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.

The cost to the NHS mentioned above are just for the birth.

What about the cases where a woman goes through a long and complicated labour, has various painful and expensive follow up operations to fix the damage caused by the labour vs the cost of a emcs which would avoid all the follow up treatment to fix the damage done by a vb?

Although unpredictable, in many cases there are significant factors to indicate complications are likely. If most of my family went through complications during VB I'd say the chances are pretty high of going through a similar experience.

I would like to say to all the people talking about the cost to the NHS for having a elcs, that it's irrelevant whether it is a elcs, a home birth or a vbac in hospital that you choose because unless you go private all 3 will cost the tax payer and untill your baby is delivered there is no knowing what the cost will actually be as you don't know what will happen during the labour or at operation.

On the topic of elcs though I think you should have a valid reason for one, when you are in surgery you are potentially taking the time of a surgeon that could be needed to save someone's life when there is every chance your vbac could run smoothly. Iv had 1 emcs and 3 vbac 3 were very traumatic births and only 1 went smoothly,
I think it's right what the op is saying there isn't a lot off information about elcs and maybe there should be more about having one so people can make informed decisions especially when in some hospitals you can choose if you want one or not,
Iv got to say this is quite a good topic, it's nice to hear people's experiences of there births.

Naturalbaby you beat me to it

I had a traumatic vb and a traumatic elcs which found unknown problems, I thought I was dying was put under general and woke up hours later. If I had to choose again I would go elcs every time. The recovery was days despite having major unplanned surgery, after my vb the recovery took 9 months and I would NEVER go through it again. Just my experience but thank goodness for choice.

Someone asked how we could change what the NhS does with regards discussing birth options. I don't believe we need major changes to the current system. It's simply ensuring women are fully aware of all the options in the same way they are provided information about home births. It's understanding all our choices and what could go wrong. We should be having rational, balanced discussions about all our birth options. What I do know is natural birth advocates portray CS as a last resort which leaves fear and stigma associated to this birth option regardless of whether its an ECS or EMCS. I am sure a VB is a wonderful experience for those mothers that really want it and achieve what they wanted. But we don't all fit into that category in the same way those women would dread the thought of a CS.

VJ32. I am interested in understanding why you believe an ECS for a new mother that chooses that option would be a guaranteed poor result? Surely if they choose that option and it goes to plan then its as good an experience for that mother as a natural birth is if that were her choice. From my perspective to say its a guaranteed poor result is perpetuating the inaccurate view that those mothers that have an ECS or EMCS are failures and should be ashamed/disappointed in their birth.

Celtic I agree that in general the NICE guidelines may not be followed by all Trusts. I do need to say that I don't believe it's those that shout the loudest that get their way. I believe it's those that are well informed and can have a rational discussion regarding their choice that are more likely to get the birth choice they want. That's why an informed discussion is so important. Give women accurate, unbiased rational information and then allow them to make their choice. I also believe it would help those mothers who want a VB but are placed in the unfortunate position of having to have an EMCS. If they were better informed they may feel they have more control.

Pass. I stand corrected on the stats. I should have made it clear that the 25% was including ECS but I assumed as this had been mentioned early people would take that into account. The 25% does include ECS. With regards the theory about MW, I haven't heard that one.

Pickle. I think you make a valid point. Yes we should review why a number of VB end in EMCS but that doesn't mean that the choice to have an ECS for those that want it should be removed. Why VB end in EMCS is a conversation/debate that should also be had. It's not one close to my heart but that doesn't make it any less valid. The only people that have had an EMCS in my life needed one because the baby was in extreme distress and they didn't want to take any risks.

I am heading a into work so I will catch up on the other comments later. I haven't had an opportunity to read through them all.

It would make a really interesting piece of qualitative research to actually question mothers who are choosing elective sections, with reference to their reasons. It may vary depending on background, geography and family experience.
I'm sure there are a cohort of women who, if asked would genuinely cite a fear of the pain and potential perceived damage to their perineum.
I'd also hazard a guess that there are women, who aren't scared of the pain but actually scared of the NHS, some because they work within it.
Among healthcare professionals that I know, there is still a split between those who have opted for VB and those who have opted for elective LSCS.
My own experience was with twins by Elective LSCS, in the end twin one being breech, made the decision for me. However, before we knew this, the consultant gently pushed me to consider a VB for twins. I declined. What I said to her, was as follows:
I'd happily try for VB, if she (the consultant) and a consultant anaesthetist were there in the room throughout. So, it would follow that if either of my twins were distressed, hypoxic and showing signs of compromise on the CTG trace, that we would go straight for em LSCS without delay. This, however is NOT the reality of the NHS. There are delays taking ladies with difficult labours to theatre, and an over-use of ventouse and forceps to exert a downwards pressure on hospital section rates. The reality of the NHS is maternity wards staffed with overstretched midwives, caring for more than one woman at once, and with junior hospital medical staff covering the nights and weekends. These issues are far too much of a risk for me, so yes, I would have definitely opted for an elective LSCS if it had not been mandated medically. I would have made the same decision with a singleton pregnancy.

The reason I listed the average costs of the birth was just to highlight how a low risk home birth costs the nhs a lot less money than other options on average. I felt the need to do this because there were people questioning the cost and resources required to have a home birth. I understand they are just an average and they were based on low risk pregnancies.

I understand why you want to debate this topic but I just don't think the nhs will make any changes on this point, nor do I think they should. First time Mum's should be trying for a vb unless there are medical reasons for an elcs.

Perhaps, from an health economic point of view, but you can see why SOME women are anxious about this given the current state of NHS maternity provision.They feel that a section is the lower overall risk for their own circumstances. Whether the NHS can accommodate these costs is, I agree doubtful. Indeed, the cost of sections is likely to contribute further to reduced NHS resources. What I don't accept, is that pushing reluctant women to labour, some of which have fairly high obstetric risks is the way forward.
I don't have a solution, the whole NHS is underfunded and the only way it will be funded properly is if politicians do the unthinkable, and ask the public to contribute more in taxation.

For those arguing against ELCS from a cost perspective, interestingly enough the head of our hospital's midwifery services presented some data recently showing that the cheapest option is actually to section every woman at 39 weeks. When you think about it, it makes sense. You would have a predictable 'birth factory production line' with all the cost savings associated with predictable staffing levels and resource requirements.

No one would agree this is a reason to have everyone deliver by ELCS however! Therefore I don't think we should be arguing the opposite, that all women should have a VB because it is cheaper. Yes I think VB is generally better for mother and baby, but I hate when costs come into the discussion. Maternity care shouldn't be based on that.

Again I am not arguing against ELCS purely based on cost. What I was trying to dispel was the myth that home births require huge amount of money and resources. I'm afraid cost is very important to the nhs so they won't change their guidelines on first time Mum's having an elcs for non medical reasons when on paper a cs costs a lot more than a vb.

I personally think low risk first pregnancies should at least try for a vb because until a woman is in labour there is no way of knowing how her body or baby will cope with it. I have huge faith in my body to deliver my baby and feel there is usually benefit to choosing natural where possible. I think this is one of those debates where I will have to agree to disagree, I really don't think I will understand why people would simply 'want' a cs for a first low risk pregnancy.

TheCake - surely all you can legitimately say is that you 'personally' would, as a low risk first time mother, want to try for a vb because: 1) until a woman is in labour there is no way of knowing how her body or baby will cope with it and 2) you have huge faith in your body to deliver your baby and feel there is usually benefit to choosing natural where possible.

However, can you not see that it is a bit strange to 'personally' have a view on how other women give birth? Apart from cost implications (which I think are, at best, unclear), what has my birthing method got to do with you?

I believe the stigma around requesting an ELCS for non-medical reasons comes from other people believing that it's incredibly important for them to understand and rationalise and approve of other people's birth choices.

Luckily for me, it doesn't matter how you 'personally' think other women should give birth during a first low risk pregnancy, and again luckily for me neither do I need you to understand why I want a CS for my first low risk pregnancy.

Luckily for me my NHS consultant obs and consultant midwife understood the importance of a woman's informed choice on how she chooses to try to give birth, even though they definitely wouldn't have wanted an ELCS for themselves. I consider them to be some of the most enlightened and empathetic and non-judgemental health professionals I have ever come across.

It's all to do with risk perception, which will differ depending in your background and own experience. It follows that SOME women based on the experiences of their own family and friends, and perhaps their own experience of seeing things go wrong at work (within the NHS) will choose an elective section in preference, even if they are low risk. In a similar vein, if a woman's family and friends are encouraging her that VB is the way forward, and perhaps she has seen lots of women have straightforward happy VBs then she will perceive the risk differently.
Risk perception is a funny thing, it's the same thinking that leads people to buy all organic food, avoid pesticides and anything that may remotely cause a perceived risk, and then proceed to drive down the motorway and text on their phone at the same time. ( just an example, no offence to organic foodies etc etc)

People are right to point out the complicated VBs and potential costs attached to these. More than 50% of UK births involve intervention (epidural, instruments, inductions or CS) and from what I have read a third of women have an epidural, spinal or general anaesthetic at some point in their birth (ref: NHS Maternity Stats 2008/2009 – I couldnt find anything later) . Another UK survey also found only 10% of women achieve a totally natural VB (ref: can’t remember what the source was but I can find it if people are interested).

Its shocking the lack of real informative information on options, risks and benefits of all birth options we get through antenatal. Consider (and reading through the experiences on this thread alone) both VB and CS recovery is painful. Putting CS to one side, from my experience it seems women are encouraged to avoid pain relief for VB even though everyone I have spoken to who had a VB said labour was more painful than they ever imagined. According to The Birth & Motherhood Survey by Motherandbaby.com the average first time mum will still spend 3 days in hospital because of complications associated with delivery, regardless of whether she had a VB or CS. And the current trend seems to be pushing expectant mums into having a home birth. Well it wasn’t long ago that women had to fight to be able to have home births in the same way women are fighting to have an ECS now.

On the question of legality/rights which was raised earlier in the thread. I had a brief look at this. It’s true that in the UK a CS is not a right but a flat refusal by the NHS is difficult without a supporting policy from the hospital. If a woman has different opinions regarding her birth then a practitioner should at the very least refer her for a second opinion. This can be to one of their colleagues in the same hospital, another NHS hospital or a privately funded hospital. So in fact a women that gets a flat refusal can conduct some research and find a sympathetic Obstetrician and request a second opinion from that practitioner. Lets also not forget the issues surrounding a woman’s human rights (article 3 is particularly pertinent to childbirth)

Blue it was very interesting hearing what your head of hospital midwifery services said. Thank you for sharing that.

Hotsoup You beat me to it, I was just about to make that very point regarding other women’s births to TheCake.

Bamboo Thank you for your input you have made some very valid points. I would widen your qualitative research to actually include all mother (VB &CS) pre and post birth to understand:- 1) pre birth why the choose the particular birth option 2) post birth, if they felt adequately prepared for the birth 2) post birth, would they have opted for a different method considering their experience after the birth. I also agree with your point on risk perception. I believe watching close family and friends experience traumatic VBs has potentially impacted my perception on childbirth. As a result I believe the CS risks are much more acceptable in comparison to the VB risks.

I really do appreciate everyone’s input into this discussion. There have been some very valid points which are all food for thought.

Well I have never been classed as low risk in any of my pregnancies but still chose to try for a vb first time round (because it the logical choice).

Do you honestly think the nhs should offer and pay for cs just because of pure preference?

TheCake a VB is the logical choice for you. It's what you choose and wanted to do. It's not for me / others and I have no interest in even trying to have a VB. i know thats difficult for you to accept but I have no interest. I am classed as very low risk. 24 weeks today with a very healthy BMI, fit because I exercise 4/5 days a week and no previous serious medical conditions. I suffer anaemic episodes but very much controllable. And Yes I honestly believe a CS should be available purely based on a woman's preference. And the fact is women can have one, they just need to make sure they are informed and understand how to request one.

At the risk of appearing trivial I'd draw your attention to the frequency of complaint on the Style and Beauty threads about CS scars leaving "overhang" that seems to be very frequent.

For me, the idea of having a baby and giving birth has always been one and the same, iyswim. I can't get my head around them not being connected, it was always part of the package. You get pregnant, you give birth - it's how it works.

Thank god for C-sections, they've saved the lives of millions of women and babies. I can't imagine how scary having a baby would be if they didn't exist, knowing there was no alternative to vaginal birth should something go wrong. How terrifying would that be?

It just seems so odd to me to disregard the idea of giving birth from the outset and opt straight for the surgery with no medical (or even a psychological) reason to do so. But that's just it, it doesn't really matter what I or anyone else thinks.

I suppose at the end of it you'll have a healthy baby. Fundamentally that's all that any mother wants.

Higgle Not trivial and yes I am aware of the potential overhang risk and even looked at the pictures online. It's a superficial risk I am willing to take and if its that unsightly for me then I would need to look at doing something about it. Which can I clarify I would pay for and not expect the NHS to pay for.

KirjavaTheCat I suppose at the end of it you'll have a healthy baby. Fundamentally that's all that any mother wants. Well said and very true.

I was also wondering what does iyswim stand for?

If you see what I mean = IYSWIM.

Thank you Lyra

Iyswim - if you see what I mean

Thanks Green

I have been following this thread from the start and can understand both sides. Although I have to agree it should be the mums choice how she has her baby. People can choose home births, hospital, to have meds or not. So why not choose to have a c section???

Like I have said further back on the thread I have chosen c section but do have reasons although I think given the choice if nothing was wrong I would still prefer it x

Littlepea- wishing you all the best for a happy and healthy pregnancy and ELCS!

I'm first-time pregnant and choosing ELCS, too :)

Seems strange to me that anyone would want to go through labour by pushing and straining hard for hours and hours....but that's my personal view and shouldn't impact or upset anyone who chooses to go down that path.

We really shouldn't get upset with each other's choices.