Elective C-Section (medical/non medical reasons)

[LittlePeaPod]

I understand this subject has been done before. I also know that ECS particularly as personal choice rather than as a medical need is an emotive subject and the debate about CS birth can be particularly contentious.

Considering 1 in 4 women in the UK experience a CS birth I have been disappointed to see how inadequate access to CS antenatal information is, so women can make a truly informed decision. Personally I think it's short-sighted to focus solely on VB and continually emphasise managing pain relief. The NHS is so focused on their target to reduce the 1 in 4 CS due to cost that they are neglecting their responsibilities to those women that choose or want a CS birth regardless of medical need.

I am currently 23+6 and I have chosen to opt for an ECS. There is no medical reason for a CS but this is a birth choice that I want. I understand that CS and VB both carry real but different risks but I believe these risks should be explained to women so we can make informed decisions about which birth risks we wish to take. Unfortunately this is not the case and the push for VB is so endemic in the NHS that women are not receiving the true facts on CS.

For those women like me that want an ECS birth. I just wanted you to know that due to the new NISA guidelines if you want/choose a CS the NHS now have to give you one. They will do everything they can to try and change your mind to the point of trying to scare you and make you feel guilty about your choice. But, regardless of medical need if you insist that a CS is the right choice for you the NHS have to honour your wishes and give you a CS. I am fortunate to have been able to privately pay for independent advice on VB and CS from three different very well respected professionals in the UK (two consultant obstetricians and one consultant in fetal medicine) and also received advice from a close family friend who is a consultant anaesthetist. I was shocked to hear how target driven VBs are in the NGS and how in fact this is what's driving the push for women been made to think they should have a VB and not the safety issue.

Ladies it is your choice how you have your babies and what you do with your body. If you want a CS you can have a CS regardless of medical need on the NHS. My DF and I have just spent a lot of money finding that out. I am 23+6 and the NHS have now confirmed I will be having an ECS and there is no medical or psychological need. I am having it because its my choice. I wanted to share this because prior to spending a fortune getting non biased information I was under the impression that I had to prove a VB was medically necessary, would psychologically affect me or that I had a fear of VB before a CS would be authorised by the NHS. Well that's not the case, its about personal choice. VB or CS you have a right to choose and the NHS have to honour your choice. It's just a shame and has royally pissed me the fuck off that if your choice is an ECS for non medical reasons the NHS are making it so difficult for you to opt for that choice in an informed way.

Flowers. If you read through the thread you will see that they cost debate has been had and I don't see the point in going round in circles on it. As one of the other posters pointed out if cost was the only consideration then as her Head of Midwifery Services in their hospital presented to them it would work out cheaper for the NHS to force women into having ECS at 39 weeks. I would love to get a hold of the data that was presented by that Head of Midwifery Services! Now I don't think it would be right to force women into having CS just because it would work out cheaper for the NHS. I think it would be wrong to take that choice away. So as stated before I will leave the cost issue aside but please feel free to discuss it if you wish to. With regards timing of the birth. A woman can actually wait until the labour process begins before going in for her ECS again this has been discussed earlier so you can wait until the baby is ready to be born if you so wish.

Whether or not you think I am doing what is best for my daughter is irrelevant to me. Unless you are a Consultant Obstetrician or a Consultant specialising in foetal medicine then your views are just that. Views based on your experiences and what you have read, just like mine. But you have a right to express those views. You also have a right to see my choice as selfish and bizarre in the same way I think your views on same sex couples having children is outdated, small / narrow minded, selfish and bizarre but I am sure you don't care that I think that.

Giving birth is a means to an end for me.. That is true. The research was for me to determine which method of delivery I wanted and which risks I was prepared to take. I have researched both VBand ECS. The method of birth doesn't determine how well a parent someone will be in the same way their sexual preference, been a single parent etc. doesn't determine how well a parent someone is/will be.

Thrustbadger you are right, you never know what could happen in the future. I could be knocked over by a bus. But if I do become critically ill or need medical assistance due to ill health I am fortunate to have have had for many years private medical, health, critical heath and death insurance. I am fortunate to be able to do that and I am fortunate not to have to rely on the NHS for those services/treatments.

Ralley. I fully understand that things can go wrong and you can't account for everything. I could be the 1 in 1000 that suffers the risk but my choice is I am more comfortable to take the CS risks than to take the VB risks.

Madox I have earlier in the thread said a couple of times it's because my DF and I feel its the right choice for me and my daughter. Having researched the risks I am more comfortable with the CS risks. Also my experience watching what my sister and people going through traumatic VB I understand will have had an impact on my perception of those risks. I too was am a HR tax payer and as highlighted earlier in the thread I self fund and never use the NHS. I go into further detail about why I am making the NHS pay this time earlier in the thread too.

I read the following quote which I thought was really good. If I've learned anything in ten years of motherhood, its that the way our children are brought into the world means very little for how they will live in the world. Nor do the intense hours in which we become mothers shape the months, years and decades of our actually being mothers. And if the experience if childbirth is in fact a crucial process, then let it be the process of teaching us that our children will emerge in ways varied and complicated, not necessarily in times or manors of our choosing, neither made in our image nor as proof of our prowess.

As stated before I am really interested in people's thoughts and feel this subject should be debated. But could I ask that maybe new posters review the thread. I am conscious we may go over old ground that can answer some of your questions. I hope you are all not offended by this request.

But really, why do you feel it should be debated? You certainly seem decided so the debate won't sway you, and the way things are within the NHS with regards to granting ELCS is fair. I'm not sure what needs to be debated.

A slight aside, but by DF are you talking about your father?

kir. Because I feel that other women in my position that feel how I feel shouldn't be afraid of expressing their feelings and thoughts because of the stigma attached to ECS or because they may be judged / attack for their choices by other people. I knew a lot of people would not agree with my choice but what has surprised me is the level of anger some people have for my choice.

Zola no, I am am talking about my fiancé (male not female)

I don't feel angry about your choice and I have read the whole thread. I do think the cost debate is relevant given the state of the NHS and I do think it is selfish of you to force the NHS to pay for your birthcare choice. One could easily argue that all of us who choose to have children take more from society than those taxpaying individuals who have no children at all. Having said that as I have already said, I fully support your decision to choose your birth method, but I don't think that choice should be funded by the NHS. You appear to have no rational reason at all for forcing the NHS into funding it when you can afford to go private, other than some random rationale that it "owes you", which it doesn't. Cost incidentally, isn't just monetary, it is time and resources too and there aren't even enough midwives in many parts of the country. I would prefer money to be put into funding better care for the majority than "choice" for the individual. Those are the hard decisions that have to be made in a state funded system.

You still haven't answered the question properly. You have already said that your fiancé is comfortable with the risks and that you prefer the risks of a CS vs a VB even though both are comparable in some cases (by no means all). What you haven't specified is what it is exactly about a CS vs a VB that you prefer. What benefits do you think it brings you that a VB doesn't or is it all about the negatives ie the potential for risk with a VB vs the certainty of the risks with a CS. Also your comments re the experience of your sisters and their experiences with VB would seem to indicate that you do have some fear/concern re a VB based on their experiences. That is certainly understandable, but it is an emotional component to something which you are trying to portray as a purely rational decision.

Madas I didn't say everyone was angry. But from this hread you will have seen alot are. Writing all the risks / benefits associated to VB and CS on here would be like writing a paper. I am sure you willundrsand. I have alluded to some earlier but I guess you will have to accept that my choice is down to the risks and which risks I feel more comfortable taking. And as noted erlier people have a right to think my choice is selfish. The same way I think some decisions made by others are selfish.

I agree the MW services in his country are inquest and you see the threads/posts on here from new mum to bes expressing surprise at their 10/15/20 minute MW appointment. Antenatal does need more funding overal but I disagree with taking that from birth choice. I think it should be taken from other cuts (certain benefits etc.) but that's a different thread and as we know anyone that dares rise any form of benefit debate on MN is accused of entity bashing.

This thread is starting to feel a little like its going round in circles a bit like watching sky news

That shoud be benefit bashing

I don't think you said everyone was angry I was just clarifying that I am not, but I do love a good debate.

On that subject, I don't understand why you would begin a debate about your choice and indeed the right of other people to have that choice without being prepared to reveal the decisions behind the choice. I for one am happy for you to list the top 5 benefits you took into account in your heavily researched decision - if only so that other people considering making a similar choice can benefit from the effort you have made. It may also help them in arguing for a similar NHS funded choice, which would seem to be the aim of your original post. Unless your benefits are something of which you are ashamed?

I am more than happy to share that. I am just getting off the trai so will share later. If that's ok.

This post caught my attention as my DS1 was born by EMCS and for my 2nd born I am certain I will choose baby to be delivered by ECS.

Little pea pod I have to agree with mad as a box that your reason for choosing ECS had not been explained the reason you give 'it's my choice' it not a reason for choosing ELC. That is just saying its my choice which of course it is no one has the right to tell anybody else what to do. I think everybody and I would like to know how you come to that decision. You did touch upon the risks of VB vs CS maybe you could explain this further.

Personally I am going to choose a ELC for my second as I don't want to go through through a long 40+ hour labour to end up with EMCS. I know from experience that CS is not the easy route, I may end up with a GA as spinals epidurals didn't work last time, the pain from the incision is really bad and the whole recovery is around 6-8 weeks. But I honestly don't believe that I would have a successful VBAC so for me would rather have the CS not being exhausted from labour.

I do think that there are good reasons why a woman would want to have a planned c section. I can think of quite a few actually, I am sure we can all imagine what it would be like if, let's say, someone had been raped or sexually abused, or if (God forbid) the woman's mother would have died in childbirth. I am sure that there are many more reasons, some too awful to think of, others that might be related to past trauma, or mental illness. It's obviously something that should be discussed between a pregnant mother and her midwife/consultant, and I hope that the NHS would have the capability to support these women as best they can and if that includes offering them a planned c section I would fully support that. However, I have read most of the messages on this thread and I do not agree with OP, I don't think that the NHS should be offering c sections just because (no reason other than that's what she wants and what she believes to be right for her).

That's a lovely quote LittlePea but tbh I think it undermines most of your argument! If how our children emerge into the world is not important, why have you spent so much time, effort and money ensuring you have the utmost control over it?

littlepeapod I have read the great majority of this thread and therefore forgive me if this has already been asked:

You say that you are planning on an elective c-section despite having no medical/psychological reason behind this. You simply state that this is the 'right choice for you'. I am in early stages of pregnancy and would like to understand more of your rationale I.e. why is the right choice for you?

You mention that you understand all the risks therefore I assume (maybe wrongly?) that what drives your decision is the perceived benefit from having an ELCS? Is this right? If so what benefits are you hoping for? Given that for you these benefits must outweigh the risks associated. Is it the predictability of date/time? isit the perception of less pain? Is it that you will not damage your perineum? Or, of course, something I haven't mentioned?

I can't help but be genuinely very curious about the background/reasoning of your choice.

I am not advocating that you are not allowed your choice as the system currently permits this. Whether this should be permitted is an interesting debate and it has been interesting to read many of the posts here.

Also it would appear that you've presented yourself to independent doctors as reasonable, rational and having done thorough research. I very much doubt that in these discussions, when asked reasoning that you would reply with 'it's my choice, I'm entitled to my choice, I pay tax'.(sorry this is an abridged version).

There must be an overwhelming influence for your decision that does not appear to have been openly shared and I think that is why some posters are becoming increasingly frustrated.

From your OP it seems you would like to encourage/empower the general public to enable them to have similar discussions. But despite this you only allude to your reasoning and this makes it more difficult to understand the decision. I assume you shared this on a national forum to inspire debate and therefore that is why there are repeated questions as to your influences/reasonings.

I was told that unless he moved the right way I'd have to have a ELCS, which I really, really didn't want! I'm quite petite and his being footling breech was not good. Luckily after some exercises he moved down :) I'd hate to have an ELCS for no real reason but at the same time I don't judge women that do. If someone is truly terrified of having a VB then it might be best for her mental health and reassurance to have an ELCS. I also think expecting a woman to have a VB a year after a CS, as mentioned in a post above, is awful.

I am hopefully having a VB with no pain relief as my mother and grandmother did BUT I'll suck it up and do whatever is best for the baby at the time.

I've also heard from a private consultant OB that if I wanted a CS and I made a fuss (I'm an only child...it comes naturally hahah) they have to respect my wishes so I don't think littlepeapod is wrong in this instance. I just think it takes a certain type of person to have the time and inclination to push for an elective Caesarian, because the NHS do put barriers to stop this. I've always wanted a VB and now I'm looking into a water birth...even if it's just to piss my MIL off, who is convinced I need a CS or at the very least an epidural. As I so politely told her 'God willing, he's coming out the way he got in.' HAHAHAHAHAHAHAHH.

I have just got in so not read all posts but I did say I would highlight some of the reasons I am having a ECS.

Commen benefits of VB and ECS (under regional anaesthetic)

• awake and alert and can breast feed the baby straight away
• immediate skin to skin and eye contact
• DF can be present

ECS

• safety
• speed
• much more controlled with the most senior dedicated expert medical team at hand
• prophylactic choice
• avoidance of labour unless I decide to have a Natural ECS. I have not decided on this point yet
• vaginal protection - shamelessly shallow I am sure I will be told this
• Timing, if I don't go or a natural ECS then I can choose when our daughter is born. This though cant be guaranteed

I also want to avoid the following VB risks

• Blood loss --my sister nearly died in a VB due to a very serious hemorage with her second and she refuses to have any more children as a result
• EMCS, not willing to risk our daughter getting into trouble through labour
• Ventouse

-Forceps -Episiotomy

• Induction
• Delivery injury, considering 85 to 90% of women tear not all requiring stitches
• MW staff shortage

I also don't want the following risk to my daughter

• possible instrumental (forceps etc) injury
• nerve damage

-shoulder distortia

• bleeding in the baby's skull
• breathing difficulties (meconium), if you look on my history you will see a close friend is in hospital because of a traumatic VB right now which nearly resulted in them losing their daughter. Their daughter ended up on an ECMO machine and is still in high dependency. So before anyone says this can't be serious I am fully aware of how deadly it can be.
• Delayed breast feeding in cases of exhaustion etc.

I think that's enough for now. I don't need to justify myself but I did say I would put a few points up. Clearly I have gone into this with my consultant in great detail. I shall leave you all to pick it apart.

Snoozy. Most of you questions have been asked earlier. And I did mention earlier that happy for all to join debate but could they read through posts so that we don't go over old ground.

Kate pissing myself at what you said to your MIL. Ha ah ha ha.

All the risks such as haemorrage, instrument use and injury to the mother are all applicable to cs as well as vb. If you go nhs you also can't guarantee you'll have the most dedicated senior team on hand.

Equally, the risks to the baby such as meconium aspiration and instrumental injury are also applicable to cs. You may also find bf is delayed after an elcs as you may be vomiting and too shaky to hold your LO from the anaesthesia.

I'm really sorry to say that it sounds like you're trying to make the facts fit your pre-conceived point of view, rather than making your decision after objectively considering all the facts.

Fair enough and very interesting. Thank you for posting them. It seemed fairly obvious that there would be a number of emotional as well as logical reasons why you should choose to go down the ECS route. Obviously most of your VB risks are miniscule, but they are clearly very important to you and that is all that matters frankly given it is ultimately your decision. I was just very curious given you are a first-timer. My friend made a similar choice and her reasons were also similar. She, however, regrets it now, which I very much hope you will not. I have had two horrible VBs, 36 hour plus induced labours and really thought after number 2 that I would opt for a private birth/ECS for my 3rd. Now I am pregnant with number 3, I know that for a number of alternative reasons, the thought of a ECS fills me with horror. That, however, doesn't prove anything other than that we are all totally different and many people won't understand your choice in the same way that many people won't understand mine. Good Luck.

PS - I still don't think it should be NHS funded though if you can afford to go private. Morally I mean.

Op, I wanted skin to skin with my cs, but couldn't have it as the drugs were making me shake uncontrollably (which I found deeply unpleasant). I couldn't hold dd until we were in recovery, after everyone else had had a go first. My vb was traumatic, but even so I got skin to skin straight away, before anyone else had held my baby.

Cs does not mean no risk of instrumental delivery. My dd was delivered with forceps during a cs. This is quite common. That was an elcs, not emcs.

Bleeding is a known complication of cs that can result in hysterectomy. I'm not sure why you think you're at less risk of bleeding during cs than vb.

The perineum is designed to tear. It's tough and heals well in the vast majority of cases, not leaving a scar. Your swapping a possible tear for a guaranteed lifetime's scar on your belly (which is accompanied by a charming overhang, btw).

No, I don't get it. I'd have more understanding if you were terrified of labour, but your reasons as stated don't make sense to me.

Yes, rally - my ds aspirating meconium into his lungs was one of the problems he had at birth, and I also had a huge blood loss - like I say, unlucky!