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

In an elective there's no hurry & it is very calm (or was in my case) so that wouldn't happen. I had a spinal block. I would have to say I would hate to have an emergency c-section. I think a long labour and then a crash c-section has to be the worst of all possible worlds.

I do know a vaginal birth is natural. But I'm not keen on a lot of natural things!

I actually think that reading Mumsnet has increased my horror of birth, not decreased it!

Ahem...hate to butt in here...but I think the ones whose epidurals/spinals don't work are in a very tiny minority. (Actually the worst one I heard of was a GA, where the general didn't work but the relaxant did, so the poor woman felt EVERYTHING but couldn't communicate her distress. In Wigan IIRC.)

Anyway - I have had 4 CSs - 3 epidural/spinal (not sure now what I had) and 1 GA. All went really well and quickly, all HPs kind and professional. The first was in NY 21 years ago, no problems at all; 2nd was the GA (in Blackburn), ditto except that I had to have a nasal tube and then wait ages because of an emergency (and was v groggy until next day); the worst bit of the last 2 was getting the anaesthetic in - with the first (3rd - in Blackburn) they had to call the consultant in as the trainee just couldn't do it, with the second (4th - in Burnley) they got it in OK but it hurt so much - shooting pain down to my toes - DH heard me moaning as he waited outside...

Getting moving afterwards was very uncomfortable but it got easier every day, scars all healed well and all my bits were totally unaffected which I do think is worth a lot!

#I've had emergency c and an elective one - the first after a v long labour. Can honestly say I reocovered v quickly after both - maybe v good "surgeons" - two different hospitals though and it did appeal to my awful vanity that I now have just one v small scar.

Again a very interesting thread ...
I have my own dilemma ... similar to Lily's mum and monkey.
I had an emergency c/section after a 50+ hour labour with DS ... he was 10lbs in weight and I have not got that big a frame and no-one noticed that my bump was ENORMOUS ... I never got past 4cm dilation but for all that time had contractions every 3 minutes. A syntocinon drip did nothing hence the eventual c/s. Aloha ... you are absolutely right ... that must be the worst scenario for anyone ... labour followed by scary crash c/s. And so, by surely I must be wanting a c/s for the next one (due in January).
Not so ... I have a very funny take on this and my friends think I am a bit strange.
I felt robbed of my vaginal birth with DS but I have got over that. I actually don't care whether I have a VBAC or a C/Section next time ... it makes no odds to me ... I just want a healthy baby (and a healthy me) at the end of it.
What I DON'T want is to have an 'elective' c/s ... in that I don't want to go in to hospital on a given date at a set time and have my baby. I have this funny thing going on in my head that I want my baby to be born on the day that it is ready to ... on the day that it 'meant' to be its birthday.
So ... I really want to go into labour ... and then once I am in labour I don't mind what happens - does anyone get where I am coming from or am I mad?
My m/w has said that depending on how things go and a scan at 36 weeks she is happy for me to go into labour ... but she has promised that if after 6 - 8 hours of contractions, if nothing is happening like last time then I can have a c/s ....
So for me that is the best option.
Am I mad?

Janh - as high as 20% of epidurals do not work properly !

Aloha- you're right!!! Must have ben in a rush to go out
I have re-done the math... less than 60% require suturing!
You could ask Mears - but MOST women who have suturiong don't have trouble with it.
TBH - if medical practioners were not in such a rush to deliver/intervene.... FAR more women would not tear ! There is even debates whether we should tell women to push ! Too many push way to hard... but in a society where your 2nd stage can be timed (in my case it wasn't and it got bloody long)... no surprise that women are instructed to push and with the threat of forceps/ventouse I have seen some push (IMO) too hard.... if baby isn't in distress... it will come out if you can bear to be patient... but this is a whole different debate.
Maybe I should take you to work with me and show you wonderful vaginal births... women are truly fabulous and they have an amazing body

I had an epidural when I had my twins, on the advice of the consultant. It took 4 attempts to get one in that worked, during which one attempt went in too far (spinal tap ?) which meant they had very little control over the dose, I gave birth completely numb from the shoulders down, and was numb for about 4 hours afterwards. I also had a week of spinal headache which meant my head throbbed whenever I stood or sat up, could only lay down, popping paracetemol, codein and caffein - not the best way to deal with new twins !

With my first I had an epidural at 4 cm because of labour with a syntocinon drip, couldn't face another 6 hours! By the time I got it 1/2 hour later I was in transition. Epidural was fine, could move around, gave birth kneeling up and in retrospect I am not sure it really did anything very much.

The thought of needles in my spine terrifies me and I really wouldn't like to do it again.

Aloha - you are right - when an planned elective C/S goes well mum and baby are both well and recover quickly.

When a vaginal birth goes well the same applies. I have delivered many women who have not needed stitches and have recovered very quickly - much quicker than the best C/S.

However, in the same way that some women suffer large tears or episiotomies with vaginal birth - women having elective C/S can suffer complications too.
Only last week I was at a C/S where the spinal could not be sited (mainly die to maternal size) and a GA had to be given - a risk in itself, especially with an overweight woman.
The bleeding can be horrendous as blood vessels are cut during the operation. I have seen an elective C/S for breech result in a hysterectomy. Incidentally I have seen a vaginal birth end up with a hysterectomy too.
Babies born by elective C/S are admitted to special care baby units more than vaginal birth babies mainly due to Transient Tachypneoa of the Newborn because the fluid had not been 'squeezed' out the lungs as it is in a vaginal birth.

Before I had my own first baby I was worried about perineal trauma imagining how painful it would be. I did not feel my episiotomy being done (without local due to speed of tear developing) and it was expertly repaired. I had discomfort - not pain - and healed well with no problems. Women do have problems though, as do women having C/S.

The point I am trying to make is that elective C/S is not superior to vaginal birth. It is absolutely necessary for some women and thank goodness it can be done. There is no getting away from the fact that many women are having unnecessary elective C/S, ones either they or their consultants have chosen.

I would like to point out that the term 'emergency' C/S is not a good one either. If you have a date for a planned C/S and go into labour before that date, when you go to theatre you will be classed as an emergency C/S, even though you are very early on in labour. Even if it is only that your waters have broken and nothing else you will be classed as an emergency, but there is nothing 'emergency' about it.
Most emergency C/S are done for lack of progress in labour rather than concerns about the baby.

Crash C/S is a true emergency and isn't done common. That is when their are grave concerns for mother or baby and is done by GA - no time to wait for spinal or epidural to work.

From all the births I have witnessed, I still believe that vaginal birth is preferrable to C/S except where a C/S is needed.

However, as you know Aloha, I believe women should have informed choice regarding their delivery. If their choice is C/S, then that is the way it should be. I would not like to see women forced to have babies vaginally - I would prefer that they chose that option when given the information.

I've had 2 sections- first "emergency" for non-progression and 2nd elective. The first was OK, the second was a nightmare (mainly becuase of scar tissue from the first). I'd like a third child but really don't want another section. If you can give birth vaginally go for it (my bladder and uterus are still stick together and it feels pretty odd at times).

Mears, your postings are always so calm and informative, I wish you'd been my midwife .In fairness mine was very good, and came to the hospital on the day of my c-section to be there. She handed ds over to dh for the first time, as they couldn't get my epidural in (funny spine as well as hips), so I had to have a general.

I agree, that a problem-free, well managed vaginal birth, and a problem-free well managed c-section probably match in terms of recovery time and difficulties with baby.

But no-one has taken into account Lilysmum's mental state (i.e. her existing anxiety about the vaginal birth). surely, if she continues to have this anxiety it will increase stress levels, making the last few weeks harder, and possibly impacting on her health, babies health, and the final birth. If she can be calmed by knowing there is the option of the elective, that may well make her pregnancy much easier.

There must be some video's somewhere, showing a c-section taking place, to help LM decide?

Excellent post Mears !
Easy can I point out that Mears wrote this :
"when an planned elective C/S goes well mum and baby are both well and recover quickly. When a vaginal birth goes well the same applies. I have delivered many women who have not needed stitches and have recovered very quickly - much quicker than the best C/S."

That is not the same as what you posted : " I agree, that a problem-free, well managed vaginal birth, and a problem-free well managed c-section probably match in terms of recovery time and difficulties with baby. "

... in reality a "perfect" ceasarean does require 3 days in hospital... it is a major operation which went very well - a "perfect" vaginal birth and you can go home right away (if you didn't have a home birth) and some women are known to be going shopping hours later (NOT that I would advocate this as I think it is dangerous!)
MY SIL just had her 2nd perfect vaginal birth (3 hiurs, 4 pushes no unbearable pain) and she was "up and running" the next day

Mears, HOW is it possible you would feel such a terrible (IMO!) thing? Is it because you were in such pain you didn't notice the additional pain? I am genuinely (morbidly?) fascinated by this.
I have noticed women saying they were in such pain they thought they were going to die...this really freaks me out.
Pupuce, I am sure you are right about being told to push etc.
My friend went home after two days after an elective (her second) feeling fine. I actually suspect that, like second labours, half the reason that it is 'easier' is because you know what's coming and the predictable is never as bad as the unpredictable.

Aloha - I had an episio and a small tear... it isn't more painful than if I had falllen and had an opened wound... it was a bit uncomfortable for a few days but by day 5 it was all fine. I was sore but NOT from the episio..... from having pushed for over 6 hours.
Of course it can be more painful in some cases.... but I think you have heard too many bad stories... there are plenty of good ones. Honest !

I had an episio with 1st baby and tearing with the other three. To be honest, the pain from each of these was so trivila as to be hardly noticed - the episio (and it was a big one - 9 week prem baby needed to get her out quickly) was a slight sting similar to having an injection - I didn't even realise that's what they were doing; the tearing I didn't notice. The pain of contractions yes that was bad! The worst bit about tearing was the stitching up afterwards. For some reason this seems to have got worse with successive babies.

I am interested by pupuce's comment about pushing. I have read this somewhere else too. I have very short second stages (from 6 - 9 mimutes). When I'm told to push I push as hard as I can. I'm reasonably fit so maybe I push too hard and that's why I still tore with baby no.4.

I know some women who tear so easily that they are told to pant not push.... babies come out very well on their own. I suspect you should not push either!
You may find this article of interest

I am definitely having an elective csection next time. Although I have been told by the Prof that this is my only route I'm sure I could find someone who would let me try a VBAC - I am too terrified though after a huge PPH last time.

The thought of going in at a planned time and it all being lovely and happy is just so good after waking up in intensive care last time. It still may happen again but will be in a controlled environment with plenty of planning and vascular surgeons etc standing by.

BTW you can drive as soon as a doctor declares you fit. A friend of mine was driving after 2.5 weeks recently.

Thanks very much to everyone who offered the benefit of their advice. I'm glad that I have been given both the pro's and the con's - so a balanced perspective.

I am still erring towards a c-section but now a bit doubtful... I'm going to discuss it with the Obstetrician when I see him in November - and I'll be using some of the facts and information that you have given me (both for and against) to frame my questions.

Thanks again

Hi Lilysmum - I was wondering which way you'd go. I think that I am going to jump the other way and try another VBAC. The thought of it terifies me, but although logically everything points to c-section, I just can't seem to make that final decision, so deep down, I think that while I don't exactly 'want' to, I think a vaginal delivery is what I 'should' do - dunno if that makes sence.

Good luck with your consultant's appointment in November - maybe I'll have had mine by then. I just keep thinking of the positives - every birth is different - I bloody hope so! Remember - a lot of women have episiotomies /perineal damage 1st time & little/none the next time. Now you've done it once, chances are it'll be easier & quicker next time, and hopefully the baby won't repeat the bad position - my 1st was breech but 2nd wasn't.
Anyway, thanks to all for helpful input.

Was your 2nd a section ? and why ?

Whao are you asking pupuce - if it's me, then, no , 2nd was vaginal delivery from hell, if it wasn't me, I'll just go and run away.

It was YOU !
Well you had never laboured that's why you had a hard labour (as we all do)- next one (vaginal)... a doddle.... promise You've streched up all the bits down there, your uetrsu knows how to contract efficiently and your cervix has opened once... next time jsut sneeze (OK I am exxagerating a bit) but -Mears can confirm - the next time is extremely unlikely to be nearly as hard !

uetrsu = uterus .... it's coded

Thanks for the words of encouragement I think now I've 100% decided, I feel a bit happier. Still nervous about the size - this one feels big to me - last one (the vag. birth) was 3.7 kilos, this one feels bigger. Last one got shoulders stuck - is this called distocia? and is this likely to happen again, do you know (no more questions after this, honest, or I'll be talking myself out of it).

I also had a bad experience with my first DD. In labour for 48 hours with the epidural not working properly. Second time round though things should have been easier but in fact were 10 million times worse. Had to be induced then had epidural which again went wrong - consequenlty had to be done again. Being monitored every 4 hours and after 24 hours still was only 6cm dilated. They decided that I would have to have a c-section. Totally scared the life out of me. However, as I produced a 11.10 baby I'm glad that I had it even though it wasn't planned. Still at the end of the day I would have preferred a normal delivery but there's no way I was giving birth to DS the natural way.

I think my problem was that I wasn't prepared for it at all. Nobody had told me that I was going to have such a large baby and it was such a shock.

The trick to having a c-section is to try and get mobile and moving as fast as you can. However you still have to take it very easy and of course there's no driving for 6 weeks which is a pain. I think you have to have an open mind for all eventualties

You can drive sooner. Look at your insurance. Mine said nothing whatsoever about not driving, and I felt fine doing it almost immediately.