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.

Op, you did mention breastfeeding way upthread but perhaps it was someone else who talked about it more-no need to ask me to read the whole thread, as you've said it's going round in circles.

My bf view may be judgemental, (I dont know how to not be judgemental if I have a view about something & think there is unfairness), but my point is I think it is selfish for someone not to TRY breastfeeding at least. I'm happy for someone to present an argument to show why it's justified not to try it. I just think what is a few days out of your life to benefit your child. So I guess this view could be extended to elcs on non medical grounds. However I think that so few women would choose it that it's not a huge problem to the nhs currently, (although this may change if uptake increases).

It's ludicrous to say then cancel all pain relief, birthing pools etc. The nhs needs to quantify value for money in budgeting & pain relief obviously costs a lot less than elcs & easily benefits many.

Your view is 'everyone should be able to bring up their children the way they want' but I would expect/hope you'd be horrified if someone chain-smoked in the house with their kids, wouldn't you? I know this is way at the furthest end of the line but everything's not always black & white.

Congratulations on the nuptials btw :)

Excited2meetmyprincess Obviously I am unaware of your situation but happy to share what I did. Also I am not a medical profession so the information below is based on my experience and what I did to get my ELCS approved. The first thing you need to be aware of is that if your consultant obstetrician does refuse your request for an ELCS then you have a right for a second opinion. Under the new guidelines UK hospitals cannot refuse your request without referring you for a second opinion. Bear in mind that the second opinion may also refuse your request but I did a lot of research and knew who I wanted to be referred to if my request was declined - which it wasn't. Below is how I approached the meeting.

I stuck to the facts which I had written down before going to the meeting so I didn't forget anything. I also kept my points rational and factual. I discussed my understanding of the different risks associated with VBs and ELCS. I explained why I felt it was in the best interest of my child and myself to have an ELCS. I explained that in my experience every person I know (with the exception of 2) have had complications associated with VBs which ended in some form of medical intervention anyway. I also explained that I understood more than 50% of VBs end in some form of medical intervention anyway and I was not willing to take that risk. I went through my friends/families experiences and also detailed the impact this had on the individuals involved. I also explained there was no way I would ever agree to forceps or ventouse because I was very unhappy and uncomfortable with the level of risk attached in terms of potential injury to our DD and myself. I also attended the meeting with my DH who completely supported my decision and made sure the consultant was aware of this. By going in prepared (particularly on the risks associated with both options and why I wanted an ELCS) you can demonstrate to the consultant that you are organised, you understand what you are doing and why you are doing it. Also by saying if they are not in agreement you want a second opinion it demonstrate that you mean what you say. Some people are scared to say they will request a second opinion if the consultant refuses.

From what you have said it's seems you do have a medical reason for requesting an ELCS which I didn't have. Have you thought of getting a referral from your medical practioner that states that in their opinion a VB could trigger a hemiplegic migraine? This could help convince the consultant that you have genuine concerns regarding the impact of a VB on you and potential the whole birth. I would also refer to the fact several doctors have said your pelvis is small and this in itself could cause a difficult birth which could trigger the migraines. If this is causing you to be worried and stressed then your consultant needs to take you seriously.

Are you seeing a consultant midwife or a consultant obstetrician? The consultant midwife in our region can't make a decision on ELCS and she has to refer you to a consultant obstetrician if you insist. Either that or you can cut the consultant midwife out of the loop and get a referral letter from your GP straight to a consultant obstetrician (which is what I did). Not sure if your GP would do this but mine did.

Evelynj I cedrtainly may have responded to someones note on breastfeeding but can I correct your original post which implied I was against it. I really don't care whether women breast feed or not. It's their choice. I think comparing how a woman chooses to bring their child up in terms of breastfeeding against smoking is a little far fetched and really irralevent. Clearly that is unacceptabel in the same way child abuse is unacceptable. Not breast feeding doesn't impact a child in the same way chain smoking would. Your view is defintely judgemental and it's a shame that your feel superior to those women that choose not to breastfeed. To be frank, it's none of your business whether they breastfeed or not. But you have a right to own your opinion. Again if you read through the thread your would understand my point on birting pools and pain relief. No point in covering it again when it has been discussed in detail. Since you choose not to read the you really can't comment on what posters including me have said as you can't possibly fully understand where within the debate those thoughts rise from. That's why I said we would be going round in circules. That's also why I have noted on several occassions that everyone joining the debate read the thread. A good example which has already been discussed is the cost to the NHS, if you read the thread you would see that in fact it would be cheaper for the NHS to force all women to have ELCS on and around 39 weeks.

Thank you for the congratulations. We had a wonderful time.

Fraggle I am not that far away from you. I am actually in Yorkshire. Oh gosh moving in 4 weeks that's going to be busy. Eeeekkkk

Terilous my consultant said that the ELCS would be booked in within my 39th week and we could choose a date but that would not be guarantee. So we are hoping for 30th December. I will find out on the 25th November.

MunchkinJess that's really not good to hear but it doesn't surprise me. My SIL had a similar experince to you and she ended up checking herself out on the second day because the MW care was so poor. How are you feeling today? Hope you are well with the exception of the shit MW care

Hi Terilou. I know the date as my Husband knows the Consultant doing my C Section. We booked ours at 20 Wks to fit in with the Consultant as we want him to operate. I don't think it's normal practice to know so early xxx

To add, mine is a week before my due date x

LittlePeaPod, you say you would refuse forceps in a vb. Will you also refuse them in a cs? My dd was delivered by forceps during my cs as she was wedged in my pelvis (this was an elective section, not emergency). Sure, there's no risk to your perineum, but there's still risks to baby.

AHardyDaysWrite I know they are sometimes used much less than in VB and less risky because of the path the baby takes in an ELCS and I would allow them in an ELCS but never under any circumstances in a VB but I will never have a VB so it doesn't really matter. However that's on the basis that the risk of nerve/brain/facial/eye/shoulder etc. damage and bleeding on the baby's brain is hugely reduced when they are used in an ELCS. As my Consulant says, he would rather a women had a CS than a forceps intervention when the woman needs instrumental medical intervention because of the frequency and amount of damage forceps can cause in a VB.

Thanks for the advice. A lot of what you have said is what we were planning to discuss with her and info we have gathered.
Xx

Congratulations munchkinjess! Glad to hear you have had a positive experience! evelynj if you don't want read the thread then why comment? Your points have already been made and discussed, plus, it seems a shame that you feel the need to post such judgemental views on a thread that has been mainly positive and a lot more constructive than your comments are.

You are welcome and best wishes Excited. Keep us all posted if that's not too intrusive to ask..

Little pea-I have read all your posts thanks so there's no need to keep banging on about reading the thread, I've read most of it. I correct you as I never implied you were against breastfeeding, merely said that it was brought up, (fine if it wasn't you initially that brought it up). It's another lifestyle choice that impacts our children in a similar way elcs does, and smoking. Yes the smoking thing was far fetched as I already said but far fetched is the best way to make a point IMO. I don't feel superior I just don't understand why someone wouldn't try breastfeeding & am happy to be educated by someone with reasons that I haven't thought of. Maybe you are superior for thinking smoking is akin to child abuse, just another pov in the same way that other posters think you are putting your baby at unnecessary risk by choosing elcs.

I believe I do understand your point on birthing pools etc, please correct me if I'm wrong but your argument is if you can't have elcs for non medical Grounds due to costs, then even the playing field & make childbirth completely natural again, no pools, no pain relief etc. which takes the costs out of the equation. That is what I have gleaned from your posts, please do enlighten me if I've missed something. If not, then I think this is a petty & ridiculous argument as clearly spending e.g. £10 on unnecessary pain relief to relieve someone's suffering is easier justifiable than £2k odd on elcs. Forcing all women to have major abdominal surgery at 39 weeks to make it cheaper all round. & more like a factory-do you really think this is a viable alternative? That doesn't include the cost of the many women whose wounds get infected & need subsequent treatment.

I'm not against your choice to have a elcs just because you want it, but I think it's understandable that the nhs try to dissuade women from choosing it.

I'm only pointing out other arguments to choices, as regardless of your f&f experience, vb is the recommended route with the least risks overall. You are obviously set on having elcs-fine. I know a woman who was planning vb & when she went into labour got scared & demanded a cs! A little unreasonable perhaps but hormones are everywhere when pregnant.

My tips for recovery from cs btw are peppermint tea and/or windeze tablets for after surgery, do as little as possible for at least 3 weeks afterwards & research cranial osteopaths in your area for baby if they are unsettled.

EvelynJ no that wasn't my point on births pools etc. actually. You have got it wrong. I have have made it clear already through the thread so I won't go over it again. But as I have said before unless you read the whole thread including everyone else points you will likely miss interrupt/misunderstand what the selective posts you read are actually saying or responding to.

With regards the breast feeding issues again I don't care whether women breast feed or not and this thread was set up specifically to discuss CS. If you would like people to provide you with their views on breast feeding vs formula then please do start a separate thread. I am sure there are lots of MNers that would engage in that debate I am not one of them don't see what the big deal is. You won't find many on this thread that are that interested in the breast feeing debate, then again I may be wrong.

Again with regards the risk between ELCS vs VB unless you are a consultant obstetrician or a specialist in foetal medicine then you don't actually have a clue whether CS vs VB carry a higher risk. They both carry risks just different and its down to the individual to decide which risks they are more comfortable with. If you read my Op you will see I have received advice from professionals within the necessary fields that do know what they are talking about. With that in mind I believe I have made a very informed choice, more informed than I would have made had I only had advice from my MW who I would like to add is completely biased if my MW had her way I would be giving birth under a tree in my garden with no pain relief. She may consider putting up a pool though

Thank you for the recovery tips. Getting quite a few as my SIL and one of my close friends have had CS both completely fine with no complications. My SIL is in for her second CS next Monday.

Thanks for starting this thread Little Pea. It has brought up some really interesting information and research. I am in early pregnancy with my second baby. With my first I was determined to have a natural birth, if willpower and determination could have secured that, it would have happened. Some previous posts on trusting the body to deliver naturally grated a bit, because I did, but baby was in a bad position and after 3 full days of labour, failed pessaries induction and 14 hours on syntocin drip I was still only 6cm dilated and was petrified to be faced with what I had dreaded all along and strived to avoid at all costs- a csection.

The c sec itself was fine, even though I was exhausted from such a long and intense labour, the staff made me laugh and it was a strangely positive experience. yes the recovery was quite long and hard, though I didn't help myself by carrying baby in car seat too much and pushing it.

At the moment I am 80% sure I would like to ask for elcs next time, think my lovely midwife will support me but have heard that in our hospital the consultants tend to sway your mind, tell you that things will be easier second time round etc. I'm not convinced, as I said I was so determined to have a natural birth, refused all drugs in case they hampered my dilation/progress, used my hypnobirth cd on repeat play, to no avail. Plus this time with a 2 year old I won't have time to spend 3 days in hospital in labour to end in ecs anyway then another 3/4 days to recover there, in terms of childcare.

Sorry my post is a bit rambling, trying to gather my own thoughts. You've actually convinced me that every woman should be able to choose, and the cost isn't probably any more when all things are taken into account. I just hope I will be able to convince the consultant to let me have the elcs.

In that case you haven't made your point clear re birth pools etc.

Evelynj everyone else that's read the thread seems to have understood it perfectly well.

Summer thank you. You will find that most hospitals will try and convince you otherwise. My SIL had a similar experience to you with her first and the Consutant MW tried every trick in the book to convince her to have a VB even emotionally blackmailing her be trying to imply she could die and what would happen with regards her first born then. Disgusting! She stuck to her guns and refused. They kept going on and even after they realised she wouldn't change her mind and a CS was agreed, the Consultant MW tried to convince her to try the VB if she went into labour early. They made her feel really guilty. The whole process was biased and guilt ridden. If an ELCS is what you want Summer just be prepared to stick to your guns.

Hi L pea.....Im new to mn just wanted to wish you lots of luck. I like yourself opted for a cs with full support from GP. You sound very similar to myself in your thought process. After 4 friends within the prev 12 months having to have emergency sections, and having an awful time by the sounds of things .....my birth by comparison was fantastic. Very civilised....very calm and as safe as I personally felt it could be. This was 3.5 years ago and I am currently 8 wks with 2nd. I will be opting for a cs again. Everyone is different and thank goodness they are! My healing was gradual....my scar now is invisible and I feel very thankful to have had the experience I did.

Wishing you lots of luck and enjoy! X

LittlePea just wanted to say thank you for the post describing your consultant meeting. I'd never have thoughts of making notes - did you bring them in so you could check them while talking?
I want my ELCS to be at 40w+ rather than the standard 39w, and I know it can be hard work getting consultants to agree to anything non-standard.

Handbag thank you and yes we do sound similar. I am relatively new to MN too only joined in March thank you for sharing your thoughts and congratulations in your gorgeous BFP

Very interesting thread and well done OP on fighting for what you want. However, I am not entirely convinced on a woman's right to choose a CS for her first birth if she is low risk or without medical reasons for the choice. Women's bodies are designed for VB. ELCS is major surgery, after which you do not have the luxury of time to really recover, it will be weeks if not months, until you get anything approaching sleep, AND you have to look after a tiny newborn who is totally dependent on you.

This isnt a judgment on your choice OP, just an observation from my perspective.

I had planned a VB for my first. Had a crash EMCS under GA before I had a single contraction or was at all dilated. It was bloody terrifying. I had an ELCS (my choice) for my second. It was a very positive experience but I did still find the surgery aspect a bit scary (which surprised me).

I recovered about as well as a person can recover from both of my births. No infections, limited scars, no issues with bonding. First time I was home before 48 hours had passed, second time before 24 hours had passed. BFing easily established in both. Good movement after 48 hours or so, after my second I was quite capable of picking up my toddler too.

However, it was major abdominal surgery. And afterwards, however well you recover, you have to look after a baby. It's not like you can just rest, however supportive family/DH are. Getting out of bed to get crying newborn took a few days to be both quick and comfortable. And despite my fantastic recoveries (for which I am very grateful) and overall positive experiences, for the first 12 or so hours at home after having DS (my second), I genuinely believed I had made the most awful mistake as I felt so unbelievably rough.

If you are forced to be in this position, you make the best of it. If you choose it having had previous trauma/previous section, you sort of know what you're up against. I'm not sure I can get my head around deliberately putting yourself in this position out of choice.

The real issue is that it is a lottery. I chose my ELCS as the only way to guarantee to avoid another EMCS/GA. If I could have known that a VB would be relatively successful (pain and perhaps some tearing expected, but no traumatic interventions), I would have chosen VB every time. Now I know that if I have DC3, it will have to be another ELCS as it appears my prospects of a successful VB are remote.

But women facing their first delivery have no indication of how their birth will go. To choose major surgery with known difficulties in recovery (the whole looking after a newborn thing does somewhat interfere with the rest the body needs) instead of something that your body is designed for, without a medical reason, does seem odd to me.

But best of luck to you OP, hope you have the birth you want and you recover well.

Is it me or is this thread going round in circles?! Does anyone read the previous posts before posting their own?

GreatJoan you are welcome, I am happy to share. I think its good that everyone is sharing their thoughts and experiences (good and bad). Yes I took my notes in with me, I personally think it helped. It demonstrated to the consultant that I had done my research and understood what I was requesting. I also had a list of questions I wanted clarity on. Things like what percentage of VB end in medical intervention and what risk are associated to forceps etc. I pushed for factual answers in terms of comparison (and where i could find the sources so i could read the source) between the two so they couldn't fob me off with scary stories.

You should be able to request a CS post 40 weeks. You can even wait until you go into labour naturally before going in for your ELCS. This way you can allow your baby to dictate his/her arrival. However my consultant did say that ELCS carried out during labour carry some increased risks and many hospitals classify them as emergency CS rather than ELCS. And there is no guarantee that theatres will be available when labour starts etc.

You can even have a "Natural CS" (not sure if all hospitals do this) which is normally only allowed on what they class as a straightforward pregnancy (not for breech or transverse). The overall experience is personalised and can include:

• delivery of baby's head first
• delivery paused to support acclimatisation, taking first breaths while baby's body is still in the womb (compression helps expel fluid from lungs)
• delayed cord cutting until breathing is stabilised
• immediate skin to skin contact as the baby is delivered onto your chest (wires etc. are attached to your back rather than your chest) where baby is covered and positioned so you can try breast feeding etc.

Mada, thanks for your thoughts. Yes I have considered those issues and they have been raised a number of times. The one thing that's true is no one knows how any birth (CS/VB) will turn out or the potential long term effects/recovery. We can all only make what we believe to be the right choice for ourselves.

Angry yes it is a bit round in circles.

Absolutely OP, it is clear that you have done that.

angry I take it that was addressed to my comment? It seemed a bit rude, given the OP invited comment. If MN according to you prevented a person from sharing their personal experience or opinion if in doing so they repeated or highlighted something already discussed, there would be far fewer posts.