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Pregnancy

Talk about every stage of pregnancy, from early symptoms to preparing for birth.

Elective C-Section (medical/non medical reasons)

827 replies

LittlePeaPod · 11/09/2013 08:21

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.

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hazeyjane · 15/09/2013 20:40

Sorry meant to say, also unable to bf immediately after birth, because of vomiting and shaking, and because ds was unable to feed due to grunting, as he couldn't breathe.

Being able to breast feed dd2 whilst being stitched up seemed like bliss in comparison!

LittlePeaPod · 15/09/2013 20:43

Ralley I am aware that they could need to be used in a CS but they are much more frequently used in a VB. I know what a horrendous time you had with your DD. I can see why you are opposed to ECS but I am wanting to avoid getting into a position were I would need to have and EMCS particularly one that could have the sort of life changing and serious implications you have had to face. We need to agree to differ. This is my choice and I am the one that will have to live with the consequences should things not work out.

Mada There are a load more but it doesn't,matter. I didn't go into detail but for me the risks to the baby with regards nerve damage and bleeding on the brain etc. are major. I did mention throughout the thread that in my experience VB tend to go wrong and I have seen the consequences of these (my sister etc) and this may very well have affected my perception of the risks of VB in comparison to CS. That is why I also said that our experiences will affect our perception of risk. I can see your point on the funding but we have to agree to disagree on that one.

By the way I fully intend to update this thread post my ECS. I am very frank by nature and I will let everyone know exactly what I think post EcS. I don't argue just to win an argument and if I am wrong about my decision I will tell you all and why. if I feel I was right about my decision I will say that too. I am due 2nd January so that's some time away.

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LittlePeaPod · 15/09/2013 20:50

I also forgot to mention. My friend who is currently in hospital was like you ladies and very against my thoughts on ECS. She now wishes she had gone for a CS because she feels her daughter would not have ended up in NICA on an ECMO if she had. None of us know if that would have happened but that is how she feels. She now believes VB are not as safe as CS. Our experiences determine our perception and that's just life.

It's about what risks as parents we are more comfortable. You are more comfortable with VB and I am more comfortable with CS and neither of us will move from that position unless our experiences change our perception.

Good night ladies

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angryangryyoungwoman · 15/09/2013 20:52

There have been recent studies that show that when the cost for the treatment of complications after caesarean and vaginal births are taken into account, there is only a difference of around £80 between the cost of caesarean and vaginal births.

LittlePeaPod · 15/09/2013 20:52

That should be NICU bleeding IPad predictive text

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snoozysleeper · 15/09/2013 21:07

littlepea thank you for listing your detailed reasoning, I do not recall a post of yours before 20:00 hours tonight that was so clear and articulate on the matter so gratefully appreciated.

Regardless, I hope you have a happy, healthy pregnancy and also a good birth experience.

snoozysleeper · 15/09/2013 21:10

I am sorry to hear your sister had such a difficult time, and can understand why this is one of the reasons behind your decision.

Also I hope your friend's child recovers well in NICU.

Madasabox · 15/09/2013 21:10

me too snoozy. I hope it goes really well for littlepea and look forward to the update!

FraggleRock77 · 15/09/2013 21:19

LittlePea - just reading the 'Tampons after Pregnancy' thread about 5 down. Some of the posts totally freak me out and again confirm my need to have a c section. Even though I'm fully aware about the risks to both which you have listed x

thecakeisalie · 15/09/2013 21:36

I ducked out of the debate several pages ago as my points were just getting muddled. I just had to say I've had 2 larger babies (9lbs & 8lbs 13oz) and I didn't tear with either of them.

It seems to me that its a control issue that you feel with a cs you have greater control over the possible risks. I can understand the appeal but I'm still of the opinion that the nhs simply couldn't cope if it had to provide this as a choice to all pregnant women. I do respect that you've been honest and open about your decision and fair play to you I hope it goes smoothly for you with no regrets.

LittlePeaPod · 15/09/2013 21:59

Snoozy thank you for your thoughts on my sister. She is fine now just doesn't want any more kids. And thank you for the best wishes. My friends daughter is dipping well. She is a little fighter. She is off the ECMO now but still needs help via ventilation but all signs are positive so we are all keeping everything crossed and trying to stay positive

Mad tanks for your thoughts in my friend too.

Fraggle I dare not look on that thread but I am sure my inquisitive nature will get the better if me Gin

Thecake you are right control and understanding is very important to me and I do think they risks can be better managed via a CS.

Angry that was an interesting post. Thanks for sharing.

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LittlePeaPod · 15/09/2013 22:05

Fraggle I just read the thread! Shock

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SlinkyB · 15/09/2013 22:20

Hello, I've been reading this thread over the past few days, and would just like to thank LittlePeaPod for starting it. There are some good points, research, facts, evidence, anecdotes and lots of experiences shared; great thread.

It's very pertinent to me atm, as am 22 weeks pg with dc2, and have requested an elcs in January.

Ds was born by emcs; I was 12 days over due, and induced. After a few hours of contractions a mw did an internal and realised baby was breach. I had seen numerous midwives leading up to that (stretch and sweeps, checks) and they'd all told me "baby is definitely head down".

I have no desire to have a natural birth, and little faith in the midwives knowing what happened last time (I know we're all human, and these things can be hard to tell, but still, that's my experience).

So I've decided to go for elcs this time, as wouldn't want to run the risk of having another emcs. Some of my friends and family have been very Shock and Hmm that I'm not even going to try for a VB, and I've been feeling rather guilty. Like I'm disappointing women everywhere or something?!

However, after reading this thread I'm feeling empowered and more confident that this is my body and my choice.

Good luck Little and thanks everyone else who contributed to this interesting debate.

Ladyboluna · 16/09/2013 01:45

If VB tends to go wrong, I wonder how the human race could have survived up until now?

A c-section is, bluntly putting it, making a hole where there isn't meant to be one through layers of muscles and tissue, and where trauma in that area might otherwise be referred to as life threatening. It was originally done as a last resort because that's what it is. Women were born with an baby exit route already in place!

Unless you need one for a medical reason, the fact is there are more complications from a c section than from vb.

Ladyboluna · 16/09/2013 01:51

Just wanted to add as re-reading I think my post comes across as a little blunt - from what I've read there are more complications from a c section. I think in an ideal world every woman should be happy with their choice and if there immediate family have had difficulties then its understanding why someone would want one over another. Still I feel from reading this thread that a mix of emotions and opinions are being taken as greater advice than that of medical opinion, who I believe are the experts. In my type of work there's nothing more off-putting than someone walking in with a few pages from google saying they know this, etc. saying that though, they often get it wrong too.

Still I respect the reasons given in this thread. And good luck to everyone.

HicDraconis · 16/09/2013 03:42

Interesting debate. This will always be an emotive subject (like ff vs bf, sahm vs wohm) until we all stop being so defensive of our own choices. Someone choosing differently doesn't mean your own choice was wrong, so there is no need to feel defensive. We make the best choices for us at the time.

It's tricky discussing things in term of relative cost because what do you count? VB alone is cheaper to the nhs than ELCS. However, vb with complications requiring further surgery is more expensive than a straightforward ELCS. Then again, vaginal hysterectomy is easier, cheaper and a much faster recovery than abdominal (can't have a vag hyst after ELCS, needs to be abdominal) - is that factored into the ELCS cost? Statistically some women will need a hysterectomy in later life and will have to have an abdominal op due to CS (elective or emergency) years previously.

Likening it to obesity surgery ("lifestyle choices") is flawed - while the surgery itself is costly to the nhs, the cost savings in terms of reduced chronic conditions related to obesity (type 2 diabetes, joint replacements, heart & lung issues) mean that a gastric band is often the cheaper option overall.

I do agree that everyone has the right to choose their delivery method. But I don't believe the nhs should fund an elective CS service on demand with no prior medical indication. The resources to do it just aren't there.

I've worked in large hospitals with separate elective and acute obs theatres. I've worked in smaller ones where there is just one obs theatre. The usual staffing pattern consisted of an obs consultant & reg plus an anaesthetic consultant and reg on during the day, going to one registrar of each overnight. If an elective case is on the table when a true emergency comes in the emergency has to wait (with worsening outcomes the longer they wait) while a second theatre team is found, and possibly a second surgeon/anaesthetist depending on the size of the hospital. Yes it's the same if the case on the table is also an emergency, but it seems slightly more palatable that an emergency has to wait because of a prior emergency. Luckily that's rare (has happened once in the 4 years I've been at my current hospital).

Many people have to pay to have the surgery they want when they want it (plastics, joint replacement if you don't meet funding criteria for public care) - I would put truly lifestyle choice CS into this category. By all means if you want a CS for no other reason than you want it, then have it - but pay for it. Yes it means those who can't pay can't get what they want - that's true for everything in life.

Personal opinion, I think CS should be reserved as an option where vb for whatever reason is impossible or too risky. So in labour if not progressing, or baby becoming distressed, or any of the reasons we do a CS in labour now. Electively if previous traumatic birth or any other medical reason why going into labour should be avoided. But in the nhs, not on demand.

In terms of your list of pros/cons - babies are delivered by forceps with ELCS too (depending on surgeon, one here will always use forceps for cs delivery). We've had 2 shoulder dystocia cases during ELCS in the last month. It's not a risk solely with vb. On the nhs you can't guarantee your elective surgery will be performed by the consultant.

I also wonder how you will cope with the loss of control if you go into labour unexpectedly, get to the hospital to discover there is one CS on the table, one semi-acute waiting (with clinical priority greater than yours) and by the time theatre is available (with exhausted junior staff on out of hours) you're fully dilated / crowning. Unless you pay to go privately you still aren't guaranteed your ELCS.

I get that you've spoken to 2 obs consultants and a fetal medicine specialist. You reiterated that. FWIW I'm a consultant in obs anaesthesia. Not sure it makes my opinions more or less valuable than anyone else on this thread though (with the perhaps exception that I've probably been involved in more CS than they have).

HotSoupDumpling · 16/09/2013 07:08

Hic, I found your post v interesting, but have to disagree with this paragraph:

Many people have to pay to have the surgery they want when they want it (plastics, joint replacement if you don't meet funding criteria for public care) - I would put truly lifestyle choice CS into this category. By all means if you want a CS for no other reason than you want it, then have it - but pay for it. Yes it means those who can't pay can't get what they want - that's true for everything in life.

Just strikes me that you could say the same thing about, say, abortions. Or vasectomies. Which seems to me to be ridiculous.

LittlePeaPod · 16/09/2013 07:19

Slinky this statement was my goal and intention for this thread. Everything else was a mater of discussion and debate. Thank you . However, after reading this thread I'm feeling empowered and more confident that this is my body and my choice.. And by the way, I too have little faith in the MWs knowing what happened to my sister the hospital admitted liability and my friend. Happy for them to take my blood pressure and measure my bump but ultimately I don't want them to be responsible for my child's life.

Ladyboluna unless you are a Consultant Obstetrician then clearly you are not in a position to determine which is the greater risk. My Consultant Obstetrician has been in the field for 34 years and he says its safer for baby via CS and guess what. I am going with his view.

Hic thank you for your post. I do agree with your statement regarding choice but I am more likely to listen to you because you are in the field than I am to anyone that's not. You do have differing views to my consultant on NHS funding and a few other points, his view is you pay enough tax and have done for a long time so you should be able to use the NHS again that is is view. I have already discussed the forceps etc. issue and we are in agreement that unless totally necessary they will not be used.

I think the bottom line is i have no intention of having a VB (with a 50% chance of having intervention anyway) and risking my daughter getting into distress before having to have an EMCS. We have read all the awful experiences on here from ladies that had EMCS. I think what those posters don't realise is that their experiences simply reaffirm my position on VB. ultimately if those VB had not gone wrong for whatever reason then those ladies would never have needed to have an EMCS. So saying CS are worse than VB because I know I had one means the VB must have been placing you or your child at risk in the first place. I am not willing to take that risk. I have sat and looked at 4 day old baby attached to an ECMO machine in Lestershire ICUS. Trust me, it brings it home.

I do feel this thread as got to the point of going round in circles with no real progress which makes it pointless to debate

But, Slinky thank you again. You post has made it all worth while Smile I hope there are others that have also benefited to it.

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therumoursaretrue · 16/09/2013 07:30

OP thank you for starting this, I will have a proper read through all the posts later but there has been some very interesting points so far.

I had a VB with my DS, now 1 and would never ever do it again. Even the thought has me terrified and feeling nauseous. My birth was supposed to be a planned delivery due to other complications (not necessarily ELCS but induction) and unfortunately I was left too late and went naturally. This had a number of serious physical repercussions that lasted months and psychological ones which I am still suffering from. Other posters have mentioned not being able to lift their babies after CS, I could barely even get out of bed for almost a month after DS was born.

My case wasn't straightforward and obviously is not the same for the majority of VB's but I do wish I could have had access to more honest information regarding CS's as an ELCS would have definitely been in my best interests.

MoominsYonisAreScary · 16/09/2013 07:32

I had a emcs due to cord prolapse at 32 weeks so nothing to do with vb going wrong, recovery was awful, much worse than my 2 vb even though one included forcepts, blood lose and stitches.

However it was nothing compaired to my elcs, where the anesthetic stopped working before the baby was even out (although this is rare) the scar opened up and became infected and recovery was even longer.)

I think its fine to choose elcs but people should be aware that it can cause problems in future pg and births.

urtwistingmymelonman · 16/09/2013 07:33

im a bit confused by the contradiction of your previous posts op.
initially you gave the impression that you had no fear of vb,that you couldn't really give a reason for opting for an elective and that you thought every woman should be given the option of an elcs should they want one one'just because'.
slowly throughout the thread this has changed from that to you giving very valid reasons for wanting one.
im just curious to know what your actual view is?
do you think a woman should be given a cs because they want to choose the date of their babies arrival?
or that they see vb as tiring?
or that they want to keep a strong pelvic floor?
and do you think women that push for a elcs are going to give these as reasons for wanting one or will they just fib and tell people that they are doing it because of a crippling fear of natural birth for fear of appearing selfish or shallow?

LittlePeaPod · 16/09/2013 07:44

URT. I have no fear of VB but right from my op its clear that I have investigated the risks. I have also said throughout the thread that I am more comfortable with CS risks rather than VB risks. That hasn't changed. It's always been clear. And on the basis I understand the two My CHoice is to have a CS. So I would disagree my position has changed. It's always been clear right from my op. would I really have seen the specialist if I was investigating the risks?

I think women should be given CS if they want one regardless of their reasons including your reasons if those reasons a valid to them then who am I to judge them?. Again I have made that clear.

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rallytog1 · 16/09/2013 07:48

Op I just think you need to realise that pretty much everything you've listed as a risk of vb is also a risk of cs. Equally, many of the benefits you've listed of elcs are far from guaranteed. Whether you like it or not, you are choosing the facts selectively to fit your pre-conceived point of view.

I'm sorry that your family and friends have had bad experiences. I know what your friend will be going through at the moment as my DD's illness was also linked to meconium aspiration (yes - in a cs) and I send her all my good wishes.

However you are letting the experiences of those around you cloud your judgement. You will hear more stories of vb gone wrong simply because more people have vb. You will hear fewer stories of cs gone wrong because far fewer people have one - so even though the risks are higher, numerically they will happen to fewer people because the initial cohort is so much smaller. Objectively, the statistics confirm that vb is the lowest risk option for mother and baby, both in the short term and the long term, where you have a low risk pregnancy.

rallytog1 · 16/09/2013 07:51

Oh, and an obstetrician isn't a paediatrician. Therefore they aren't qualified to advise you about the long-term potential effects to your baby from being delivered by cs when there is no medical need.

LittlePeaPod · 16/09/2013 07:59

ralley I think people assume I don't know anyone in RL that has had an ECS or an EMCS. I do. They are all fine and thankfully Didn't experience the issues experienced by some of the ladies on here.all their children are fine. You have to take my word for it. I know the risks on both and I am making my choice on that basis. I have to live with those consequences. Thank you for your comment on my friend. I guess I am be clouded by my experiences but you to have based your position on CS on your experiences. Like I said before our perception of risk is based on our experiences.

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