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.

Dear LittlePeaPod

Thank you for bringing this up and letting other mothers know that we have this option under NHS, although it seems quite a lot of fighting is involved.

Reading some of the posts on this thread once again alerts me to how pro-natural birth people are in England. I am originally from Asia where people get to choose either C-section or natural birth, since it is a personal choice and each method has its risks/benefits, we do not criticise other people's decision as much (or as fiercely) as here.

Upon my arrival and my pregnancy, I also found out that, to my surprise, that the medical care in this country is less advanced than I thought (sadly less than where I am originally from!) and people are often not given medical information about C-section/natural birth except some generic information like you recover better after natural birth, C-section is more expensive for NHS. The population tends to accept generic information, question less and accept lower standard of care both during labour and post-natal (compared to other developed countries - remember we are supposed to be in a 'developed' country).

I really admire you for taking this up, for doing thorough investigations with consultants, and for exercising much independant thinking. I can imagine it is hard for you against this cultural backdrop.

I wish you a very happy pregnancy and a very smooth delivery, best wishes from many of us.

Thank you littlepeapod for this thread. I have encountered the same reactions about my elcs from NHS staff and some people in my life and agree that it is a problem for those seeking an elcs. The biased information and scaremongering that goes on is negative, unhelpful and does not mean that a woman has a free 'choice' unless she is prepared to do her own research, as you and I have done. It is something I also feel very strongly about, so thanks to you for starting this thread and to everyone who has contributed. Very interesting reading.

I love this thread, well done littlepeapod.
I too have asked for an ELCS but unlike you I did have to jump through hoops, ie pretend the fear was psychological, see the perinatal team etc before they would agree to it.
My reasons are simply that:
-I want to get a specific date to give birth.
-I want doctors in the room, not just nurses, professionals who have trained for 7+ years who I can have full faith in. I just can't bring myself to have the same trust in a midwife, I am sure they are perfectly good if the birth progresses "normally" (and indeed in my London teaching hospital they are all lovely); my fear is if something goes wrong they are not properly equipped to deal with it (and if they were, why would/do they need to call a doctor when something does go wrong?)
-I want to be guaranteed an epidural. In the NHS they try to push you to use gas and air, thus saving more money, or they say the anesthetist (apologies, sp!) is in surgery so unavailable and then suddenly it's too late and you've progressed too far.
-I have friends who work in the NHS who say that some midwives don't like to have to "defer" (for want of a better word) to doctors and therefore will keep you pushing often for longer than medically right, endangering both the mother and baby.
-I think the downside of an ELCS recovery (and I'm not naive enough to think it's pain free) is outweighed by the potential downside to a VC (going 2 weeks overdue, being induced, forceps, baby starved of oxygen, baby getting stuck in birth canal, EMCS etc)

With regard to cost, I would certainly not trouble myself with the additional expense I'm costing the NHS. Firstly I'd happily pay the extra £1k or whatever it costs the NHS if that option were available. That said, I don't see why I should ever have to do so given I pay 45% tax and a whole heap of NI to fund it and rarely use it or any tax funded infrastructure. (I'm sure I'll be forking out for private education while subsidising state educated children but that is another thread/topic).

But what irks me more than all else is the need of the Vaginal Birth Brigade, much like the Breast Feeding Brigade (again another thread), to ram their opinions down other peoples throats rather than just accepting that other people make different choices and it is their choice in how they choose to have a baby.

The bottom line is, will I be a bad mother because I'm choosing an ELCS and to bottle feed my little one? Absolutely not. This baby is the most wanted in the world, will have more love than it knows what to do with and my husband and I can't wait for him or her to arrive.

Finally if you choose to give birth with no pain relief at all and to breastfeed for 5 years then good luck to you, I am certainly not going to judge you.

LittlePeaPod - take a break. You must be exhausted by this thread now. You've done a great job x

Well this was a pleasant surprise. Really tired having had a very long day at work. But I will read through properly tomorrow.

Jojo - a lot of people would be quite offended by your implication that midwives aren't professionals (you choose a "professional"
doctor over a midwife) Also, for the record - midwives aren't nurses. And the reason a lot of midwives will try to persuade against an epidural is because in the majority they slow labour down and often end in either an instrument delivery or EMCS.

I think one of the issues people have here is women trying to make the NHS into some kind of private health provider just because they "pay their taxes". It is of little relevance how much tax you pay - the NHS is strapped and that is a fact. You don't get to ring-fence your NI contributions to later "claim back" by dictating your care. I also find it quite shocking you lied about your reasons for wanting a caesarean - there are actually women out there who have a genuine fear of labouring and you're just diluting their cause. The more people that use this reason, the more obstacles will be put up in front of those that have a genuine psychological need. At least be brave enough to state the reasons for your choice.

People have said it before, and I agree - it's your choice how you give birth, but if you want to choose non-standard care in the form of a c-section for little other reasons than wanting to know when the baby's going to arrive and arbitrarily mistrusting midwives, pay for it privately.

MunchkinJess. I too am surprised by the anger other people particularly women have regarding my choice. On a positive note how exciting. You meet you baby in a few weeks. I am so envious, I have another 14 weeks...

1944girl. Thank you again for sharing. I think it's important women hear what happened historically on all aspects of female life I believe we sometimes take for granted how things have changed and lucky we are to have the choices, options and freedoms we have now.

ksksnod thank you for sharing your thoughts and posting on the thread. I just felt that it was high time women like us voiced our opinion even if that's against the current trend. It's a shame to hear how hard some women have to fight for a CS. I agree the population do accept generic information and when you consider the very professionals MWs providing this care are inherently biased, well is it a surprise the stigmatisation continues. I believe a lot of this mind set is perpetuated by the barriers the MWs put in place because ultimately MW will always push for a VB. IMO, Asia seems to be much more enlightened by offering women a real choice on their birthing options and not criticising these choices. You are right and it has only become apparent to me recently how poor the antenatal education is in this country first time mum to be. one of my frustrations is the fact the lack of antenatal education isn't to do with the UK not been advanced its actually a strategy taken by midwifery to not fully educate women on all aspects of birth. Don't get me started on the NCT well they will get a shock when i attend their class. I also recognise there is an issue with staff shortage and how can they possible provide adequate support / education to women when the MW appointment is so short and the spend the first two trimesters filling forms or taking blood pressure and if you are my MW banging on about home births.

angry. Thank you. It's true the attitude in the NHS and society in generally whiffs a little. I understand ECS is not a common choice, nor the most accepted and a woman requesting it is treated with suspicion by those who do not understand the choice she is making. And with the lack of real education how can women approach any discussion on this subject with any real knowledge outside of Dr. Goggle to try and support their view and rationality. It stinks!

JoJoMahon thank you for sharing your experience and posting. Sorry to hear you had to jump through hoops and resort to pretending to fear a VB so you could have the choice to a birthing experience that is right for you. A choice most other women have (eg MW lead units, pain relief, no pain relief which sounds barbaric to me, home births etc.). It really doesn't surprise me that you did because currently the system is forcing women that want this birthing choice to lie. There is no real opportunity to have a rational discussion with a MW and particularly a Consultant MW or the gatekeeper. I also understand your feelings regarding MWs. When it comes to acutally giving birth, my preference is to be in the hands of a surgeon rather than a MW. Your view on the epidural is also true, it happened to a couple of my friends. MWs delayed the process till it was too late for them to have an epidural. I think that's disgusting that women's medical requests can be so easily ignored. I don't care what a MWs rational was, if I ask for pain relief then I expect it. Again it's my choice and if that delays the process well so be it.

PassTheCremeEgg this whole issue regarding women using the NHS as a private health provider doesn't stand up for me. This argument can be made on the other birthing options. Lets take the home birth choice. In my area to get two private MWs to support a home birth costs c.£5000. Maybe the policy should change and all women should only be allowed to give birth in hospital. A bit like a conveyer belt system. We should take away all choice (incl MW lead units and home births) with the exception of the old fashioned hospital birth. By following this system, logically there would be cost containment benefits for the NHS (planning, no spending money on MW lead units, birthing pools, no costs associated with sending ambulances to failed home births etc.). Anyone wanting a birth outside of this should pay for private health care to fund that choice. This way no one has to worry about women using the NHS as a private health care provider.

It really saddens me to see how women are forging forward in business, politics, making informed choices on whether they become SAHM or go back to work but when it comes to our birthing options we are almost forced/made it feel guilty/stigmatised because our choices run against tradition and the "you should/must have a VB" culture. Well you know what, we no longer live in a century were women had no place in business, couldn't vote, and generally had limitations how they lived their lives, what they said or what they did with their bodies. This is my personal opinion but this whole expectation that all women should have a VB unless their is a danger to the baby or mother feels very outdated in the world we live in now. Women should have control and a choice on birthing the same way they choose how to raise their children or how they live their lives. I don't begrudge the money spent on the shiny new MW lead units, so I expect others not to begrudge my choice on an ECS.

I'm all for people having a choice, but. Jojo your post irks me somewhat. As a mental health professional I find it distasteful that you cite 'psychological' problems along with having to see a perinatal team to get an ELCS ( because you wanted a certain date?). Now that is a waste of valuable NHS resources. Perhaps it is for actions such as yours that the 'vaginal birth brigade' get vocal.

JoJo, for the record, it's perfectly possible to adore your child beyond measure and make choices not in their best interests. All those kids with tooth decay from too many sweets or obesity from too many happy meals - their parents love them just as much as other parents love their kids. So bottlefeeding, for example, doesn't become as magically as good as breastfeeding just because you've thought about your choice and really love your baby.

The point is that money is being spent in areas where a natural birth can be encouraged - home from home birth centres, home births etc. Money is being spent to enable women to give birth the way nature actually intended it to happen because incredibly, it's deemed that's the safest and easiest way for the majority! That's why I said "non-standard" procedures. Surely even you would be appalled if the NHS took money away from encouraging natural birth and piled it into encouraging surgery instead?? Even if you wouldn't, the vast majority would!

It is just so selfish to consider your NI contributions to be your own pot of cash within the NHS for you to select personally how to spend. Why should you take up valuable resources choosing to have major surgery just because you don't fancy labouring? I don't care how much you've paid in NI contributions, I can guarantee "your" money would be better spent elsewhere on an actual medical need! What you're asking for is no better than asking for cosmetic surgery for solely aesthetic reasons, and expecting other people to pay for it. No one is denying your right to choose but as you keep saying you're a higher rate tax payer, you can obviously afford to pay for a private CS.

Pregnancy and childbirth are not illnesses so I don't understand why some women want to medicalise them.

I think I should disappear from this thread though; I find it so depressing and we're never going to agree. I wish you luck.

PassTheCreamEgg so the true issue you have isn't the actual cost of a CS to the NHS. It's that maternity funding is been used to support some women achieve their birth experience via a ECS. So in your opinion it's alright to fund some aspects of maternity care because its quote "natural" regardless of the cost to the NHS. Therefore we should force all women to have a VB. What appalls me is the clear double standards been expressed here. I think all women should choose how they give birth. If one choice is considered wasting money then why should other choices (eg birth pools / home births etc) not be considered the same. Why not have all women on a bed pushing babies out with no support, after all that is truly the natural way. No gas/air, no birth pools, no pain relief. If we going natural then lets go completely natural. Lets not offer women a choice at all. As long as its natural and not costing the NHS any additional money. Lets put in place a cost containment policy on maternity care!

With regards you National Insurance point, I assume that's aimed at another poster considering I haven't mentioned National Insurance.

As I explained, it seems reasonable that funding is directed towards achieving birth in the way that nature designed. It would be extremely odd if NHS funding was allocated to surgery in preference to natural birth, why on earth would it be?! So - where there are limited resources, as there are - of course that's where they will go.

Part of achieving birth as nature intended is the presence of adequate support and in most cases, adequate pain relief. So actually, paying for this support in the form of well trained and experienced midwives, comfortable and relaxing rooms and natural pain easing methods such as pools, balls, gas and air, ability to move around throughout labour and deliver in different positions etc etc is actually money well spent if the NHS aims to allow women to deliver safely and easily. Thrusting money at discretionary operations for the small minority would not be seen by the majority to be money well spent when the NHS is in dire straits.

I can't imagine why you think pushing a baby out on a bed with no support is "the natural way". The natural way is giving birth vaginally, as your body was built to do. Which actually isn't flat on your back on a bed where the baby is fighting gravity. Throughout the ages women have had support around them during this process. What a bizarre statement. If you think that's natural birth, no wonder you want to bypass it all.

In terms of NI contributions - I meant tax contributions.
Baby brain took over and replaced in my head/post. For NI contributions, read tax contributions. So, yes, I did mean you.

PassTheCreamEggs. IMO your tax issue is a mute point really. Yes i am a HR tax payer and I do contribute more to the system than others. Which i don't begrudge. The only consideration is as a tax payer I like all other tax payers have a right and say as to how the government spends my money. With regards the bed point, that too is a mute point. You have interrupted what I wrote in your own way. If you read my point again you will see I said women on a bed. Never specified they were flat on their back.

If we are going back to basics, natures intention is to get the baby out. Pain relief, cosy MW lead units, gas/air, birthing pools are all human interventions just a different form of intervention from CS. As the NHS is in dire straits then why not cut costs by stopping the provision of CS, MW lead units and access to home births etc. After all women were meant to give birth naturally. Why should the NHS fund any form of intervention? It would save a fortune considering the number of women that use these facilities. Women can give birth vaginally in a hospital maternity ward. Its natural to give birth vaginally without intervention. If they followed that model the NHS would probably be able to slash the number of MWs required too scheduling etc But personally I don't think we should do any of that. WHY, because I believe ALL women should enjoy the benefits of modern day intervention regardless of type so they can have the most positive birthing experience that they choose to have.

I am surprised to see this debate ongoing, out of interest I have looked at some publications regarding this issue as linked below, some may find them helpful.

www.ncbi.nlm.nih.gov/m/pubmed/23652524/?i=5&from=/24002290/related

www.ncbi.nlm.nih.gov/m/pubmed/17324176/?i=3&from=/23957085/related

www.ncbi.nlm.nih.gov/m/pubmed/17011403/?i=5&from=/23957085/related

They make interesting reading and if you scroll to bottom of page, there are links to similarly themed articles. Some of these articles are not specific to UK but interesting nevertheless.

littlepea I know you said you had done lots of research, would it be possible to post some of the links?

Just realised.. That should be moot not mute.

snoozy my research has been via consultation and material which I got advised to read by the consultants and my MW. I have posted some of names of the articles / publication / research documents on this thread already for those that wanted to review them.

I'm sorry I just can't agree with anything you've written in that post at all.

Interventions (including emergency sections and elective sections with medical need) are used to save the lives of mothers and babies when things go wrong. It is ridiculous to suggest that it would be equally right to cut spending on these things as to cut spending in discretionary elective sections. The whole point of what I have repeatedly said is that your section is not medically necessary so why should anyone pay for it? Again - it's the equivalent of getting plastic surgery on the NHS for purely cosmetic reasons.

Actually you don't have a right to dictate how your tax is spent. That's why we vote - to elect representatives who make those decisions on our behalf. You can't just wander into a hospital and demand x,y and z treatments simply because you pay tax. You can make representations to your MP and therefore to Parliament on what you think is right, but that's pretty much where your say ends. Like I said, your tax contributions are not your own personal pot to decide yourself how to spend.

I'm just going to get annoyed if I keep engaging with this thread because so much of it is nonsensical, so I'm taking my leave now. It's been an interesting read and I thank you for raising the debate. I hope your section works out for you.

By the way, it's a moot point, not mute.

Cross posted with you regarding moot/mute

Addendum

Should have said this debate is good to have but for those who want to make informed decisions, I would encourage closely liaising with medical professionals (asking for second opinions if not happy) and reading through relevant literature/studies, I'm sure littlepea would agree with this and has probably already suggested similar.

I am considering a NVD.

passTheCremeEgg. Thank you for your contribution. Could I just add that you seem to have misinterpret what I wrote on a couple of occasions again. Wont mention them all but regarding the moot mute comment. I did actually correct myself if you have a look. Wishing you all the best with your pregancy and thank you again.

Cross posts again regarding the moot and mute point.

Snoozy. I couldn't agree more with your statement.

and the anger on an ELECS echoes!!

you know not all countries have this view!!

some are open minded that you as a human being have a choice how you give birth to your child and raise your child.

I still dont get where all the anger comes from!! it really is beyond me.

No, as a tax payer you don't get a right to decide what your tax is spent on. You have a right to an opinion and the right to choose who to vote for in an election but that's about it. And I've no idea what being a higher rate tax payer has to do with anything.

As for your statement saying the NHS could cut costs by removing access to midwife led centres and home births. It's been pointed out to you several times that these options are significantly cheaper than a CS. So I've no idea what sort of logic you are trying to apply.

I totally understand that everyone has the right to choose. But I don't understand why the NHS should fund that right. That's why private hospitals exist. I appreciate that you haven't used the NHS much and feel entitled to your money's worth somehow but the majority of NHS resources are spent on the elderly. So you in the future, along with everyone else, will almost certainly get their use out of the NHS eventually.