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.

surely listing families bad vb experiences as one of the reasons for an elcs is a fear of having the same happen to oneself?

It's an understanding of what can go wrong. Therefore having experienced it and investigating the two. I am able to make an informed choice.

Not sure why this has been raised now because I mentioned it right at the start (first few pages) of the thread.

I can't imagine why it's pissed you off, really, I can't. It's completely logical and ethical to deter someone from having a surgery they don't need.

Are there points you would rather I discussed then pod other than ones you have freely listed yourself on this very same thread?

The thing is Pea, the the "people you know" and "experience I've had" don't make a statistically significant sample. So you may know more people who've had a bad vb or a good cs but that doesn't make a cs less risky in objective statistical terms.

As I said before, you're more likely to know people who had a good cs outcome because fewer people have a cs so there are fewer times it can go wrong. That doesn't mean the risks aren't higher.

So I think you've got your starting point of fear of the same thing happening to you as has happened to your friends and family (which is perfectly rational), and then have found evidence to back up your point of view, and ignored most of the evidence that doesn't support your stance. I think I'm just trying to get you to admit that your choice isn't based on objective facts but on your own subjective experience.

Incidentally, despite an attempted vb going wrong for me I still believe it is the safest choice for the vast majority of women and babies. That is because the evidence says so. My experience is just my experience. I feel cs should be reserved for those who need it (which includes electives for medical and psychological reasons).

Having said all this, I wish you well and hope it does turn out to be the right choice for you.

Ralley we really are going round in circles on this now. I have said on a number of occasion I have looked into both options probably more so than most people do. I have also said unless you or others are consultants then I will be going with the consultants advice. After all my consultant has worked in the field for 34 years and understands the stats a lot better than any of us. You are not me and you can not tell me what I am thinking or how I determine risk in the same way I can't tell you. So for you to say I have ignored evidence or that my choice is not based on objective facts etc. is totally incorrect. You have not attended my consultations or seen what I have done in the real world on this. You do not perceive risk in the same way I do as I do not perceive risk in the same way you do. Like you say regardless of your experience you believe a VB is the safest method of delivery and that's great. But my friend who is in hospital currently now believes a CS is the safest method of delivery. You both had traumatic VBs. As I have said before I am awfully sorry to hear what you and your family have gone through but this is my choice not yours. Ultimately we all have to live with the consequences of our decisions and choices. Thank you for the best wishes. I wish you and your family all the best for the future too. Best regards.

Regarding the issue of risk and the statistical chances of such. There is actually statistically more risk of having issues such as tearing, incontinence and other effects from vaginal birth. There is statistically less risk of side effects from a caesarean birth although these side effects (problems with future fertility etc) are generally considered to be more serious if they do happen. (though this is obviously subjective, the issue of 'serious'; someone who suffers permanent incontinence from a vaginal birth may consider this to be a serious side effect on a par with someone who takes longer to conceive after a caesarean, for example) To summarise, there is greater risk of issues after a vaginal birth. The risk of issues after a caesarean is less likely, but potentially more serious. This is an overview of what the research says. Ultimately, there are risks for both, it is naive to keep saying, as people are on this thread, that one is 'safer' than the other. Both have side effects and potentially unknown side effects, no one knows the extent of which until it happens. So the choice is a measured risk, which the op has analysed and decided. There is no right or wrong here.

This is a PERSONAL choice and it's not for anyone else to judge. Quite frankly it infuriates me when people start saying that it's a waste of taxpayers money etc. No one would dare suggest that a person in reciept of state benefits or someone earning below the tax thresh hold, should not receive the same medical care as someone that pays lots in tax. Because if this idea were entertained where would a line be drawn? Why is littlepeapod accused of wasting taxpayer's money but a person with a self inflicted disease is not? People can argue that it's not necessary but it is for her. Just as it is to treat everyone that needs medical attention, to make THEIR life better.

I'm proud to live in a county where everyone is entitled to socialised medicine. Yet I have always had health insurance and have therefore been less of a burden to resources needed more by others. Now I too have chosen to have my baby on the NHS - mainly because I want my birth to be the polar opposite of littlepeapod's and I think the NHS are far better at providing this service. However I don't judge her or think my choice for a water birth is any more noble.

I have been reading this post religiously and have found a lot of the information very interesting.
I am of the opinion that the nhs is a service that we are very fortunate to have and that it is not designed for people to pick and choose what they want unless they have valid reasons for their choice.
I think whether these reasons are valid depends on the nhs trust and the hospital that you use and is not up to everyone else.
Do i personally think that you should be allowed a cs because you want one on the nhs without any medical/psycological reason? No. But there are a lot of things that are available on the nhs that i dont think should be.

If the hospital and staff in question are prepared to pay the money for a elcs for the reasons given then that is their choice and the op is lucky that they allow this as a lot of other hospitals would not.

I do think that it is important to remember that if the op has an elcs and it doesnt turn out as hoped (i do hope it goes well though) then it will have been on her decision and hers alone. If she is pushed to have a vb and something goes wrong she will blame the nhs forever and that will be very difficult.

I think information on elcs should be available but women should be encouraged to have vb as much as possible (therefore i dont think everyone who wants one should have a elcs as it may be possible to show them that vb is a good choice for them) If they are adament that elcs is choice is for them, then if their nhs trust agrees then so be it.
Hopefully whatever birth plan a woman has they are able to remain relaxed and calm and it doesnt cause them undue stress that will affect their unborn child.

Op i wish you luck in you cs, but for me a cs is the one thing i hope to avoid unless absolutely necessary

angry I agree with your post and also agree there is no right or wrong. It's only what's right or wrong for the individual.

Kate I also agree with your post too. Thank you for sharing your thoughts.

1944. I would not be so disrespectful as to criticise you. You kindly shared your experiences and it just shows how lucky we are to have the choices we do now. My mum had children in the early 70s (twins-older then me) and I was a 1976 baby. She has shared her experiences and how different things were then. She explained how CS were viewed then. And also examples of differences in attitude to birth generally i wont go into all of them. For example our father dropped her off when she was in labour. Men didn't really attend labour like they do now. In those days she had to go it alone and our father came post birth. But she also told me about the fact she was in hospital for about 10 days I may be wrong with number of days and the MW helped the ladies prepare before they went home. I know how lucky I am to have this opportunity. An opportunity that would not have been available to me back then. I also know how lucky I am because in the last few decades there have been significant improvements in techniques, medicines and outcomes of CS. I also know CS are safer than back then but I also know Cs are not risk free or easier than a VB.

Frizz thanks for sharing your thoughts and tank you for the best wishes. I really hoe you also get your wish and never ever have to have a CS.

We all seem to agree on one thing. That is there are no guarantees in any birth. I really do believe antenatal education has a duty of care to help women understand that regardless of birth choice, intervention may be necessary. IMO it's really short sighted to focus solely on VB. I have become more convinced that antenatal education is generally failing women I understand some women would rather not know by omitting key information about CS when preparing us for birth. Like I said before a VB I am sure is a wonderful experience for those that choose it. But, births don't always go to plan so surely its better to prepare women for all circumstances. The more informed we are, the greater our chance of a positive experience.

I had two sections because I wanted to. They were both wonderful calm experiences. I had no issues bonding or breastfeeding and was walking around same day.

Don't let anypne make you feel bad. There are potential risks with any type of birth; do what is right for you.

Also, I have no overhang at all, only a small scar just below my bikini line. I don't know why people are so desparate to tell you your stomach will definitely be ruined by a cs.

Butwilliseeyouagain thank you for that.

No worries! :)

You get a lot of people scare-mongering when it comes to CSs. Suspect a lot of them are confusing elective with emergency. Naturally there are risks, as there are with any type of birth. Some of my friends have had bloody horrific vaginal births. Hemorrhaging, 4th degree tears, broken pelvis etc. A section is major surgery so there are risks there too eg infection.

Do your research and get a really good obstetrician. Many are very supportive to deliver your baby how you choose. Midwives prefer you to give birth naturally, unsurprisingly!

Butwilliseeyouagain Yes you do get a lot of scare mongering about CS. I also think many women are nervous/scared/worried to challenge the prevailing hegemony and request an ECS for fear of been stigmatised as too posh to push or "you think it's an easier option" or having no faith in their body or some other ridiculous stereotype. In the same way the used to be a lot of scare mongering about home births but now its all the rage with MW pushing it to every woman that they think could have one. My MW is a lovely lady but if she had her way I would be giving birth at home, with no pain relief possibly under a tree. From the moment I met her all she talked about was having a home birth, until I started asking questions about other options/pain relief etc. But even then she always pushed for a home birth. I completely agree that ECS are very often confused with EMCS that's not taking away from potential risks.

LittlePeaPod - unless your doctor is the only consultant in the uk, his opinion isn't the be all and end all. Maybe in some ways its safer for baby. In others, not. What about safer for you?

Also, has it occurred to you that many doctors are too polite to disagree with someone who is clearly hell-bent on getting a cs?

In fact I don't think us women should have the choice and it completely bizzare that its come in. Would you ever think you were qualified to tell your doctor how to look after you in any other situation?

Ladyboluna I am unsure whether you read my op or the thread from the start. In case you haven't had an opportunity to. If you read my op and read through the thread you will see that I have got independent advice from three different consultants that specialise in their field and not a just my doctor. Although my GP is also fully aware of my decision and so is my MW. I find it completely bizarre and outdated that women should not be able to choose what happens to their bodies and how they want to deliver our babies.

With regards my safety I think we discussed my thoughts on CS risks in some depth on the thread already. Going through it again is simply going round in circles.

Ladyboluna it is a good strategy to find a doctor you trust and do whatever they suggest but it is also reasonable to be an active patient and become informed about the different ways of treating whatever is your condition and the varying risks with different options.

When I had suspected ovarian cancer the surgeon was very keen for me to make an informed decision between different degrees of surgery or non intervention. DP had an operation recently and the anaesthetist discussed three different possibilities for anaesthesia each with different risks and benefits.

I am halfway through my pregnancy. My circumstances are different from the OPs but I will probably need to decide between trial of labour and elective cesarean. So far I have found out that some bad outcomes are more likely with one path and others more likely with the other. A doctor cannot tell me which risk I should take. There is no risk free option.

Can I just point out to those saying ELCS take up theatre space that might be needed for EMCS that "elective" is just medical terminology for "scheduled in advance". Some ELCS are done at maternal request because the mother thinks it is the lowest statistical risk for her, some are done for mental health reasons (tokophobia, for example), some are done for the mother or child's physical health (placenta praevia, pre-eclampsia, in my case, low birth weight - my baby was deemed to be too fragile to be put through an induction, but because of the risk of placental failure, they didn't want me to go too far beyond term). One of my friends had an ELCS at 32 weeks for pre-eclampsia (scheduled 3 days in advance, to allow for the steroids to take effect). Not an emcs, but done because without it she and her baby would have died. Mine was not urgent in this way - simply that the consultant's expert opinion, based on stats, was that an ELCS was less risky for my particular baby than an induction or a very post-term natural delivery.

I just wanted to make that clear because even if you disagree with Little Pea Pod (I personally don't -CS wouldn't have been my choice, but LPP has thought seriously about the risks and decided it is the right choice for her), I'd hate for this thread to become fodder for Daily Mail frothers who think all women having ELCSs are simply "too posh to push".

Re. cost, I don't feel the slightest bit guilty. Because one of the reasons for changing NICE guidelines is that once you factor in post-birth costs of repairs to fistulas, prolapses, etc, the average cost of a VB is approximately the same as the average cost of a CS. Of course, straightforward VBs are cheaper, but the total cost including corrective surgery of a bad VB is higher. So just quoting costs for the actual birth itself doesn't tell the whole picture.

I have found this thread really interesting sometimes infuriating to read and I thank OP for bringing the subject to light.

I am booked in for an ELECS in 3 weeks and 2 days. I dont feel guilty, I dont care about others opinions because at the end of the day its my baby, my body and my family and everyone else opinions are just that opinions.

ive had some pretty nasty comments along the way and more so from other women which have shocked me but have not deterred me.

as ive said before on this thread whats shocked me most is people's anger towards women who choose to have an ELECS and yes their is anger in this thread from others. ..

their is such a stigma attached to it and their really shouldn't be

I really do think the NHS have a level of care to inform a woman of ALL birthing choices with warts and all.

I personally wanted a VBAC this time after 2 EMCS with my older two, but I am looking at ELCS with potential for another EMCS due to placenta praevia.

I think there are risks either way and women should have the right to choose, but it is also right that women are encouraged (not forced) to give birth the way nature intended unless there are extenuating circumstances.