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.

[Foxeym]

I had a horrific vb with DC1 ending in baby's heartbeat slowing and episiotomy and forceps. It took a very long time for both myself and my baby to recover from this and I nearly lost her. I had an ELCS with DC2 and can honestly say I recovered within days. The physical and mental problems I had after vb were a hundred times worse than the ELCS. I'm currently 34 weeks with DC3 13 years after my last DC and again I am having an ELCS. I agree that some people have fantastic vb deliveries but I think the choice should be there

[thecakeisalie]

Nobody is debating the choice to have an elcs when you are either high risk or in a subsequent pregnancy following complications/emcs. What is in question is whether the NHS should allow first time Mums with no medical reason to easily opt for an elcs.

morningsarepants - I understand now in your position if you were at risk of complications first time around why you wish you had pushed for an elcs. The problem is if the nhs offered c-sections as a matter of course many women may opt for this when they would have gone on to have straight forward labours.

[hazeyjane]

There is a higher risk of the baby having breathing difficulties in an elective caesarean, as the baby isn't squeezed through the birth canal and because the lungs haven't been prepared by the start of labour.

I had a very traumatic elective caesarean, and a long recovery.

There are no absolutes with either type of birth.

[LittlePeaPod]

Again ladies I am in work so not had a chance to review all posts/questions. However a couple of ladies have asked why I want an ECS. The answer is simple, I want (and I am having one on the NHS, already confirmed) an ECS for the same reasons women want home births, hospital births with no pain relief or hospital births with pain relief. I don’t think it’s an easy option – neither VB or CS are easy options! It’s my body, it’s my choice, it’s my baby and this is my chosen birth plan. I have made an informed decision and thankfully I have been in a position to be able to pay to get unbiased professional advice/information from three separate senior Consultants specialising in this field –as per my original post--

I guess other people will not understand my choice in the same way I can’t understand why anyone would risk having a home birth. What if the baby was born with breathing difficulties and required emergency assistance. Surely having a homebirth placing that baby in very grave danger because the baby would not have access to the high tech equipment that is required (e.g. ECMO machine etc.)?

We all should be able to make informed choices on how we want our child/children to be born. I don’t tell people they shouldn’t risk a baby’s health by having a home birth and in the same spirit I don’t expect/want that others to tell me what I should do. Unless you are a qualified and experience Consultant Obstetrician, Gynaecologist or Consultant in some sort of Fetal Medical field. And even then I want unbiased information about all my options. This is our first child and sadly it has become apparent how biased the antenatal information dished out is. We remain rather naive about caesarean birth and take on board the negative opinions and media hype told to us by the very people supposed to be helping us make information choices. –its BS as far as I am concerned--

Because of the lack of information on all options, the shame of it is that many women are totally unprepared for a caesarean outcome (specifically talking about EMCS here) and when it happens as the Consultants I have spoken to say “many women are completely unprepared and this can add to the traumatic experience”. And I talk from experience having had close friends and family having an EMCS.

In addition we can’t compare an EMCS to an ECS. These are two totally different situations and one will be more traumatic for obvious reasons.

Again I am at work ladies so not had a chance to read through all posts. I will endeavour to do this when I get home this evening.

[noblegiraffe]

bright
The consent form for a c-section says 1-2 babies in every 100 will suffer a laceration during a c-section (accidental cut).

www.rcog.org.uk/files/rcog-corp/CA7-15072010.pdf

[HotSoupDumpling]

littlepea - I think you're brave for posting and agree with most of what you are saying. I believe that a first time mother who requests an ELCS is no less 'irrational'/'greedy'/'selfish'/'lazy' than a homebirther who has 1-2 midwives in attendance at their home and if anything goes wrong gets use of an ambulance to transfer them to hospital.

Everyone should take off their mcjudgey-pants and try to understand that how a woman gives birth is a personal decision without a right or wrong - the woman should be able to (within reason) take whatever risks she wants as long as she is fully informed.

[PassTheCremeEggs]

I agree you're brave for posting OP but I'm still none the wiser why this is your choice. Home birthers might say they want to be in a familiar place with the least amount of intervention, those choosing to labour without drugs might say they want to be closer to the experience and/or be able to feel everything in order to listen to body and labour more naturally etc. Those wanting a more medicalised labour (eg in hospital
unit as opposed to midwife led unit/home birth) would probably say they want the safety and security of immediate medical attention on hand.

But none of that answers why you want a c-section when you've already said you don't fear a natural birth. I agree it's a woman's choice to choose how she gives birth but as you don't have personal experience of either a CS or VB I'm surprised you feel so strongly about not trying to labour naturally.

I genuinely don't mean to push you, I'm just really interested in the thought process behind your decision and would love to hear your response.

[mouseymummy]

HaPPy... I wish the hospital saw it like that. When I saw my consultant at 20 weeks I was told another cs was 'unlikely' I argued the point and was met with a.shrug of the shoulders and told to talk to the consultant mw.

I explained my argument to the consultant mw,.who proceeded to tell me I would get the cs if I went over due but she wanted me to have a VBAC and asked me if I would "at least try to not be so stubborn" I explained myself again and said I was not willing to risk my own life, nor that of my unborn child to please her. I was also unwilling to be forced into a VBAC and requested to speak to another consultant mw. That was denied.

At my 30 week scan, I saw another consultant, I explained what had happened at my last visit to the hospital and said that I was very unhappy and explained my argument again. I was told I would get the cs and a VBAC was only on the cards if I went into spontaneous labour and baby was out before they could get me to theatre.

I'm going to the hospital again tomorrow so hopefully I will be able to sign all the paperwork and get it booked in!

[PickleSarnie]

It's interesting you say that you have paid for the advice of two consultant obstetricians and a fetal medice consultant.

I would like to know how many unassisted VBs they have been involved with. They are generally only ever involved with "high risk" pregnancies and then only when there are issues in labour. I personally didn't see a doctor or any sort throughout my last pregnancy and labour so my experience (which was lovely and straighforward) would never be one they'd have been aware off. I can't and won't believe that the opinion of those medical professionals you sought are entirely unbiased. Off course they will be more likely to take a medical approach because that's what they are trained in and that's what they see.

[NaturalBaby]

As a mother who had a drug free home birth 3 times I agree with what you're saying about choice but cannot fathom why anyone would choose to have an ecs for the 1st baby without specific medical reasons - you have no idea what your body is going to do in labour and childbirth so why assume the worst and opt out?

You've obviously made a fully informed choice but as someone who made a fully informed choice for the exact opposite birth plan, I'm curious as to what made you arrive at your decision.

I also had very good advice from both sides, including all the usual scare stories and what ifs, and was confident in my midwives ability to diagnose and respond to any complications at home as well as, if not better than a hospital environment.

[AJH2007]

I don't think all doctors/midwives try to put you off c-sections anyway, though I'm sure some do. The midwife at my hospital booking in appointment said I could have either and it was my choice, without me ever raising it.

[rallytog1]

I really hope you've read up on the risks of cs, both to yourself and your baby Pea. A cs baby is less well equipped for breathing and doesn't have the same 'friendly' bacteria in their gut as a baby born by vb.

After a botched cs, my baby was fighting a life-threatening infection in the neo natal unit while I was on the operating table under general anaesthetic for hours having my mangled organs put back together. My DH honestly didn't know if either of us would pull through and we're both lucky that we did.

That was 20 weeks ago and I'm still in constant pain and discomfort. DD is fine now but only because a very observant mw realised something was wrong with her so quickly. Bf was a complete disaster because of my injuries and all the time we had to spend apart. I have put on a ton of weight because I'm still not well enough to exercise. Bonding took a long time. And psychologically I've suffered from flashbacks and depression.

I have plenty of friends who've had very traumatic VBs as well but their recovery speed has been like lightning compared to mine. It actually makes me cry to see how much I missed out on in the early weeks because I was so unwell.

Frankly, unless there is a valid medical reason, having a cs shouldn't be a totally free personal choice. Birth isn't a consumer experience and the safest way to bring a baby into the world is via vb. There are many situations where the circumstances make a cs the better option but I'm afraid yours is not one of them.

Oh, and your thoughts on home birth are totally irrelevant to your argument.

[KittyKK]

Really interesting and emotive topic!

I think each individual should make their own decision about how they want to give birth. Not really anyone else's business.

I'm choosing an ELCS. Thankfully I don't have to ask permission from a Dr, as it's private.

My personal reasons are:

1. I don't want to wait for a random date to go into labour, and
   
2. I don't want to push/strain.
   
   Will just deal with whatever recovery comes afterwards.
   
   Good luck all :)

[Bamboobambino]

They aren't irrelevant at all.
Why is it more deserving to allocate NHS resources to personal choice home births than it is to elective sections?
I know this is a separate argument to the OP's post, but surely if it's resources that we are talking about then nobody should have anything non-standard on the NHS, i.e no elective section (if not medically indicated) and equally, no home birth on the NHS.

[rallytog1]

I meant her safety argument re homebirths Bamboo not the resources argument.

Tbh I'm concerned about the amount of resources needed for home births too!

[Kelly1814]

I also hugely recommend reading this book....debunks a lot of the myths about ELCS with lots of research and feedback from patients and doctors. Very balanced and no 'caesarians are more dangerous' hysteria. Really helped me.

www.amazon.co.uk/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110/ref=sr_1_sc_1?ie=UTF8&qid=1378911681&sr=8-1-spell&keywords=Choosing%20caesaran&tag=mumsnet&ascsubtag=mnforum-21

[thecakeisalie]

But a home birth probably saves the nhs money. Not taking up a hospital bed, not eating hospital food, not using the hospitals electricity, being dealt with by the community midwives, only 1 midwife is there until towards the end when another will arrive (same as a hospital birth 2 midwives will attend at delivery).

I think home births and midwife led units work out as the cheapest birth options from the nhs point of view.

Most home births don't end in a transfer to hospital so the point about ambulances isn't relevant in all cases.

Just a quick google turned up this link as well - www.nhs.uk/news/2012/04april/Pages/home-birth-cost-effective-labour.aspx

So actually from the nhs website it seems home birth is actually the cheapest option.

[thecakeisalie]

So a little bit of research puts the cost to the nhs at -

Home birth £1066
Midwife led unity £1450
Hospital birth £1631
Elective c-section £2539

I'm not sure if that covers the after care as well or simply the birth but quite a big difference in cost. I'm not sure how accurate those figures are but they are taken from the nhs website and provide an average cost for each option.

[FraggleRock77]

I really dread when these posts go up as it is such an emotive subject. I'm also having an elective section for non medical reasons. I think it is personal choice. I don't smoke. I don't drink. I've hardly used the NHS for anything else and I've paid in all my working life.
I never want a vaginal birth

[MissPlumBroughtALadder]

But it's not just the 'major surgery' aspect. Choosing a section has potential immunological consequences for your baby. Because the baby doesn't go through the birth canal it is 'inoculated' with the resident vaginal flora, bacteria which start the colonisation of the previously-sterile infant gut. Also, the composition of your breastmilk is different depending on both mode of delivery and whether or not you go into labour. All of this goes part way towards explaining why babies born by section have a significantly greater life time risk of autoimmune disease (the most studied being coeliac).
Section delivery is like formula feeding: a valid option where the natural way is not a possibility but vastly inferior in terms of the baby's long term health. It should not be seen as just another way to give birth.

[VivaLeBeaver]

LittlePea - Its NICE not NISA.

Happy8 is correct - hospitals/the NHS do not have to "allow" women LSCS for maternal choice. Some hospitals will, some don't.

I work in the NHS, I write guidelines for maternity units and inspect maternity units. I can promise I know what I'm talking about.

The guidelines do say that firstly women should be offered the opportunity to discuss their anxiety with a perinatal mental health professional and then if the woman still wants a section then they should be allowed this.

There's very few hospitals which offer access to a mental health professional and they don't have to. These are guidelines, not laws or rules. Hospitals can choose not to follow certain guidelines.

Ditto the second part - though you've probably got more chance of a consultant just saying OK than seeing a mental health professional.

But some hospitals won't at all. One of my friends is an Obs consultant and she isn't allowed to book maternal choice sections. The PCT (we had this conversation last year when they still existed) simply won't pay for such sections. If the PCT won't pay for it (or commissioning group now) then the hospital certainly isn't going to do it no matter what you say.

And trying to "scare" you is quite possibly a health professional making sure you're making an informed choice. It is higher risk than a vaginal birth so they have to spell out the risks to you so if it happens you can't turn round and sue.

[tinkerbell666]

Having had 4 'normal' but very painful births, and one section due to major placenta previa, i have to ask why the hell anyone would choose a section !! its bloody awful !! from all the drugs, delivering in theatre, down to the pain for weeks afterwards, not being able to drive etc etc. There is the choice in labour to be given lots of different pain relief, i had an epidural with 3 of mine, and i personally see it as a far better option than major surgery. Oh, and my section was only 3 weeks ago, so its all a bit fresh in my mind !

[mrsvilliers]

Tinkerbell I saw you posted on another thread too about hating your section, I'm so glad you're saying it! I hated my section and the scarring it left. I am now pregnant with no 2 and get searing pains through my scar when I push the buggy.

OP I am sorry but I think you are mad. Yes, there could be complications but you could also be one of those women who give birth easily and are discharged after six hours. With a c section, at the risk of being brutal, you are awake while someone cuts into you and then you are awake if anything else e.g. haemorrage happens. It is not pleasant. And to add to the unpleasantness you are then on a post natal ward for three nights!

[SaucyJack]

Personally no, I don't think it's a shame that the NHS make it difficult for people to demand major surgery for no medical reason.

I don't think it should be a choice at all for first time* mums. And it most certainly is not an informed choice. How can it be when you have no experience of what it is you're so desperate to avoid?

*I can appreciate tho that women who have had a difficult and/or traumatic previous birth experience may opt for ELCS in subsequent deliveries, whether strictly medically necessary or not.

[LittlePeaPod]

Hi All,

Just got in from work and I now have some time to try and respond to your questions. I will endeavour to cover everyone’s points off. Thank you to those that think I am brave to post about this subject. I don’t think I am brave I just want to voice the opinion of women like me. We exist and I am not ashamed for having chosen this birth option.

Starting with the why am I having a CS. I thought I had answered that. It’s my choice and there isn’t really anything much more to it than that. If really pushed then my honest answer would be I would rather take the risks of an ECS than take the risks of a VB. There is nothing else to it. Personal experience also shows that most of my family and friends that have had VB have suffered one trauma or another. I have no interest in having a VB. Challenging my decision on this is the same as me saying “Why would anyone want to take the risks associated with a VB?”. The people choosing this option would think I was mad. Why is it different for me and my choice? VB and CS both carry real risks, just different types risks. I know what these are and I am more than comfortable with my decision.

With regards the NICE not NISArightly corrected by Viva guidelines. I never said anything about these been a legal requirement. I think someone else interrupted what I said as this. These are guidelines in the same way the FCA have guidelines. However the Consultants I have met all made it clear if a woman insists they will get their CS. But I do take your points on board Viva. I am sure different Trusts will have different procedures. I do need to point out though that I am proof that if you want a CS you can get one. I am 23+6 and I have no medical need for a CS and my CS is already confirmed. I didn’t need to wait till 28 to 34 weeks to get a decision and I didn’t need to jump through any hoops. I would say I am assertive and will say exactly what I think. I told my MW my decision was made. Spoke to my GP and asked him to refer me straight to a Consultant which he did. Then had a grown up unemotional conversation with the Consultant about it and explained I understood the risks in terms of VB and CS and I personally would rather take the CS risks. That was it, decision made. Clearly I was well informed before attending the meeting. And if I hadn’t been accepted then I would have gone private anyway.

The recovery time really doesn’t bother me. Again the Consultants advised that this can be anywhere between 2 and 6 weeks. My SIL had an EMCS and she was up and around (driving etc.) after 2 weeks. My close friend is currently in hospital because she had an extremely traumatic VB about 2 weeks ago and her daughter nearly passed and ended up in the Lestershire NICA unit on the ECMO machine because of breathing complications associated with a VB. Thankfully her daughter is off the ECMO now but still getting help via a ventilator. With regards the surgery she says it’s not that bad and she is healing well. She just wishes she had opted for a CS instead of a VB because they would be all home now. My SIL’s scar is hardly even noticeable. Now I understand that everyone is different and some people are not so fortunate. Everyone’s healing will differ. In terms of cost to the NHS again that isn’t on my conscious I pay/have paid a very large percentage of my wage in tax for 19 years (maybe not so big a percentage in the earlier years). I think I have paid my way on that front.

Someone mentioned the breathing difficulties to babies born via CS. From the information I have been given 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. For this reason apparently official guidelines recommend CS not to be schedule before 39 weeks when the baby’s lungs are fully mature, unless medically necessary. Apparently many studies also acknowledge that both prematurity and underlying reason for the CS play a significant part in the likelihood of the baby experiencing breathing difficulties. It may be true that CS without labour increase breathing risks but research is very unclear on this specific point. All they know is the later in pregnancy the CS the lower the risk. Now I may well be wrong on this point and happy to hear differing views.

Rallytog I am really sorry to here of your experiences and also sorry to hear of some of the other traumatic CS experiences and I am so sorry you went/are going through this. But, I have also lived through seeing loved ones suffer extremely traumatic VB and it was awful to watch. We nearly lost my sister because of a VB and as stated above my close friend is still in hospital two weeks after her daughter was born because of complications caused by a VB. We have no idea when she may be able to go home. Both the VB and CS options have risks. What matters and the point of my post is woman having a right to know all the risks/benefits so they can then make an informed decision on what they want to do.

I have made my decision. I have had no second thoughts and feel no guilt about what I have chosen. Again, this is my choice.