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.

I had an ELCS and I couldn't give a flying fig whether anyone else thought it was a good idea or not. When someone else is prepared to give birth to my baby, I'll take their pov on board.

I chose a CS because it gave me more control over risks. An unproblematic VB would have been great but since no one could guarrantee me that, and the risks of a VB with complications are the worst birthing risks of all the options, it was an ELCS for me.

My experience was slightly different as I was in France but I struggled to find information. The first consultant I asked for advice asked me to stand up, checked my height, literally patted me on the head and said I would be OK with a VB. The second consultant said that the country's policy was not to offer ECLS therefore she was not prepared to discuss either the option or the reasons behind it (I am not convinced she knew the reasons, as I mentioned quite a few statistics and studies and she dismissed them all as "American fads"). The third consultant was willing to engage in discussion, acknowledged that I might have a point about risk but said that she could not go against the country's policy.

Luckily I could afford to tell them all to sod off and go give birth in another country but I appreciate that is very extreme and not available to everyone!

As it turns out DD was transverse so probably would have been a scheduled or emergency CS anyway and the experience was positive, pain free and with a quick recovery, but I don't think you can justify (or unjustify) these decisions retrospectively, you can only go with an assessment of risks beforehand.

A very interesting and emotive thread.
Firstly, all credit to OP in retaining dignity whilst being torn to pieces.

However, I'm inclined to agree with those who say that we shouldn't be demanding elective c-sections. The choice is whether or not to get pregnant in the first place. If you do, you have chosen to have a baby, and therefore give birth.

It's an interesting thread to me because I have a fear of surgery, and am terrified of the idea of a c-section. There is a small chance I'll need one depending on what happens with my blood, but thankfully it's looking unlikely.

This is anecdotal, so possibly unhelpful, but within my family, my mum had 4 natural births without complications, which she remembers positively. And my sisters have had 5 c-sections between them (no natural births). One sister had 2 EMCS, then one planned. The planned one was the most traumatic, but both sisters are fine and fully recovered, with healthy babies. They do not have positive memories of birth though!

So of course C-Sections are necessary in some cases. I would have lost my sisters in childbirth otherwise. But I feel, like many who have already posted, that demanding surgery should not be a choice. We should not be led to fear birth.

You're right, it was rude. I still think that opting for major surgery in a facility that you have concerns about is absolutely insane! But I should have directed my incredulity towards the idea, and not the poster, so my apologies.

On the cost issue it is entirely misleading to compare the cost of one CS directly with the cost of one uncomplicated VB. One has to look at longer term costs to make sense of this.

For example, on the face of it smokers cost the NHS more because they tend to give themselves costly conditions like lung cancer, however if you actually look at global figures smokers cost society less by dying younger. Had they not smoked they would have lived longer, cost the state in retirement costs and died of something expensive anyway (costs associated with old age are a huge proportion of total NHS costs). So actually smokers cost society less because they chose to smoke and tend to die young because of it. (for facts and figures see onlinelibrary.wiley.com/doi/10.1111/1468-5930.00128/abstract)

I suspect the same will be true with the long term costs of birth decisions simply because of the enormous costs of looking after babies that are severely damaged at birth. A complicated VB runs the risk of hypoxic brain injury and the costs of looking after someone with such an injury for life are estimated at 4 million dollars (National Institute of Neurological Disorders and Stroke, 1989, February, Interagency Head Injury Task Force Report. Bethesda, MD). Purely on cost issues we should be encouraging women to opt for CS as it is a cheaper option than risking VBs a small proportion of whom go wrong.

I'm planning a very lentil-weavery home water hypno birth this time (DC3). But should something prevent that, eg PROM without natural progression, breech presentation, going past 42w, etc, then I will be requesting a section without considering induction or similar intervention.

My easy VB was pretty much perfect; my difficult VB took months to recover from. That's a huge range.

By planning a home water hypno I am maximising all my chances of an "easy" VB without increasing risk to the baby. That wouldn't be true of a DC1, incidentally, where the risk to baby is higher at home than at hospital.

I've been finding this thread very interesting too, and hats off to the poster who said that she just didn't want to give birth because of the straining and pushing, I've never seen anyone say that on MN!

For me, the risks associated with VB seemed not only more real than those associated with ELCS, but they seemed more repulsive and horrifc (tearing, incontinence).

Zola, cs carries risk of incontinence too - the possibility of damage to the bladder or ureter is a known possible complication.

Yes, but the risks of VB feel to me much more of a concrete concept. Also the horrific image of ripping open is for me much less palatable than being sliced open.

Usually if there is a risk of tearing an episiotomy will be offered. So in that situation you'd be sliced rather than tearing too.

And the thought of an episiotomy is absolutely horrific and repulsive. Any further DC are coming via ELCS.

Zola those are some of my concerns outside the babys safety. Although you could get bladder/ureter damage via a CS the risk is 1 in 1000 and even less in an ECS. Plus repair work can be carried out during the CS should this occur. And if you take into account 50% of UK VB have some form of intervention and then consider intervention with ventuse is 12 in 100 and forceps 23 in 100 births. I would rather take the CS risk. This type of intervention can physically damage the baby and mother. The need for repair work the women's bits is likely, in addition to increased risk of infection and excess blood loss, these types of delivery are associated with increased risk of bowel damage, urinary, anal incontinence, pain during sex and haemorrhoids. From what my Consulants said this kind of damage can be perceived to be greater than CS.

Pass. I agree regarding its is fascinating how we all choose different paths.

Ch1134. Thank you. I am simply staying true to myself.

I think the statistics for complications with a VB are actually quite misleading. The risk of these things are higher in certain circumstances eg twins, breech baby, induction, huge baby, prem baby. I could have tried to have DS4 naturally but the risks of intervention and complications were really high. With the older 3, my labours started spontaneously and I was low risk so I had VB's with no interventions and just a tiny graze with DS1.

I know it is different for everyone, but honestly, for me an episiotomy and 3rd degree tear was nothing compared to having a section!

If I have to be really brutal in weighing it up, it was - which was worse, going for a poo after having a 3rd degree tear or vomiting for 12 hours after having a section?! (the vomiting was worse by many miles)

I think maybe I'm just not very good at giving birth - whatever the method!

This thread couldn't be more timely for me. I have to see the conultant midwife on Friday and argue my case for an ELCS.

I had an EMCS with dd1 after failure to progress. She was stuck and too high up for forceps. Recovery was fab, despite being exhausted from a long labour and then in A LOT of pain. I bf straight away and bonded with no problems. After 2 wks I was off all pain relief and back to normal.

DD2 was an horrific VBAC. She also got stuck but for some reason the anesthetist couldn't get the epidural in so she was delivered via forceps with just a general anesthetic gel. I had to have an episiotomy which lead to severe bruising, I was incontinent and also had stomach pains for about a year.

I am point blank refusing to consider a VBAC this time round. The registrar I saw on Friday said he would have booked me in for a ELCS but its procedure to see the Consultant Midwife first.

I am worried about seeing her. I don't know so many things myself about the VBAC.

I don't know why the anesthetist couldn't get the epidural in, was because it because I was bearing down and couldn't it still because I was in agony? I don't know if the stomach pains I had for a year were related to the VBAC but I'd be surprised if they weren't.

Is it enough to say that if I'm going to end up in theatre anyway (all my babies seem to get stuck) I might as well jut have a VBAC?

Will she care that the thought of labour scares the life out of me?

Horry the risk to baby at home is 9 in 1000 vs 5 in 1000 for hospital birth, it's just the unknown with first babies.

Both still under 1% and if the figures were presented like that I'm fine with them. (Although it doesn't say what risk, if its referring to mortality etc so not a lot of clarity)

Little pea - not sure your instrument rates are right. Birth choice UK says 12% total are instrument delivered - 6% forceps and 6% ventouse.

Not to be argumentative, just in the interests of people having the right information. Not sure where you got 23% forceps from.

greentshirt the figures I found last week deliberately split primip and multip home births because the numbers are so different. I expect this is because doing so selects out those with eg too narrow a pelvis.

That said, it's a case of risks of A are higher in hospital and B higher at home, which cancel out, so it does merit an amount of personal research and thought. Shoulder dystocia frightens me (a FOAF lost an otherwise healthy baby to this very recently) but my mw pointed out that there wouldn't be a great deal she could do about it in a hospital room that she couldn't do in our house, and if it came to that we'd already be ringing 999. I know that I have a plenty wide enough pelvis for a standard delivery and that I am physically and mentally capable of doing so.

PassTheCreamEggs. Sorry I should have referenced my sources. The ventouse rates were from NHS Maternity Statustics 2008-09 (NHS Information Center2009) and the forceps stats were from Inter-Relationship Between Women's Expectations And Experiences of Decision Making, Continuity, Choice and Control in Labour and Psychological Outcomes: Summary Report (Leeds Mother & Infant Research Unit). I appreciate that maybe these institute research reports may have been superseded. I have not read Birth Choice UK - was this a study?

Bymoonlight if the Consultant MW refuses to support the ECS then you can request a second opinion. The second opinion can be from a Consultant in the sme hospital, a different NHS hospital or a private hospital.. If a ECS is what you want then stick to your guns and make sure she is fully aware that you are not in a position to have a VB because of historic and traumatic experiences. Be prepared your Consultant MW will try proably say and do everything to get you to agree to a VB. But if you are lucky you may get a more understand Consultant MW.

Please ignore above post... On my phone.

Pass sorry that should have said was the birth choice stats from an institute report or based on NHS stats or a research/study? I would be interested in knowing which so I can read them/it.

Seems a shame that a lifestyle choice gets precedence in financial terms over caring for the elderly, helping cancer sufferers and the like...

I hope that your surgery goes well OP, but I'd be very interested to hear your views on the matter afterwards.

Irrespective of the medical side of things, I think you're risking missing out on a major life experience. Witnessing your body take over in the way it does during labour is an incredible thing - DC#2 was a VB (long but straightforward with no interventions) 15 months after I'd finished chemo. Seeing what my body was capable of was wonderful: I'd lost so much faith in it after being ill.

Giving birth vaginally is a natural experience and should remain that way unless otherwise indicated. Or should people be allowed IVF simply because they don't fancy having sex...??

Think I'm going to stop reading this thread now as only 3 weeks to go until due date of my first. It's become almost a competition between who can say the most horrendous things about each type of birth choice and their side effects. Am off to a happy place to read the thread about bonding at birth etc and get excited rather than terrified.