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.

I do appreciate other birth options have been discussed not just home birth it just seems to be the focus for irrational risk assessment more so than other options. Surely you have to understand how Chocolates sweeping statement about the risks of a baby dying from breathing difficulties following a home birth is likely to make women choosing a home birth defensive. It's slightly patronising almost suggesting we wouldn't have considered this possibility and weighed up the risks based on statistics/scientific evidence in the same way as woman choosing an ELCS.

Also I find it interesting that breathing difficulties were listed as an area of concern when (here comes another sweeping statement about risks) following a CS babies are more at risk of breathing difficulties as fluid wasn't forced out of their lungs as they were squeezed through the birth canal.

Interesting how different people assess risks isn't it because both birth options could lead to breathing difficulties but people feel safer in hospital. In reality bad things still happen even when babies are born in hospital, its about what choice you can live with.

Thecakes you have been on and off this thread to know that the whole breathing VB vs CS difficulty debate has been had over and over again several times. And in actual fact the risk is the same for both when a CS baby is delivered at 39 weeks. The whole birth canal argument is actually misplaced. But I guess if people google enough rather than speaking to actual professionals they can come up with an argument to the contrary. I won't get into the breathing difficulty debate again.

Also I doubt many women planning a home birth will be that interested in this thread. Personally I agree with Chocolate I wouldn't take the risk if a home birth just on the off chance my baby needs help breathing. It says a lot when my own consultant obstetrician says that he would never have his children at home because if it goes wrong, it can really go wrong. And considering more than 50% of VB end in some form of intervention. It's a risk I am not willing to take. But, that's me. Others think the same about CS. Each to there own

littlepeapod I'm really hoping for 27th as I don't want to be in hospital over new years eve/ day. I want to be at home by then so I'm with my other kids and dp. It looks like we will be elcs partners and just 4 weeks to go!

I've read the majority of the thread but not in over a month so forgive me for raising a topic that's been covered. When I clicked on the thread again I intended to just read but felt the urge to post when a judgemental statement about home birth was posted as I felt it was unnecessary.

Just to say you know a midwife carries the same equipment to a home birth that a stand alone midwife led unit would have. Both birth options are considered safe but as with all choices they carry risks.

With regard to the homebirth risk, I find it interesting because a lot of the debate about whether its risky or not centres on how you display the risk and what you focus on.

If you put the risk for babies dying for first time mothers in terms of absolute risk it appears very small. But put the relative risk the figure looks a lot scarer.

Then you could start looking at the risks of other things. Like the risk for mothers of interventions for second or subsequent births for a home birth versus a hospital birth. Its a lot safer for women after they have had their first birth.

The list goes on and on. As soon as you start to do that, then actually the whole debate about whether a homebirth is a risk really does start to get very fuzzy. Just as much as the ELCS debate.

The fact that the NHS is currently doing a lot of research into how it presents risk says a great deal about the subject and something we should be interested in. The way risk is presented has a great influence on the decisions we ultimately make. So how do you present it in a way that people understand and is unbiased. And do we even want to present it in an unbiased way? There is a fair amount of ethics in play here.

Ultimately, not being able to get your head round other people's decisions and priorities is fine as long as you can get your head round the idea that everyone has those different priorities and that birth, no matter how you do it, has a risk attached. The most you can do, is to take a gamble on which risks you feel most comfortable with and to be able to understand both the absolute AND relative risks of any decision you make.

Don't see the problem, as long as you are paying for it of course.

Of course loveolives. Then again, it might be cheaper option for the NHS for the OP to have a c-section...

...perhaps you'd like to read a few posts before posting next time.

The most you can do, is to take a gamble on which risks you feel most comfortable with and to be able to understand both the absolute AND relative risks of any decision you make.

Perfectly succinctly put.

Thecake - I was only saying that FOR ME the risks of home birth would feel like too much. But I WOULDN'T judge women who go for this kind of birth. Not sure which in your opinion was the part where I was being judgmental?

"Zippy I am sure a VB is a wonderful experience for those that want one. But to me any form of childbirth doesn't really turn me on. It's a means to an end. Whether people think a CS is yucky or shitting yourself in front of a room of strangers/your DH and ripping open is gross is irrelevant really.

The meracle will be seeing my daughter having felt her growing for so long. That is what is awesome for me."

I am freaked out by thought of being cut open for a cs but would thank my lucky stars if I had to have one for medical reasons, so my choice is vb until midwives/ me decide process not working. I have read thread with great interest but felt rather ambivalent to be honest until I read the above, re ' shitting self and ripping open' . I did not tear at all either time with a 9lb baby. Lucky? Listened to midwife? Baby in favourable position? Sucked on g & a like mad lady? Who knows. But the phrase ripping open I find rather vulgar, my best friend had a lot of stiches for her tear, quite a bad one but she said it was well dealt with and she didn't realise until they told her anyway, I don't think she would describe self as ripped open at all.

I pooped in the birth pool both times, I knew despite gas n air, sieve provided for the purpose and lovely lovely midwives dealt. It's very common and means baby nearly out as head so low it pushes out whatever maybe in back passage as it descends. Dh wasn't remotely phased and he was a star for nappy changing while I showered and ate afterwards. Best tea n toast I ever ate, I hate losing control and giving birth is like that, however you may choose to enter the process initially. It is a dirty messy natural business, even after a cs Lochia etc, constipation to deal with. It is risky can be scarey, painful and amazing however you end up doing it. What a shame women can't just leave each other to it eh? I am very proud indeed of my deliveries. I will take credit for the outcome and it is a badge of honour to me!! Amazing experiences and fab midwives and post natal care. I'm sure if dc3 is a cs for any reason ( and I do have medical reasons that could arise this time) then I will be just as proud. I don't think birth is merely a means to an end. It is the beginning of new life and until you go through it (however that happens!) then you just won't get it. It is truly amazing and I hope you cherish every moment op, of course being a mum is far bigger job than merely giving birth but that in itself I truly believe is something to be celebrated.

Chocolate- You made a sweeping statement about the risks of a baby dying due to breathing difficulties following a home birth. It did not come across as 'these are my fears about a home birth' more how on earth would these people live with themselves if their babies died after a home birth and haven't they thought about these risks. This is the bit I found judgmental - like I said further up your wording almost implies we wouldn't have considered the risks in the same way you have for an elcs.

I have to agree GoMomma at no point did I feel like I was ripping open and/or shitting myself. I couldn't tell you whether I did or didn't poo. Again its fairly amusing to think people are aiming for some level of dignity out a birth experience. Regardless of CS or VB there's little dignity in childbirth. I don't much fancy being naked from the waist down with a room full of medical staff operating on me but if I needed a CS I'd suck it up and get on with it.

Anyway I'll probably take my leave on this one now. I doubt I'm adding much to the debate as I have a different viewpoint.

Red you make some very well articulated and informed points which I agree with.

This thread was never set up to discuss the rights and wrong of any of the births. To be honest, I don't give a flying hoot which birth method any woman chooses to have. Thats their choice and their decision! And yes to me. There is nothing special about the actual delivery of a baby. Birth is a means to an end. It doesn't make a woman any more special or wonderful because she happened to delivery a child (VB or CS). I stand by my comment the miracle is the baby's development and the thing that makes parents (mothers and fathers) special is how they parent. How they parent is what should give them a sense of achievement..

With regards the dignity aspect of giving birth. Again this has been discussed throughout the thread and we all acknowledged that there is nothing dignified in any of the birthing methods. Plenty of women have discussed how horrendous it was for them when they suffered 3rd/4th degree rips/tears (same difference), women who required major surgery up to 9/12 months after delivery to rectify vaginal, bowel and uterus prolapses as a result of a VB, broken pelvis and we have also heard from women that had horrendous experiences with CS.

My point has always been pretty clear. Woman should be able to choose how they wish to deliver their babies. Ultimately, its their body and their child/children. No one should force them into delivering via a method they are not happy/comfortable with. But to do this, women have to be able to make informed decisions. And this is my point as it stands women can't make informed decisions unless like me they are in a financially fortunate position to be able to pay to get the information they need to make an informed choice.

The level of antenatal education provided by MW and the NHS is verging on non existed and incompetent IMHO. We don't get any real form of education. This is so evident on this thread alone. So many women resort to Dr. Goggle to find articles, sound bites, news clips and arguments to justify their own position. MW appointments consist of pee tests, blood pressure, poking and measuring your tummy and that's about it. It's a 10/15 minute conveyer belt and form filling exercise. Outside of actually delivering babies, what actual value are MW adding to this process. I am really struggling to see it!

The NHS have a duty to ensure women are properly educated on all forms of birth. They should be speaking to women and ensuring women understand the risks and benefits attached to the different options. This should include all forms of pain relief. They have 40 weeks to do it for god sake. I really don't think that would be rocket science!

Again I don't give a flying hoot how anyone chooses to give birth or whether they think giving birth is the biggest achievement of their life. Give birth on a field for all I care! What I would like to see is the NHS providing the right level of education so that whatever birth method a woman chooses, they know what the risks and benefits are. I would also like to see the NHS giving women access to all their birthing options.

munchkinjess I'm so sorry that you were upset on the postnatal ward. The physical parts of your care sound very normal to me and similar to when I had my cs. At my hospital the midwives were a lot kinder though which makes a huge difference. My baby was prem and in NICU so I wasn't expected to care for him at first but as soon as my catheter was out (21 hours after surgery) I was expected to collect my own meals from the ward kitchen, sterilize the breast pump and take my bottles of expressed milk down to NICU (the other side of the maternity unit and a 5-10 min walk for a well person) every 4 hours. My DH was looking after our other children so I was on my own most of the time too. My mum rang me a couple of times and expected me to be sitting in bed being waited on and didn't really get that I could only talk for a few mins before I had to shuffle off somewhere.

Terilou87 that's a good point. DP and I were hoping to see if we could sneak a little bottle of bubbly in for NYE if I was still in. But we don't have any other DC and this is our first. Figures crossed we both get the dates we want.

I feel it does make me special I delivered my babies. Any woman has a right to feel that, why shouldn't I be as proud of that as my two degrees and career. I don't really discuss in RL just makes me feel good! what the the big deal?! Like I said in My post 'being a mum is a far bigger job than the birth'......., I know, ......I am one. Don't worry I get huge sense achievement out of parenting, just also fond memories of pushing them out, with the poo. And gaining pride and a baby at same time, I get sense of achievement from many other aspects of my life too but ...."antenatal ed provided incompetent" ?! Really? My midwives all three times are informed, helpful, friendly, busy yes but there when you need them. As were the docs involved antenatally with dc1 and currently with dc3. I guess I'm with thecakeis and departing thread but wish you well with delivery op and hope you do get enjoyment out of the process, however it turns out, 'there is nothing special about the actual delivery of a baby' ??? Can't get my head round that hence why am leaving thread. Maybe when you have your birth experience/parenting journey you may change your view on that, I def won't be reading to find out.....I'm too busy parenting and feeling amazing about giving birth I would be gobsmacked if you didn't feel some sense of achievement when you get that baby in your arms, be it through vb or cs, being brave enough for a voluntary epidural, taking the medications required for a cs.....many things you will go through for your cs that you would hopefully feel proud of coping with?! The birth experience and baby arrival are ingrained in my mind and I know much older women with amazing clarity of memory about the days of their children's birth, it changes your life, yes it's great for women to have a choice but you have very strong views about something you haven't even gone through yet, again best wishes with it, it is truly fabulous the majority of the time (a family member had a stillbirth so believe Me I don't say that naively). Enjoy your baby, and your birth experience.

LittlePeaPod, I know you don't want to get into breathing difficulties and electives, but I have to take exception to this

The whole birth canal argument is actually misplaced. But I guess if people google enough rather than speaking to actual professionals they can come up with an argument to the contrary.

I didn't have to google, and I have spoken to several professionals including the paediatrician in NICU, when ds was in with severe breathing problems at birth and both of his respiratory consultants. They have all talked about the combination of premature lungs (my ds was born at 39 weeks - but as both my dds were born at 42 weeks, it may be that I gestate babies longer!) and problems with the baby not having gone through labour.

GoMamma I never said you should not be proud. That's your right. You have a right to feel that way. But, please don't make generic statements patronise me and other women by implying that because we haven't given birth we don't really know what we are talking about. I don't live in a vacuum and I am actually the last of my group of friends and family to have a child. I can assure you having spoken to them the split is equal between those that are a bit whats the big deal with giving birth, its a means to an end and those that think like you.

It's great to hear your MW spent more time than accessing your pee and taking blood pressure etc. throughout your antenatal checks. Although I am truely sceptical that they went through all birthing options and discussing all risks/benefits. As you have read through the thread you will see that I think my MW is lovely. Home birth obsessed but lovely all the same. But, in terms if antenatal education, well its very poor and non existent. How often do we read on this forum "don't get too excited about booking in or other MW appointments. It's all just form filling and pee tests etc". You must be one of the lucky few that gets more than this.

Regarding all the things I have to go through to deliver via CS (epidural etc.). It's what's required to get to the end result. I have had surgery before and I remember that clearly and don't see dealing with the pain or pain relief as a badge of honour. It all sounds a bit attention seeking/martyr for me personally.

Our DD is a mericle and it will be amazing to see/meet her. I agree a new life is a mericle. But my delivering her is a means to an end. I won't get all "wow how fantastic am I for delivering her".

Finally thank you for your thoughts. It's good to hear other perspectives and views. Wish you all the best with the remainder of your pregnancy.

hazyjane you will see from my op that I too have spent quite a lot time consulting with medical professionals. You will also see that I spent alot of time supporting a very close friend whose baby was in NICU (breathing difficulties) and on an ECMO machine for 2 weeks. Their DD is now 12 weeks old and at home but she is still on oxygen and has a little mobile oxygen pack.

Basically from the information I have found out from the professional advise I paid for and speaking to my friend and their paediatrician the main factor in breathing difficulties is premature lungs and meconium complications etc. babies born prematurely or with premature lungs may encounter breathing difficulties requiring admission to NICU. However planning a CS for week 39 reduces the level of risk to no longer statistically significantly different to that of a vaginal birth at the same stage. Thus the squeezing through the birth canal is irrelevant. Research is really unclear on this point and no one can say for a fact it makes a difference. This is the reason the official guidelines recommend CS not be scheduled before 39 weeks, when the lungs are fully mature, unless medically necessary. The prevailing advise seems to be that both lung prematurity and the underlying reason for CS play a significant part in the likelihood of experiencing breathing difficulties.

I agree with LittlePeaPod on the "amazing birth experience" and "badge for delivery" discussion.
For me also birth is means to an end. Many people insist that giving birth vaginally is the most natural thing on earth and women were designed to do it but at the same time they think they gain some badge of honour for doing it.
I've gone through a lot to get pregnant (2 miscarriages, 4 IUIs, 5 IVFs). Only those who have been through infertility themselves will understand how tough it can get. Does this make me special? I don't think so. I'm just grateful that I had the help from modern medicine to help me create a baby. same about birth. Whichever way my baby gets out it will be equally amazing. I don't need any recognition for pushing or for undergoing a major surgery.
But again, thats my personal view. And if others feel particularly good about themselves after VB - good for them (that's not meant to be sarcastic!) It's a shame though so many women feel like failures if they don't manage to get the birth of their dreams and deliver naturally, without painkillers or other interventions.

Its a shame though so many women feel like failures if they don't manage to get the birth of their dreams and deliver naturally, without painkillers or other interventions.

Chocolate Couldn't agree with your statement more. It's a shame that some women are left feeling disappointed and almost like they have failed in some way because they don't achieve the socially defined perfect, intervention free birth. I just find it really sad that so many women are been led to believe they can control what happens when we all know that childbirth is completely unpredictable. With this sort of prevailing culture is it a surprise some women blame themselves when things go wrong and leave other women scared/worried/frightened when medical intervention (eg EMCS etc) is required?

Surely a more sensible approach would be to focus on the phycological and physical health of mother and baby. And surely the best way of doing this is by ensuring women have the right unbiased antennal education and have the option to choose how they deliver their DC.

I've had different kinds of births including HB and ELCS. Personally I prefer the no intervention no pain relief option if I can get it because I hate feeling "out of it" or not being able to move. Also I don't mind pain in labour when I don't have to think about anyone else and DH is there to rub my back etc. Pain after CS is horrible because you are also looking after a baby and getting up in the night when all you want to do is either sleep or lie perfectly still.

littlepeapod bubbly is probably not a good idea. The combination of codeine and oramorph makes you feel drunk without adding alcohol into the mix and anything fizzy is a really bad idea because of the painful trapped wind.

Ellie I was been facetious regards the bubbly.

oops, sorry. champagne after a C-section sounds like something I'd do and then wish I hadn't

# Ellie for the champagne post. God. Can't wait to have a glass of guilt free bubbly.

hazeyjane Fri 29-Nov-13 12:22:56
LittlePeaPod, I know you don't want to get into breathing difficulties and electives, but I have to take exception to this

The whole birth canal argument is actually misplaced. But I guess if people google enough rather than speaking to actual professionals they can come up with an argument to the contrary.

I didn't have to google, and I have spoken to several professionals including the paediatrician in NICU, when ds was in with severe breathing problems at birth and both of his respiratory consultants. They have all talked about the combination of premature lungs (my ds was born at 39 weeks - but as both my dds were born at 42 weeks, it may be that I gestate babies longer!) and problems with the baby not having gone through labour.

I would agree with you too a point, HOWEVER, the trouble I have is how misinformed even professionals are on the subject of birth and what research actually shows. Sometimes healthcare professionals are guilty of giving anecdotal opinions rather than scientific fact. There is so much bias and misunderstanding on the subject, its difficult to trust what you are told.

In terms of how true the above is, the best thing is to point this out to people:
The risk of respiratory morbidity is increased in babies born by CS before labour, but this risk decreases significantly after 39 weeks. Therefore planned CS should not routinely be carried out before 39 weeks. NICE

If you actually look at the evidence NICE looked at, then the risk at 39 - 40 weeks is very small, and actually the key here to reducing the risk might well be getting as close to predicting EXACTLY when a baby is ready to be born rather than how the baby is born.

Then you look at how you can conduct a fair experiment on the subject its very difficult to do if not impossible. The problem is that most ELCS are carried out for medical reasons, and any research done compares both women with and without a medical need for an ELCS with women who don't have this need. You can not eliminate that the possibility for the difference is the underlying medical need rather than anything else. To date NO SIGNIFICANT STUDY has EVER been done in any area which ONLY looks at women with no clinical indication for an ELCS (as much as anything due to the small numbers of women who are doing this). The best studies currently available use women who have an ELCS for breech babies as a way to get round this 'no medical reason' thing, but the mere fact they are breech might be influencing the results - we don't yet understand the reasons why babies are breech which is an important and signifant flaw. I believe that there is a university in Australia that is currently trying to do the first research of its kind into women who just choose without a medical need, but its not yet complete and won't be for some time.

Its also worth pointing out that key point that NICE decided that the level of risk was acceptable enough to recommend that it was ok for women with no clinical indication to be allowed to have access to an ELCS. If they though the level of this risk was significantly higher would they do this? The point is about the need to balance a number of different risks not just looking at one single risk.

Much better than getting into a slagging match about how you are putting your baby at risk of one thing, whilst you completely ignore the bigger picture of numerous risks.