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.

Stripytop - I agree childbirth is not a competition it's a means to an end. What I will say is that a broken bone is not something our bodies are meant to do it's an injury which we treat to speed healing. Childbirth is not an illness or injury, unnecessary intervention can lead to further complications. I agree refusing medical intervention in a circumstance where it is needed is of no good to anyone. However the reason people advocate natural childbirth where possible and ideal is because it generally leads to the quickest recovery time for mother and baby.

Simply due to my bmi with ds1 I was heavily encouraged/convinced to have an early epidural 'just in case' things went wrong. This unnecessary intervention stopped my labour after I'd already progressed to 7cm and resulted in me needing a hormone drip to get it started again. I fully attribute the 2 hours of pushing to the epidural and being forced to lie on my back. I only just managed to not have an assisted delivery.

Compare this experience to my ds2 where I was active and only had gas & air right at the end - I pushed for 3 minutes. No threat of assisted delivery or delay in recovery time.

Intervention isn't always a good thing and preferring the idea of an intervention free birth doesn't mean I am against modern medicine. If you want to look at higher intervention rates you should consider the US stats. They are very pro medical intervention but its seems with very little benefit in the overall figures.

In terms of whats 'better' there are some pretty odd patterns out there. There are some countries where the CS rate is considerably higher than the UK - and the neo-natal and maternal death rates are lower. There are also some countries where the reverse is true.

I would definitely NOT look to just the USA when you talk about higher rates of intervention. There are other countries which the evidence seems to suggest something entirely different. Certainly isn't evidence that being more or less pro-intervention is the key issue. There definitely seems to be something more to it - perhaps the point of intervention and other levels of care, perhaps the general health of the population or the age they first have children.

Just wanted to update on my ELCS -
Our beautiful baby boy was born on 9 Jan (at 40w exactly) at 12.14pm, weighing 10lbs even. Apgars of 10/10/10, had skin-on-skin time within 5 minutes of him being born, and started breastfeeding as soon as everything was stitched up. We were number 3 (out of 3 ELCS) so the wait wasn't too long; got called in at 11.30am.
The bad - as this was my 3rd CS, unfortunately there was a problem. After my last CS, my bladder attached itself to my uterus. As they pushed and pulled to get DS3 out, the bladder got ripped off again, so it had to be stitched where the adhesion had been. Original plan was to leave the catheter in for 48 hours (instead of the usual 24); but then my case got reviewed by a specialist who recommended leaving it for a week And so I was discharged after 2 1/2 days with the catheter still in place. It was miserable - having to empty it, having to change bags, having that bloody tube dangling out of your bits all the time, unable to lie in bed comfortably; all the while hurting anyway and trying to take care of a newborn!
Finally on day 8 had my appointment for a cystogram which showed all had healed, then they took the catheter out, hallelujah! Still had burning and stinging for 4-5days after that when I went for a wee.
On the plus side, the pain in/around the incision isn't as bad this time, and the scar is healing nicely. But then I have learnt from my mistakes and am really taking it easy this time.
So all in all a positive experience, but it goes to show that there are risks associated with it.

im having a real freak out now. I thought noone would have to go 'down there' for a section. Now i find out how they put acatheter in.. Aggghh.. And dont say it doesnt hurt because they put it in aftr spinal that in someways makes it worse because i have no control and would feel really violated either way. I really dont know what to do because a natural birth would also leave me feeling violated. Im really regretting being pregnant now..

You won't feel the catheter being inserted. But oh how you will feel it when it's being taken out!

its not about feeling.. But cheers for making it o so much better.. Not

peeapod please don't worry about the catheter. You honestly won't feel a thing. They put a screen up once the spinal is in, so you can't see what they're doing. You probably won't even know they're putting it in. The operating theatre will have lots of people in it and it will seem like there is a lot going on, so you'll be surprised how distracting all that can be. Plus once you're on the table and under the spinal, you will honestly feel so excited about meeting your baby any minute that you won't notice a lot of what is happening.

Taking the catheter out can be a bit sore, but honestly not too bad and you can ask for gas and air if you're worried. That bit is also not intrusive as they use a little external pump to deflate it, then pull it out, so no one will actually have to touch you to remove it.

Oh peapod - please don't get upset or worried. If you are really, really anxious or worried then perhaps ask just how necessary it is that you HAVE to have a catheter and whether any exception can be made? Ok, it may mean you have to wear granny nappies whilst the spinal is in place post procedure, or there is a risk without a catheter of you urinating during the CS but you just need to weigh up what psychologically is better for you. At the end of the day they can't physically force you to have one (unless they pin you down and assault you against your will) so maybe they will be open to alternatives if you genuinely think you won't be able to cope with it x

I don't think less of someone who has to have an CS for medical reasons or indeed who chooses to have one. I don't think it is a competition, I don't think there is a right or wrong, but there is a big difference between the level of effort involved for someone who chooses to go into a hospital at a pre-arranged time for an ELCS and someone else whips their baby out and a woman who labours for possibly several days to give birth to her baby. I am not anti-pain relief, I am not pro-natural birth.

I guess it depends on how you define an achievement in life. For instance if you are skiing in the Alps, you can choose to take the lift to the top or you see these mad nutters who walk up. The end result is the same, but the level of effort involved totally different.

As for those who said I had no choice I was doing what my body chose to do, total bollocks. I could have easily given up after 36 hours and said you know what I am too exhausted to do this any more, I really am, I need a CS and they would have given me one. I didn't. That does not make me better than anyone who has had a CS and I don't think it does, but for me having a CS would have been less of an achievement than doing it myself, BUT..... for the rest of you who are happy with what you chose then your definition of personal achievement is different and that is absolutely fine.

It's a bit like running a marathon, for me running a 5k would be a major achievement, for my super fit friend who has run 20 full marathons this year, it would not even register on her scale as exercise. I am not foolish enough to think that a 5k is as much effort as a marathon, but for me it is probably as much of a personal achievement as her 20 marathons, but to a totally objective bystander, clearly her achievement is greater.

writer to answer your question on lengths of induction 25 hours for my first and 36 for the second.

Is interesting you choose the term 'mad nutters' to describe those skiers who decide to climb up the mountain instead of taking the 'easy option' of the lift. Does that not imply that the people who choose to put in all the personal effort of a VB as opposed to choosing the 'easy CS option' are also "mad nutters"?

I certainly think I am after the last two goes!

and I don't think a ELCS is an easy option, it is a different option. I just think there is less physical effort involved in the process of giving birth with an ELCS, but hopefully I have made it clear that the achievement is a personal thing. Hopefully it goes without saying that the number 1 achievement is having a healthy baby at the end of it, but presuming that for both scenarios, then there is a difference between the two options, but that difference is totally personal.

Carrying on the topic of catheters, my best friend had an ELCS 7 months ago and they inserted her catheter before they gave her the Spinal

"For instance if you are skiing in the Alps, you can choose to take the lift to the top or you see these mad nutters who walk up. The end result is the same, but the level of effort involved totally different. "

You don't ski, I take it.

Nobody walks up the mountain in rigid ski boots (not made for walking) with heavy skis on their shoulders if there is a lift that goes to the same place. Seriously, Not One Person. Those mad nutters walk for hours up a mountain to ski in virgin snow, down peaks where lifts don't go.

"As for those who said I had no choice I was doing what my body chose to do, total bollocks. I could have easily given up after 36 hours... they would have given me one (a CS)"

You have misunderstood. The point wasn't whether or not you could be Rambo and stand the pain for 36 more hours. It was that your body would have given birth to that baby even if you had given up.

What did you think would happen? Would contractions go away if you gave up and decided not to push? Women have given birth while in a coma fgs.

I had a catheter put in after my vaginal birth the last time because I had a bad tear and needed a spinal to get the stitches. I was fully awake the whole time, there was no screen, and I still didn't know they'd done it! A nurse had to tell me after that I'd had one put in. So don't worry Peapod, you won't even notice it. I also didn't find it painful getting it out as far as I can remember.

See the 'personal achievement' thing? Are we forgetting the nine months of carrying the baby that we're all going through? I will have a section and I expect my husband to BOW DOWN to my awesome achievement because I will have had 5 months of horrible sickness and nine months of varicose veins, extreme heartburn, restless legs, hormonal craziness, anxieties about all sorts of real possibilities of problems, many blood tests and other tests..... seriously, anyone who thinks I'm lazy can feck right off, and my labour has gone pretty smoothly thus far. What about my best friend who had sickness so bad for the entire nine months that put her in hospital and then had a section at the end of it all? Lazy? I don't think so. It's such utter bullshit to put the emphasis on how the baby gets out of your body when your body has gone through hell growing an actual human being for the best part of a year. /rant over!

I have been running up this mountain for six months. I'm knackered and still three months to go!!

For 'labour' I meant 'pregnancy' there, but maybe labour is an appropriate word for the whole experience. Lucky you if your pregnancy isn't such hard work.

the recovery after a c section is the 'endurance race'... Surely?
Thanks for the help everyone. Compared to a natural birth its less intrusive and traumatic so its a case of bravery...
Needs must n all that. Ugh.. Its not about pain per sea but the violation of someone being down there without me 'knowing'. Its why an epidural assisted birth would be traumatic (and thats as natural as i could consider)

Cote d'azur actually I do ski. I was on my university ski racing team and my husband is a qualified ski instructor (retired), I have spent several full seasons skiing as a consequence and there are mad people who do choose to walk up in ski boots as a feat of endurance (which is why I said they were nutters).

weebigmamma we all go through the 9 months pregnancy if we are lucky. We were discussing the giving birth part at the end for comparison. I happily and freely admit that people who truly have awful pregnancies have endured more than those who have easy pregnancies, although to use someone else's words they don't have much choice in that do they. Similarly those who have ELECTIVE CS choose to go through less effort in giving birth than those who don't. If you read my post properly you will see I am not talking about those who for medical reasons have C sections - for medical reasons they have put a lot of effort in elsewhere which is why a CS is the better medical choice. My only point was that for someone who has never given birth vaginally, never even tried to give birth vaginally to say a CS was the same as giving birth vaginally is clearly nonsense. I did not say it was a worse choice, I said it was less effort, which it blatantly is

Yes and my point is that focussing on the end hours is bonkers when you consider how much work has been put in previously. I object to the word 'achievement' in that regard. I had a vaginal birth with only gas and air so I am well aware of the differences and I don't think it's less of an achievement to elect for a section, not in the slightest. I had the birth I wanted last time, and this time I will have the birth I want. Achievement all round! Avoiding being guilted into thinking you're a failure or somehow less good because of your legitimate choices? Also a big, big achievement.

Sfry a planned section is nothing like an emergency section. An emergency section is no fun, the risks are higher and recovery is prolonged. Of course no one would choose this. A planned section is much different. Calmer, safer, With a much better recovery time. But still, you would only choose this if there is good reason. A psychological need is as valid as a physical need.

You don't agree that it should be the burden of the NHS to pick up the cost? We all have different maternity needs and Whatever they are, it is the duty of the NHS to provide safe maternity care for mother and child regardless of delivery method.

Well done umber congrats on your new baby.

Peapod. You really can't have a c-section without a catheter. Is there a midwife you have a good trust relationship with who you could ask to do this for you?

There is not a lot less effort involved in having a c section though. I did not put the effort in elsewhere in my pregnancy compared with other people. My effort will come in the psychological sense through the c section and the physical recovery afterwards.

I see the effort as different, but pretty equal. Perhaps timed differently too, but recovery after a c is longer than a vaginal. The effort involved in recovering from surgery is tough on the body.

ultimately my badge of honour will be equal to that of other mums..

a baby.

Madasabox - If you are not making that up, you must know some very strange people. Do you "I'll go suffer so I'll feel I've achieved something" types hang out together? I have been skiing for 35 years and in 4 countries and over 15 resorts I have been in, I've never seen people walking to a peak they can get to by lift.

Anyway, it is not a good comparison to VB/CS. The reason why the vast majority choose ElCS is not "So it will be easy". Trust me, there isn't much that's easy about having your belly cut open and stitched back together.

Congratulations littlepeapod glad it all went well for you, hope you are enjoying your lovely new baby.

Congratulations also to GreatJoanUmber, having a catheter for a week is an unpleasant experience, I fully sympathise having had that too after my ELCS. Hope your recovery is going well.

peapod don't worry about the catheter I had to have mine taken out and re-inserted to check my bladder a week after surgery, it was fine. The spinal was already active for all of my CS when they inserted it before surgery.

Just thought I would pop on to mention one of the risks associated with c-sections. There is a very serious obstetric complication called placenta accreta (morbidly adherent placenta) which (as in my case) is often associated with placenta praevia or an anterior placenta overlying the previous c-section scar (but not always) and the risk of this increases with each c-section you have.

The risk of you developing placenta praevia doubles after one c-section and 50% of women who have had a c-section previously who have a low lying placenta at the 20 week scan will go onto have placenta praevia. In placenta accreta your placenta grows into the uterine wall. In the presence of a praevia or low-lying anterior placenta the risks are 11% after one c-section, 40% after two c-sections, 61% after three.

I have had three c-sections, 2 EMCS and one ELCS. I had my third CS an elective two days before Christmas 2013. I had placenta accreta of the worst kind and my placenta had grown through my uterus and into my bladder (placenta percreta). During my ELCS I lost all my blood volume and wouldn't stop bleeding and because my placenta could not be separated from my uterus I had to have a hysterectomy to save my life. I also had surgery on my bladder to repair it after they cut around the placenta to separate it from my bladder.

For me ELCS was not an easy option, but a necessary one.

I mention my story to highlight the potential longer term implications of choosing a c-section.