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.

Iv got to say peapod I disagree, if you choose to have a elcs yes if there is an emergency cs that needs doing before you go down you will wait but while you are in surgery you could possibly be taking the surgeon away from other more serious needs for an operation but because you chose that option the emergency then has to wait for your surgery to end.

Where do we draw lines though with NHS resources? A section request, lung cancer treatment in smokers, knee replacements in the obese?
Off topic again but just making the point that much of what the NHS spends money on has to do with peoples' choices and lifestyles.

Agree with terilou. I had to have a category 1 emergency section (immediate threat to life of mother and/or baby) which meant my baby had to be delivered within the next five minutes. The decision was made, I was given a general anaesthetic (no time for spinal) and DD was born four minutes later. If there had been an elective section on the table at that moment, there just because she wanted it, I would have had to have waited with potential outcome looking pretty bleak. Interesting thought...

The simple fact is that no matter what you pay in tax, resources can't stretch to allow people to demand surgery just because, when their body is in most cases perfectly capable of delivering the baby itself. It's very short sighted to take the view of "I've paid my taxes so I should get whatever I want". Yes you have, but that doesn't change the fact the NHS is financially crippled.

But it's not just about money, it's about availability of surgeons, theatres and anaesthetists. Hospitals don't have endless amounts of any of these things. How many times does a woman who wants an epidural get told they have to wait because the anaesthetist is in surgery? So often! (And often it can be too late for the epidural to be put in once anaesthetist is out.) So by demanding elective sections you are diverting these resources away from those giving birth naturally.

Terilou you are right if I am in surgery then that could happen. I guess in the same way if the surgeon was on annual leave or doing private practice or already operating on another emergency and an emergency case came in the same thing could happen. I will however riase this as a question with my Consultant and let everyone know what his view on this is.

Kir I want women that feel this is the right option for them to ask for what they feel is right for them and their babies. In the same way I want all women that would like a home birth to have a home birth not for me but if it's right for them good on them and I wish them well If that increases the number of CS then so be it. As Bamboo rightly points out we are already funding other peoples choices. Choices that end up costing the NHS a lot more than a CS.

I really don't feel any guilt on the cost to NHS front. And as another poster said earlier in the thread. If cost was the issue then the NHS would be better forcing all women to have ECS because it would work out cheaper for the NHS, as told to them by their Head of Midwifery Services at their hospital. So on that front I will be putting the cost to NHS discussion to one side. Not stopping anyone else in raising it on the thread though. But there is no point in repeating myself because it takes it away from the other points about the lack of antenatal information and the debate on the right to choose.

"If the surgeon was on annual leave"

Are you serious?! Do you think he/she wouldn't have a replacement while he/she was away? "Oh sorry, no EMCS this week because Mr Surgeon is in Mauritius."

In the same way I guess they would have more than one surgeon on call at any one time . Oh maybe hospitals only have one surgeon working at any one time. Maybe someone can enlighten me? Pass we really are going to have to agree to disagree..

This has been interesting reading, and quite depressing reading at the same time. In particular the view of the op that feels she is entitled to something and encouraging others to do the same.

I am 37 weeks today and feel grateful that where I live, elcs is simply not an option on this countries version of the NHS (/I live in another EU country). If I want to have an elcs I quite simply have to pay for it and go to a private clinic. This is my first DC and I am struggling to understand why the op still cannot give any justification for not wanting to have her dc the way or bodies were designed to do it. I fully appreciate when it's a second and the first has been a traumatic VB and there are psychological issues involved, but we still don't now your reasons for being so obsessed with not having a VB. You say you shouldn't have to justify it, but I truly believe you do, mainly as you are putting extra strain on an already over-stretched health care system.

I know I'm not saying anything new here, but after reading the whole thread I just still can't see your argument other than saying every woman should have the right. Why should they?? It's just not physically possible for everyone to demand one.

This thread is msking my head spin.

Your attitude astounds me, OP, and I pity you. I pity you because of your lack of confidence and trust in yourself and your body. How sad. And as for the earlier poster who said that she wanted a CS because she lacked faith on her local hospital - how stupid you are, that you would subject yoursf to even more medical intervention there.

Demanding major surgery because you can't quite be bothered to put the effort in to having a vaginal birth - and other than medical/mental health issues I truly haven't heard another reason for demanding a CS - shouldn't be allowed on the NHS. Just as the overweight person who needs to lose weight shouldn't be able to demand a gastric bypass because they can't be arsed to eat less and move more.

Angloamerican there is really no need to be so incredibly rude by calling someone stupid just because you dont agree with them. .. totally unecessary! !

In the same way I guess they would have more than one surgeon on call at any one time

Depends on the size of the hospital but where I work then yes only one "surgeon" (aka obstetrician) on labour ward at a time, along with a junior SHO who's normally doing a 3 month obs and gynae placement so they can stick a cannula in and prescribe analgesia but apart from that are not much use.

So yes if the Dr is in theatre and there's an emergency on the ward then the midwives have to deal with it until either the Dr finishes in theatre or the consultant arrives.

If its after 5pm or at the weekend the consultant will be at home, maybe 40 mins away!

And say its an emergency on the ward that requires theatre then even if the consultant arrives if the main theatre is in use with an elective then it takes ages to get another theatre and team ready.

Not all hospitals have a second theatre on labour ward so you may have to go to gynae theatre or main theatres which could be some distance away. You have to ring the theatre co-ordinator up and beg for an ODP, scrub nurse and anaesthetist and then wait for them to arrive.

If its out of hours then that team may be busy with an RTA, etc so there may not be anyone to come.

Not all electives are done 9-5, mon-fri. If you go into labour at 3am the week before your surgery is booked then you get done at 3am with minimal staffing.

So situations like this can and do happen. Rarely.

You're right that emcs are prioritised over elcs before surgery starts - but what about when your medically unnecessary operation has started, and a woman becomes in need of an emcs then? They're not going to leave you halfway through and go to her, are they?

You're very keen to mention that you pay 45% tax she therefore feel "entitled" to choose surgery. Is this a choice only available to top earners, then? Do women who pay less/no tax not get to make this choice, using your own justification for it?

If a woman has a medical need for elcs, of course she should have one, no questions asked. But this thread has made me believe more strongly that if you want one without any medical need, you should pay for it privately. I can't see why your surgery is any more justifiable than weight loss surgery that you don't think the NHS should fund.

How very rude AngloAmerican. Had you bothered to actually read my posts on this thread you will see I said that its the quality of care during a VB that is my concern. I also said that I would prefer a VB over a section and my other option is a homebirth.

Researching and considering the options available to me and making the best decision for the health and well being of both me and my baby certainly doesn't make me stupid. Wading into the middle of a debate shouting the odds? Well I'll leave everyone to draw their own conclusions as to who the stupid one is.

Can I just ask, why is the OP so obsessed with talking about the fact that its "her choice"? Why does the fact that its "her choice" somehow mean its absolutely right for her? Not sure about anyone else but I would be the first to say that I have made many choices in my life and a good proportion of them have been totally wrong! They may have been my choices but they certainly weren't "right for me" as the OP is so fond of saying. Specifically to this debate, I did lots of research before the birth of dc1 and decided tht a natural birth was "right for me". Hurrah! I had made a choice, and it was my choice so therefore it had to be "right for me", right? Wrong. I had to have an emcs. This time, after some research, I'm going for an ELCS. Now, unlike OP, I haven't got the foggiest whether this is right for me just because I made the choice. In fact, anything could go wrong! Scar tissue affecting fertility, slow recovery, and who knows, a l natural labour could actually work out well if I go for it.
My point is, by all means go for an ELCS but maybe OP should a little more tentative in professing what is "right for her" just because she made a choice. You don't know what is right for you, you don't know what your body, or fate has in store for you.

Hi everyone, long time lurker, first time poster. I am choosing an elective caesarean because of various reasons, personal to me. I don't understand the judgmental nature of some of the posts on here at all. I compare some of the attitudes to those of hardline opposition to abortions. Ultimately, it is a womans right to choose what happens to her body, no-one else has the right to choose for her. If you want the right to dictate what someone does, you must take responsibility for the effects, such as potential mental health issues, and as that is not possible, people should have respect for keep your nose out of other peoples choices. The argument that if everyone should be allowed an elcs, there would be chaos is ridiculous as many women would still opt for a vaginal birth. Making it an option is not the same as making it compulsory! It is not just an issue of mental health/traumatic birth/life experiences reasons either, for some women it is an informed choice, based on evidence, and there are risks involved in both vbs and elcs so the choice and therefore the consequences should be the womans own.

MummyLuce no need to speak about me as though I am not here. You can ask me those questions directly. The answer to your question is simple because it is my choice and it is the right choice for me right now. I am fully aware of the risks associated with ECS and I am also aware of the risk associated with VB. If things don't go to plan then I have to live with that outcome. If you read through my posts you will see that personally I would rather take the risks associated with an ECS. I have said this throughout the thread. You choose a VB and I am really sorry to hear it ended in an EMCS. I am choosing an ECS, fully understanding the risks associated with that choice.

Vatican if you read through my posts you will find my answer to your question(s) regarding women paying a different level of tax or not in a position to work currently. I have already addressed this. With regards what should and should not be funded by the NHS or the Government, well we all have opinions on that.

Thrustbadger thank you for answering my question on theatres. I am in a what would be classed as a big hospital and there is another big hospital not far. Not sure how many theatres they have but I will be asking my Consultant about this.

angryangryyoungwoman Couldn't agree more and very well articulated.

People are right about elcs potentially delaying or causing problems for emcs cases.

I outlined what happened to me a few pages ago on this thread. What I didn't mention was that when it became clear that I needed an emcs, the two operating theatres were both occupied with other ladies having elcs. I ended up having my emcs in a normal delivery room which was much smaller and more dimly lit than a standard operating theatre - and afterwards the staff pretty much admitted that my injuries and my DD's illness were very likely to have happened because of the unavailability of the operating theatres and very stretched surgical staff.

Obviously, this is rare and I don't know the reasons for the elcs that were taking place at the same time. However, I do know that I probably wouldn't have suffered life-changing injuries and my DD wouldn't have nearly died if my emcs had been performed in a proper operating theatre. This was in a well equipped large teaching hospital by the way.

Yes, it's your body and I do honestly agree to disagree with you about your decision. But you do need to be aware that your decision may potentially have consequences for other people.

I've had 3 straightforward VB's (1 at home, the other 2 with 3 hour discharge straight from labour ward) and one straightforward cat 3 emergency section at 35 weeks followed by a 3 night stay in hospital for me and 4 weeks in NICU/SCBU for DS4. I would choose VBAC if I have DC5, no question about that. Oh and definitely no control over dates guaranteed with a C-section. I was meant to be having a C-section on the Sunday morning so no food or drink from midnight and sat around in hospital gown all day. At 11pm I get told no C-section today. I can eat and drink for an hour and then I have to start fasting again. Thankfully I was first into theatre on Monday morning and eating toast and jam by 11am.

After my VB's I was up and walking after an hour maximum and in hardly any pain apart from afterpains that you get after any birth. I'm still in a bit of pain after my C-section when I lift something heavy or spend time on my hands and knees and DS4 is 3.5 months old. C-section recovery was hideous, not helped by people saying I was lucky to not have gone through labour and that I must be having a lovely time being waited on. I got waited on for the first 24 hours, after that I was shuffling down the endless corridors to NICU, coming back every 4 hours to express and take painkillers. Oh and I did more than my fair share of pushing when trying to poo while taking codeine and iron tablets!

I'd just like to comment that my Husband is a surgeon and most elective c sections are planned during the day in elective theatres. Most hospitals have an on call surgeon in a separate theatre just doing emergency work, so non elective c sections (aka red sections). If things do get busy elective work is cancelled. In most hospital an elective section would not interfere with any emergency x

I would be genuinely interested in what would happen if you went into labour before the date if your planned CS (only for non-medical reasons). Would it be your choice to be given an Emergency CS? Would this be authorised by your consultant / hospital?

I was told by my obstetrician that once you are booked in and confirmed for an ELECS you will still get one if you go into early labour.

unless your labour has progressed very quickly in a short amount of time you will still get an ELECS.

obviously they assess the situation as soon as you get to the hospital such as how far along your labour is , how far you have dilated etc etc. its really dependant on other factors but in principle you would still get an ELECS.

I have had some time to reflect on this thread so far. The thing that has struck me the most is how angry others are in relation to another persons my choice. Personally I don't think home births are a great idea but I would never get angry because another woman disagreed with my view on this. Why would I? its her choice. Generally I dont respond and/or change my thinking because others are angry etc. and attack me for my decisions or thoughts. Its irrational to me to make decisions based on other people's emotions. What does tend to sway me is logical fact based arguments. My mind on a ECS is made up and I fully understand the risks. Unless someone can give me logical arguments based on the risks. Outside of the difficut and traumatic experiences others have mentioned both on VB and CS I am yet to hear any fact based, tangible reasons risks as to why an ECS places me and my daughter at higher risk than a VB. I feel no guilt for my decision and I am comfortable with it and can sleep at night.

Ralley I am really sorry to read your experiences and I can't possibly ever comprehend the stress and pain your family have gone through. Please take what I am have said/am about to say without thinking I am in any way undermining or under estimating your experiences.

Everyone tells me how safe a VB is in comparison to a ECS no facts pertaining to actual risk have been discussed but considering how many women have come on here saying that they needed an EMCS actually highlights how badly VB can turn out. I have no intention of taking that risk and waiting till our daughter is in distress before having an EMCS. Not even if the chance is slight.

iamnotalone my consultant has advised that should I go into labour early then I head into hospital straight away and an ECS will be performed unless the baby is crowning. A woman can also choose to wait until she goes into labour naturally before going in for an ECS. You dont have to book one prior to that. A CS is only classed as an EMCS when a VB is planned but complications arise during pregnancy or labour while some are not immediately life threatening mean mother and baby would benefit from early or immediate delivery.

Fraggle thanks for sharing that. I do intend on asking how the process works in the hospital I will l be in. I would assume as its a major hospital with a specialist baby unit that this would be the case.

Little pea - would you still go for a CS if you go into labour naturally, and progress to the point that a CS would have to be performed immediately to avoid a VB, without the usual elective preparations? in other words would you be happy for your CS to become an emergency section (for all intents and purposes) rather than a calm, planned elective?

I'm not being argumentative, honestly! Just interested in where you would draw the line (if you would). I find this topic fascinating.

With regards to home births, it really wasn't that long ago that all women gave birth at home. So it's much more normal (and natural!) than the highly interventionist caesarean. I couldn't do a home birth personally, I only answer this as an explanation as to why people aren't questioned on their choice to home birth to the same extent as ELCS.

Pass. Yes I would still opt for a CS. And yes all women gave birth at home but we also had a 2 in 5 infant mortality rate. That didn't make it right. I don't mean to be argumentative either.

I agree with you! I wouldn't want to give birth at home either (actually I would love to, but can't overcome the risk in my head). I know the mortality rate was higher, I just mean it's instinctively more normal in a lot of people's heads than choosing a section.

I do find it genuinely interesting (not anger making!) that you would halt the natural labour process to have a section, when that labour could be progressing perfectly. It's fascinating to me how widely all of our views vary on this topic.