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.

[VivaLeBeaver]

You're proof that if a woman really wants a section at your hospital then they can get one. I'm not been arsey by been pedantic but I'd hate for someone to read your thread who's at a different hospital and they can't get it and then they're wondering what they're doing wrong.

I'm pleased for you that you're getting the birth you want. As a midwife I'd always be a woman's advocate and fight as much as I can for a woman to get the birth she wants whether its something I agree with or not as long as its an informed choice.

But a midwife only has so much power and if a Dr/hospital says no it's not going to happen. As hospital trusts are increasingly trying to save money I wouldn't be surprised if it gets harder and harder to get sections for maternal request.

[LittlePeaPod]

Again you are right to point out that difference Viva with regards hopital procedures. And one of the disappointing things I discovered through my research is the push on VB isn't just for the woman and baby's best interest. It's also very much driven by cost containment.

[LegoDragon]

I have an ELCS date three weeks away, soon two, thanks to MH issues. If you are terrified of the idea of a VB, you're meant to have counselling, aren't you? I have a friend who did this, had a course of (NHS) counselling, which didn't resolve anything and it was more like a phobia than fear, so it was decided she wouldn't be able to physically or mentally cope, and she had an ELCS.

[greentshirt]

This is a really interesting thread, lots of food for thought on both sides. I am only 9+3 with my first pregnancy and am torn between a homebirth and discussing an elective section. To be honest, im not at all scared of the pain of a VB or actually doing it, im worried about the quality of care at my local hospital and I half think that at least with an elective section there is some control, which is what I wouldnt have with a VB at the hospital. With a homebirth I would have the monitoring that I feel is lacking at the hospital.

Im sure my reasoning for not wanting to labour at the hospital wouldnt warrant an ELCS but it is interesting to know how far it could be pushed if neccessary. Lots to think about over the next few months

[VivaLeBeaver]

The NHS is run by accountants.

[thecakeisalie]

I have to say personally the thought of them performing major surgery on me while I'm awake scares the living day lights out of me. Also would never ever want an epidural again following the first one I had (planned due to high bmi) left me with severe itching from the waist down, I would take the pain of contractions over the itching any day. I'm hoping I never have to go through a CS.

I don't think anyone is trying to convince you to have a vb here or even necessarily judging your choice - as you say its your choice to make. I don't think I will ever understand it in the same way I doubt you would ever understand my choice to challenge the consultant to let me have a home birth despite being high risk due to high bmi. I've done my research weighed up the risks and made my choice. However if I get the go ahead I will not be writing a thread on here suggesting that other women take the same risks. Also I have previous experiences to base my decision on which helps.

It just doesn't sit right with me to encourage cs as an alternative way to give birth for a first time Mum. I do not buy into the horror stories because for every horror story there is about 10 positive birth experiences and you can find horror stories for every decision in life.

[Isabeller]

I am not sure which ELCS or VBAC is the better route for me and I am currently researching it (20 weeks) so this is a very helpful thread.

[LittlePeaPod]

Lego glad to hear you are getting your birth choice.

Again it's a shame that women that choose an ECS are so often stigmatised and referred to in derogatory terms such as to posh to push or made to feel guilty/lazy because others assume they are doing it because they think its an easier option. You know what, we don't think it's an easier option!

We live in a modern world and as women have liabilities, choices and options we never had historically. Why some women want to reduce that choice for other women because its not what they would do themselves really shocks me. . Everyone should have control over how they want their birth plan to go (VB or CS).

Greenshirt. I think the key is to really understand what you want. Also getting very well informed about your options and choices, which isn't easy.

Viva I think the world is run by accountants or salespeople.

[LittlePeaPod]

thecake as you say I will never understand your choice and I too don't buy into the horror stories. There are risks in everything, things can go wrong CS or VB. It just depends on how risk averse someone is and what risks thy will accept. With regards this thread, if people are uncomfortable or unhappy about it they can comment and say so or hide it. I think we need to debate these issues, its important.

[weasle]

I am astonished some people think major surgery is a lifestyle choice. A home or hospital birth is safer and cheaper. We are all affected by our previous experiences and those we are close to, but statistically, CS is not as good as VB, although of course no birth is risk free.

We currently have about 25% of births as CSs. OP, If that increased further, how should we fund it? What NHS service would you cut to allow 'free choice' in this matter? Good that you don't smoke, but it's not relevant.
The NHS is there as a safety net. If you can afford to have an unnecessary more expensive treatment privately, then go ahead, but why should the public purse pay?

[LittlePeaPod]

Weasel I never said I didn't smoke. Although I actually don't smoke.

I doubt we would have a huge influx of people wanting CS. I wouldn't cut anything from the NHS if additional funding was required my preference would be to cut costs from other things. But if pushed on what could be cut from the NHS then maybe we can start with the cosmetic surgery, weight control surgery etc.

With regards having a private CS so I should carrying on paying 45% tax and help fund home births and other women's choices on how they have their babies but I cant use the NHS. Yea right!

[FraggleRock77]

I would cut weight loss surgery too x

[PickleSarnie]

What weasle said.

[PassTheCremeEggs]

Greentshirt - I'm probably not the only one who finds it extraordinary that you would choose to have major surgery at a hospital whose level of care you question!

To me, choosing to have a section is not retaining control at all. You are literally paralysed and cut open! Why would you entrust someone to do that, get your baby out safely and then successfully close you up again without any complications/infection etc if you don't have confidence in the hospital's general level of care?! If I was worried about care levels I would be putting my energy and trust into relying on my own body to do what it was designed for and has successfully done for thousands upon thousands of years, and take full control in managing that process myself. I would not be choosing to be put on an operating table and paralysed. Where on earth is the control in that?

[hazeyjane]

The feeling of vulnerability, and loss of control was one of the many things that I found awful about my csection, and one of the many things I was completely unprepared for.

[KirjavaTheCat]

So out of interest, if you could change the way that the NHS offers and discusses birth options with expectant mothers, what would you change?

[greentshirt]

Pass the creme eggs - I have actually had surgery at the hospital and it was fine. My concerns are all around the amount of monitoring whilst labouring and midwives failing to recognise an emergency situation until its too late. That's why I'm veering between the two very different options and in all likelihood if I have a low risk pregnancy will go for a homebirth as I would prefer a VB if poss, just not st the hospital.

[LittlePeaPod]

I cant comment on the hospital,issue. you make a valid point. But ultimately childbirth is unpredictable regardless of VB or CS. I wonder how many women really achieve the socially defined "intervention free" birth. It's tragic that people are led to believe that they can control what happens in a VB when we already know a quarter of these end in a CS anyway and those that don't a lot have some sort of intervention (pain relief, forceps, inductions, episiotomies etc.).

Personally I feel the control is in relation to knowing and choosing what you want your birth to go like. Going in well informed and fully understanding what will happen, whilst also understanding what the risks and benefits are. Just my personal feelings not saying ts right or wrong.

[vj32]

I guess a ELCS for a first timer is a guaranteed poor result, rather than taking the gamble that you might have a great birth (easy vb) or you might have a horrible one (assisted birth with complications or EMCS after long labour or worse). So I suppose it comes down to whether you are naturally a pessimist or an optimist. I don't think the NHS should pay because people are pessimistic.

[CelticPromise]

LittlePea I've read this with interest, I know there are NICE guidelines which aren't followed because of financial pressure, I'm sure that is the case with sections in many trusts and rightly so IMO. I expect that those who shout loudest and are prepared to argue usually get their way though.

Re your SIL driving, it's worth knowing that you have to inform your insurance company, and mine were not prepared to cover me to drive until eight weeks after my very straightforward, easy healing section.

[PassTheCremeEggs]

I would clarify that it's not a quarter of attempted VBs that end in c-section, it's a quarter of all births, which obviously includes all of the electives. It's actually 14% in England that are born by emergency c-section. Which means that 86% of attempted vaginal births are successful.

Also - there is theory that says the rise in the number of elective is causing midwife skills to drop. There used to be a time that breech babies would be delivered vaginally but now it is nigh on impossible to persuade midwives to attempt this because they don't have the experience anymore to do them. How much truth there is in this however I don't know, but it's an interesting thought.

[noblegiraffe]

A quarter of births may be a c-section, but that doesn't mean that a quarter of VB end in a c-section. That figure will include ELCS. Not sure what the EMCS rate is.

[noblegiraffe]

X post, creme egg. Glad to see someone has the figures :)

[PickleSarnie]

"It's tragic that people are led to believe that they can control what happens in a VB when we already know a quarter of these end in a CS anyway"

That's a poor use of statistics there OP. You are suggesting that a quarter of all attempted VBs end in CS. No they dont. A number of those CSs are planned for medical reasons, mental health reasons and because people, like yourself, "just want one".

Don't you think that we should be addressing the reason why a number of VBs end in a CS when perhaps they needn't? Increased intervention - epidurals, syntocin etc has been proven to lead to a greater chance of ending in a CS. I agree with you when you say it's tragic that people think they can control a VB when, often, unnecessary medical intervention gets in the way.

[PickleSarnie]

Aaaaargh. Crossed posts with others due to slow typing skills.