.
I'm sorry you had such an awful time. I am sure you will be told that not all births are the same and that you are likely to find things progress faster, less painfully next time. That may or may not be enough reassurance for you.
I looked into it a lot and even though I had no choice over my cs, I did believe it was a safe procedure.
I think psychological reasons for a c/s are as valid as physical. Congratulations on your pregnancy. You've got a long time to think about this. YOu must make the choice that makes you feel happy and optimistic.
Not all midwives are evil. Mears is a latterday saint.

I'd say go for a section. When I was pregnant with my first and attended classes or read pregnancy books, I just couldn't picture giving birth and was as most mothers are quite scared of the prospect. In the end dd had cord around her neck and was distressed so they sectioned me quite quickly. With dd2 I tried to give birth naturally but only dilated about 4cm and sensing my apprehenion about the whole thing they sectioned me. I was back to myself after a week. and as theres only 14 months between dd1 and dd2 I had to lift a lot but you cope no problem. Driving I left until about 4 weeks as I had help around me but I could have driven sooner. Know what you mean about some midwives, they were appalled at me saying second time around that a section would be very nice thank you. I think it was Joan Rivers who said about childbirth "wake me up when the hairdresser arrives" and I tend to agree. I think we all know our limitations and capabilities and it sounds like this is the option you'll be happiest with.

Have recently had an emergency cesarean. Not comfortable by any means, but we all recover. Driving thing is a bit of a pain but can cope with it. You may find that having a wriggling baby as well as a toddler close to your scar uncomfortable but copable.

I had a very bad labour before the c-section, and it has actually put me off falling pregnant again. (this may fade with time). I could understand why you would elect to go straight to the c-section.

I would say go with what ever makes you happy. You may even be given the opportunity as your first labour was so touch and go. I know the midwife mentioned that i would be given the option.

I had an elective c-section with ds, because of my having funny hips, and would suggest that you go for it.

I honestly had no problems with it, but I do heal well from surgery (believe me, I have plenty of experience, especially this year).

You do need to make sure someone will be with you for the first couple of weeks to do the lifting etc. ease the problems of lifting by making sure that moses basket/bath stand/changing table are high enough. (The problem is mostly bending and lifting rather than carrying from an upright position). As you get nearer full term encourage your toddler not to need so much picking up. cuddle him while you are sitting in your chair, or let him stand on your armchair while you stand and hug him.

The 6 week driving ban isn't automatic. Your insurance company will probably say you can drive when a doctor says you are fit to do so, so if you have no other probs, this shouldn't be too much of a difficulty, test your GP or obstetrician on this. My GP gave me permission at 3 1/2 weeks.

Finally bear in mind that an infected c-section wound will be just as painful as the infected episiotomy wound was (but could go deeper). If you are prone to such infections, or your hospital has a particularly bad reputation for infections then think again. I didn't have any prob with infections tho.

People told me that I would take a long time to get over a c-section, but honestly, after 3 or 4 days I felt fine. I know lots of mums who took longer to recover from labour than I did.

But do try and keep yourself fairly fit, and not pile on too much excess weight during pg.

Incidentally, my baby was always very placid and easy to deal with, a good sleeper right from the start. I attributed it to not having the terrible stress of being pushed and pulled about when being born, but I may be wrong (oh and he didn't have a funny shaped head, which often happens during labour.

Finally I would say talk it out with your obstetrician.

Thanks you guys,

Its nice to get some balanced and positive views about c-sections, they usually get uniformly bad press.

....and apologies to Mears the non-evil midwife! (actually my sister is a midwife too, and I quite like her...its just the ones with the closed mindsets that I take exception to...you know, the one's who think they are advocates of what women want, unless of course you are a woman who wants pethidine, epidurals etc)

Can I play devil's advocate or am I too late ???

I am not trying to put you off and from what I read from your original post I can't see you (now) wanting a vaginal birth but I am aware that other women do ask themselves that question so I thought I'd explain why sections are not that great either (and of course elective is less risky than "emergency"

Here is a reply to some of your specific worries

• As someone pointed out if your section scar gets infected it can as bad or worst than the episiotomy infection
• Breathing difficulty are more common in sectioned baby than vaginally delivered babies (it is one of the reasons why sections are not recommended on the whole : respiratory distress syndrome - it can kill a baby) - babies usually have lower APGAR scores too.
• At the Portland a woman died due to poor section care... sorry there is no guarantee of no mock up with a section... they could also leave forceps or other surgical instrument in you that was reported this week) - if staff can make errors in vaginal births they can also make them in ceasareans. And don't forget that once the section is done you are looked by the same midwives as the women who delivered vaginally... their understaffed everywhere !
• Statistically you have higher risks of many problems to YOUR body during the section and it can get as bad as needing a hysterectomy or dying ! According to a 1999 study in The Lancet, even when emergency Caesareans are excluded, maternal mortality occurs nearly three times as often in Caesarean deliveries as in normal births.

As for driving as someone said - ask your insurance company - usually they await Dr's approval... the reason you are not suppose to drive is that if you are going to break a bit hard and your seat belt does its job.... you could really hurt/damage your scar !

Breastfeeding is not always straight forward when you can't sit up - but this can be overcome with good support. And there have been studies that are showing a link between length of BF and elective section... i.e. if you have an elective your baby is less likely to BF as long... but if you don't plan to BF long term than this may not be an issue.

I know someone whose first birth experience was very much like Lilysmum (including terrible backpain when she was told she wasn't even in labour, near-miss C-section, very large baby, episiotomy & ventouse). Her 2nd baby (also named Lily, btw!), was born with very little fuss. They barely made it to hospital in time labour was so fast and (relatively) easy.

hi Lilysmum - I've been reading your replies with great interest. I'm 32 weeks and having the exact same dilema as you, except I've been chewing it over & going round & round in circles for weeks & weeks to the point I'm now loosing sleep over it! And I'm running our of time. (sorry to everyine , I'm sure most mumsnetter must be sick of my fretting, but it's great to hear someone trying t make the same decision)

My 1st delivery was emergency c-section due to undiagnosed breech. My recovery time was very long & uncomfortable, but in hindsight I put this down mainly to appalling post-natal care (good old Chelsea & Westminster).

I really wanted a natural birth, and for my 2nd pg had no 2nd thoughts but to go for VBAC. My labour was very fast - less than 2 hours from 1st contraction, baby got stuck, I had massive episiotomy, threatened forceps, 3rd degree tear and months of painful scars, painful sex, pain pain. Recovery definitely longer & more painful. Zebra, I'm glad your friend was so lucky, but quick doesn't necessarily mean good. I've been advised my next delivery is also likely to be as quick, if not quicker, and that really scares me. I've already torn so badly, i'm terrified of it all bursting open again.

Now I keep going round in circles. i think I'd almost finally come down on the c-section decision, but then I read pupuce's post. the thing that puts me off the section is the longer hospital stay and the fear of complications - mostly for my boys than for myself. I'm now back to that eternal circle.

Lilysmum, how do you feel now after reading your replies? Do you feel any closer to a decision? Would you like to make mine for me? (Only kidding)

OMG, that sounds like an awful experience. I think honestly the risk of anything very bad happening with a c-section as very tiny. Remember, that 99% of women having sections (even 'elective' ones) are having them because something is already wrong with the pregnancy which means that of course there are associated risks . For example I had placenta praevia, which means that even with a section I had a high chance of uncontrolled bleeding which can lead to all sorts of hideous things and I could have ended up needed an hysterectomy. However, a vaginal delivery would have been a totaly medical disaster and I and ds would probably have died. I could have had complications after the cs, but they would have been due to the PP rather than the op, if you see what I mean.
Without those sort of complications most specialists say that a modern cs is a very safe procedure - at least it won't lead to a third degree tear, which is a pretty big complication in itself IMO. You may well find your recovery from cs much easier this time. My friend went home after two days following her second section. I also had a quick and easy recovery. There are advantages and, of course, disadvantages with both methods of birth, and I would hate to push you into a decision you weren't happy with, but with your history, an elective cs without the trauma and exhaustion of labour beforehand might feel surprisingly easy. I was going to suggest that if you go the natural route, I would suggest you have someone with you for support like a doula (like Pupuce) but it sounds like you wouldn't have time!

Monkey, two things I'd like to say following your post... your second pregnancy was your first vaginal birth which loosely speaking means you are more likely to have interventions. My first delivery sounds similar to yours with a large episiotomy, ventouse assisted deliver and 3rd degree tear. The difference is that I healed well and quickly with little pain and no complications. 2nd time round, I had an "elective" episiotomy to protect the previous tear when it looked vulnerable but no further assistance or intervention was necessary. Again I healed well and quickly.

I was offered an ultrasound scan (no photos to take away though) to confirm how well the tear had healed and whether it was advisable to attempt another vaginal birth.

What I'm trying to say is that your next delivery won't necessarily be the same as the last one.

Lilysmum, I know of people who have had fantastic c-sections, I know of bad experiences and I know of a work colleague who died following c-section complications. I know of a similar range of vaginal birth experiences (without the last one). Both methods come with a completely different set of risks and only you can decide which set you wish to take and which are applicable to you. It seems you are doing the right thing by weighing up the pros and cons from early on. You don't need to decide now and can change your mind later. Second labours don't always follow the path of the first. I must say that I considered c-section with DS2 but in the end, my personal pros/cons list came down on the side of "normal".

Good luck!

Aloha - I am quite interested where you got the 99%???

Pupuce, it's an educated guess. Around 9 per cent of c-sections are electives. As you know, elective means pre-planned, not 'chosen by the patient'. So out of those electives, the vast majority will be for breech presentation, very large babies, small pelvis, placenta praevia, previous sections etc etc. c-sections for 'social' reasons are extremely rare and almost impossible to get on the NHS (sadly!) And the number of women who have babies privately to get a c-section without a pre-existing complicatin is tiny.
BTW I really wonder about statistics about complications. I read the litany of appalling things that happen to women with 'normal' births, the tearing of flesh, the cuts to the vagina, the stitches - surely these are 'complications' of birth? Not to mention the many other horrors I read about on this website. I honestly cannot imagine having my skin literally tear apart. It truly makes my flesh creep and my blood run cold. It sounds like torture to me!

Pupuce, it's an educated guess. Around 9 per cent of c-sections are electives. As you know, elective means pre-planned, not 'chosen by the patient'. So out of those electives, the vast majority will be for breech presentation, very large babies, small pelvis, placenta praevia, previous sections etc etc. c-sections for 'social' reasons are extremely rare and almost impossible to get on the NHS (sadly!) And the number of women who have babies privately to get a c-section without a pre-existing complicatin is tiny.
BTW I really wonder about statistics about complications. I read the litany of appalling things that happen to women with 'normal' births, the tearing of flesh, the cuts to the vagina, the stitches - surely these are 'complications' of birth? Not to mention the many other horrors I read about on this website. I honestly cannot imagine having my skin literally tear apart. It truly makes my flesh creep and my blood run cold. It sounds like torture to me!

Aloha - allow me to dispute your figure if I may.... why is it that in the UK 24% of women are having sections whilst some countries have numbers around 10% and Belgium and France - which are into HIGHLY medicalised births have 15% of sections.... are you saying that British women have higher chances of having "something is already wrong with the pregnancy "??? (to use your words).

There are the planned section due to medical reasons... placenta praevia is an excellent example. There are women who have sections because of psychological reason (such as tochophobia - intense fear of delivering vaginally) .... then you have the "previous section" group... now depending wher eyou go... some Drs feel you SHOULD try it and others would much rather that you have another section.... these are women in similar scenarios with DIFFERENT recommendations (sometimes 1 women will be told 2 different things within 1 hospital!).... there is nothing wrong with their pregnancy!
And then you have the large number of women who end up in "emergency" sections... a significant number of these could have been avoided if these women had NOT been managed from the start or had better care during their labour.

So I disagree with your 99% figure - I would say that it is MUCH lower... 99% of women who have section do NOT have something wrong with their pregnancy!

Then you write : " I read the litany of appalling things that happen to women with 'normal' births, the tearing of flesh, the cuts to the vagina, the stitches"....
Here is some info :
It is estimated that over 85% of women who have a vaginal birth will sustain some degree of perineal trauma and of these 60-70% will require suturing. Perineal trauma may occur spontaneously or intentionally by a surgical incision (episiotomy).

If my maths are correct.... 15% of women have a perineal trauma... and in total only 10% require suture.... that's LESS than the 25% of women who have sections. Not all suturing is cause for a traumatic experience... and it's only the traumatic ones which are worth "talking about", "telling friends about" - I had one and I never talk about it because it was fine... my clients who have had tears or episio had no problem with it (and I know as I follow them postnatally).

I'll shut up now... off to wedding anniversary dinner

If you have had major surgery before, and recovered well, I would say go for the section.
If not, I would think twice. I took a very long time to recover from my csection and mentally I felt traumatised for ages as though I had been sliced in two...also my body wouldn't do what I wanted it to for a while which upset me.

The other ways to 'calculate' risks of a c-section is just to be aware of the possible, likely or most common post op complications so that you YOURSELF can detect any problems and alert medics for treatment purposes. Don't leave it up to medics to do all the things you can do to protect you from complications ....like disinfect toilet seat before sitting on it, not having a bath in unclean hospital bathroom, protect your scar from infection.... I'm having an elective and intend taking in my own dressings, ones that I know are protective. Read up on things like how to get out of bed without hurting yourself, how to adopt an easy position for breastfeeding etc... better informed is better planned and all that. I don't feel too worried about my elective as I have had major surgery before but I am taking trying to anticipate what I need to prevent post op complications....

Pupuce, I don't want to argue - honest! - but I don't understand your maths. 85% of women suffer perineal trauma, and 70% of those need stitches - how does that translate into 15per cent? How could you bear to have your skin literally tear?? I don't understand how any human being could stand that. It's literally beyond my comprehension - even worse it the though of being in such pain that I could not even feel my own skin splitting apart. Yikes! The horror! If that happened during c-sections the revulsion would be universal. I never had anything that awful happen to me in my life, and, please God, I never will!

Please God may nobody take a sharp knife and cut into my abdomen, parting muscles, slicing around fat and muscles and internal organs when there's a perfectly good alternative route for the baby to exit my body. The idea of someone tugging the baby followed by serious pulling on the placenta to rip it out of of a big hole in my tummy, blood dribbling out the side, sounds like something out of the movie Alien.

I guess we are each allowed our own personal definition of "torture".

Indeed we do Zebra! I just can't imagine that degree of pain, I really can't. With surgery, there's none, and you don't see anything either. I think if you have a vaginal birth you are very brave, but it's not for me.

BTW, it's a surprisingly small hole!

Oh, and isn't there plenty of blood in a normal birth? And cutting/tearing? And stitching? But without the 100% effective pain relief?

Did you have your C-sections under a general, Aloha? Only I remember the story of the lady on misc.kids.pregnancy: she had 4 epidurals, none of them worked properly. The doctors wouldn't believe her when she said she could still feel things and there was much worry about the baby so they started an emergency C-section while she could still feel everything. They put a gas mask on her (to give her a much delayed general) when she started screaming & thrashing too much. She has tingling in her spine for life from where one of the epidurals nicked part of her spinal cord. Yup. Effective pain relief, all right (NOT).

I think the posting name is Melody, if you want to look it up on Dejanews .

We sh0ouldn't lose sight of the fact that we are "meant" to give birth vaginally and our bodies are designed (however poorly) to do this. C-section is a fantastic option when an emergency occurs or where the normal route would result in a disasterous outcome and the procedure has undoubtably saved many lives. However, I don't really believe it should be the first choice where no medical necessity exists. I agree completely that women should be able to choose the birth they want be it natural or c-section but a part of me doesn't think c-section should be chosen just for the hell of it (so to speak!)

Having a vaginal birth is not brave just as having a c-section is not cowardly (or brave, depending which side of the fence you're sitting). You can, of course, have an epidural which offers the chance of 100% effective pain relief.

I guess the c-section hole is about the same size as the standard route isn't it ?