Elective C Sections

[BaDumShh]

Just asking for general information really.

Has anyone on here requested an elective C Section for non-medical reasons? (i.e. severe anxiety/fear over VB) What was the response from the doctor/midwife, were you refused the procedure or did they agree to it? Was it a huge battle to get them to agree?

I found this thread helpful: www.mumsnet.com/Talk/pregnancy/1849354-Elective-C-Section-medical-non-medical-reasons?pg=34&order=

If you ignore the many comments about how non medical c sections are wrong. I'm in a slightly different position as I've got a medical condition for which the specialist has indicated a c section would be preferable but I still have to request it so to speak.

Other advice I've been given is:

-Be clear on your reasons why you want one
-See if anyone can recommend a mw/consultant who is more amenable to maternal request c sections
-Be well researched in the risks of both vaginal and c section delivery, both have risks
-They might suggest counseling for you, and it's part of the process of getting one in many hospitals
-See if you can find out the hospitals c section rate. Anecdotally, the ones who are failing to meet their target are much less likely to grant a c section request
-Read up on the NICE guidelines

As I said, I've not had mine granted but just what I've gathered. A lot of women recommend taking your OH in with you to show they're supportive of you, although I find doctor take me far more seriously when DH is there and there's less fobbing me off, but perhaps I'm unlucky.

Would you mind me asking your reasons for wanting one?

FWIW I'm a big believer in maternal choice, I believe a Mum who feels empowered with her birth choices is what we should all be aiming for; but I've been told I'm too posh to push by people, so be prepared for that!

Ah just reread your post. Tokophobia will almost certainly require you to have counselling before they agree to it.

I had an ELCS when I went overdue and declined sweep / induction as they both sound horrendous and ineffective. Yes, people have commented on me being too posh to push and blah blah blah... fuck 'em. I stood by my decision then and I stand by it now. Good luck

I did. I have never wanted to give birth naturally. I have a severe fear of childbirth.

I didn't have to go through counselling, I just had to speak to a midwife and explain why I wanted one.

There was no fight. They agreed very quickly.

Thanks for the info!

I’m not pregnant yet but going to start TTC very soon. I know probably around 15-20 people who have had babies over the last few years, and I think only 1-2 of them have had no complications whatsoever. Several have been in agonising pain for days, had to have assisted deliveries, forceps, episiotomies (the thought of which makes me feel physically ill), had perhaps a 3-4day painful labour which has resulted in an emergency CS, not been given access to adequate pain relief, been left with long-term medical issues such as incontinence and permanent pain during sex and generally had horrible and traumatic experiences which in a lot of cases have led to PND. I’ve looked up the stats on my local hospital and it seems as though a large percentage of VBs there need to be assisted.

It seems as though complications with VB are now the rule, rather than the exception, and I really do not want to put myself through that. I know CS come with risks, but to be honest the risks involved with VB seem a lot worse than those with CS.

I feel like I could have written your last post. Like you, I'm not yet pg & the thought of a vb is terrifying. My mum & sister both bled a lot & required transfusions. Nurses giving blood tests comment on how I'm a bleeder. The thought of giving birth just send anxiety into free fall!!

I've been reading a lot of threads & there is a lot of criticism for elcs but you are the only person who's opinion matters in this decision!!

When the times comes for me I will be fully armed with all available info & family history to advocate for myself.

That was my reasoning. I saw a cesarean as having risks that were less horrible, vaginal birth is unpredictable and in cases unpleasant.

Ignore anyone who gives you negativity about it. I'm very open about my elective cesarean and I've had a few negative comments, I usually retort with "your concern for my vagina is truly touching" which shuts them up.

Most of my friends are male and every single one has said if they could give birth they'd have a cesarean.

I also read something on here the other day that said that the majority of female doctors and medical professionals have ECS, which says it all really!

I'm positive that I want a ECS and to cut out the anxiety, I'm just worried that doctors and midwives will basically call me a silly scared little woman, refuse to give me one, and tell me to suck it up and deal with it like everyone else does.

If they speak to you like that, complain.

Go in prepared. Do your research and explain why you want one. If they try to patronise you, tell them you're an informed educated woman who wants to exercise choice.

The NICE guidelines state they should offer it. However not all do.

Di the majority of healthcare professionals have elcs?

JustaKitten I'm stealing that line! Or I'll say I just fancied it

I initially wanted a waterbirth in the MLU but the condition I have makes that impossible, and I feel that a c section is the best thing for me, regardless of anyone else's opinion on the matter.

I have heard of women discussing tokophobia with their GP prior to getting pregnant so they can have a c-section agreed in advance. Could be worth considering if you are TTC?

I'm an obstetrician. I had an induction and normal delivery 6 months ago. I can think of one colleague (out of many, lots of us are female!) in the 2 regions I've worked in who had an elective section for maternal request. Honestly, the majority of medics do not request elective LSCS. Unfortunately there are risks inherent to any mode of delivery and I personally did not want major surgery unless I had an obstetric indication.

However, that's not to say it might not be the right thing for you - but you need a detailed chat through the relative pros and cons with an obstetrician, who will almost certainly recommend counselling if anxiety is your main reason for preferring LSCS. Some of my colleagues are more amenable to discussing these issues than others but you are always entitled to a second opinion if for any reason you find your initial appointment unhelpful. You need to book early and request prompt referral to consultant ANC as if multiple appointments are required it can take time to sort out.

I'm not sure the majority of healthcare professionals do have ELCS.

When I was having DC2 the woman in the bed next to me was an OB/GYN registrar who had actively chosen to go for induction rather than straight to ELCS. I also know an anaesthetist who spends most of her working life doling out epidurals who had water births.

This has nothing to do with your choice as regards how you decide to give birth. I'm just not sure sweeping statments within no corroborative source about female HCPs rejecting natural birth options in favour of ELCS are helpful to women reading a pregnancy forum.

Sorry cross posted with Robin7 who is clearly much more informed than me

(They should never belittle you or make you feel silly but an elective LSCS is a serious undertaking and I do feel the risks can be underplayed on here. Yes, the majority are straightforward but you need to have had the right counselling so that you'll know it's the right decision for you even if you happened to be one of the unlucky few who had a serious complication)

Robin do you think the risks of natural birth are underplayed too? I always think it's weird how we have to explicitly state the risk of cesarean but very few people will explain the risks of a natural birth the same way.

It seems like act v omission bias.

I had a VB (waterbirth) i was on the complete opposite side as you OP, I was terrified of the thought of ever having a section but I was also worried about tearing etc.. fortunately I had a textbook labour with not a single cut (think due to the water)

It's always interesting to see what other people think though! Now pregnant with my second, all the best to you when it happens and stick by your decision whatever that may be at the time, don't let people sway you!

The quote re: female HCPs having ECS was just something I saw on here, so probably just purely anecdotal and not much evidence to back it up.

If you’d asked me 5, or even 3, years ago how I’d like to give birth I’d have said naturally. However, in the last few years it just seems like all I’ve heard is endless horror stories about VBs. I have good friends who have been left absolutely traumatised by their experiences and have needed counselling for PTSD. It’s the unpredictability of it all that makes me anxious. Plus I don’t believe that it’s “what our bodies are designed to do” any more. Our brains have evolved at such a fast rate and our pelvises and vaginas haven’t kept up. Oh, to be a cat and just pop the babies out in a shoe box in the wardrobe…

A c-section is far far far from the less painful option, it's major abdominal surgery.

I have no problem with ECS, I agreed to an emergency one whilst in labour (not needed thankfully). I don't think method of delivery is important, just that it's the safest way for the individual circumstances but I would not consider a c-section the easy option.

I am certainly not expecting it to be easy, in any way. I know there is a lot of pain and discomfort involved and a slow recovery. But when faced with an ECS, or the thought of a 3 day labour with inadequate pain relief, a forceps delivery with an episiotomy and the recovery from that along with potential lifelong incontinence as well as the emotional recovery from the pain and trauma, I do feel that an ECS is the more attractive option of the two. Others may disagree, and that’s fine – it’s just my opinion.

Yes, in some respects. It's a very difficult line to walk - not all pregnant women want chapter and verse on every risk they may encounter in pregnancy and labour.

One difference between LSCS and spontaneous labour is that birth is a physiological process, not something we're doing to you as healthcare professionals. That definitely shifts the balance of responsibility onto us as HCPs to justify why we're performing a particular intervention. Conversely you could argue that by getting pregnant a woman does to a degree accept the potential risks involved both antenatally and intrapartum.

The recent legal cases in this area worry me somewhat as they essentially present spontaneous labour and elective section as equivalent treatment options to be chosen between as you might choose from two medical treatments. Labour is essentially the inevitable consequence of pregnancy - so for a truly informed choice as the courts would like, we should be seeing all women of childbearing age for pre-pregnancy counselling to discuss mode of delivery pre conception!

I do think women should have better antenatal discussions regarding location of delivery and interventions such as instrumental delivery and induction - as ever, so much is crammed into ever shortening appointments and I think a lot of things are discussed briefly if at all.

Sorry, several crossposts - that reply was to JustAKitten!

OP, that's why I say you need a chat to your local obs team - some people find a middle ground for them e.g. Would decline induction, augmentation (if slow progress) or other things that might increase their risk of intervention but would be happy to try for normal delivery if spontaneous, normally progressing labour. Obviously no one can guarantee you an uncomplicated natural birth (otherwise we'd all sign ourselves up for that!) but the discussion should be a bit more complex than a binary choice between section vs natural if you have concerns. Good luck with it all.

I fully support maternal choice and if you decide you want ELCS then I hope you get the support you need.

It's interesting that others have said you'll get called "too posh to push" on here though. I tend to think MN is very pro-CS and I've read lots of stories from people saying they had really positive experiences, especially with electives.

Equally I scared myself silly reading all the horror stories about vaginal births and in reality it wasn't as bad as I was expecting! Most people I know did have quite straightforward births in the end as well, although I realise that's different to your experience.

You can't really predict what will happen, there are good and bad experiences with both VBs and sections. But I suppose if you want to have as much control as you can, ELCS probably would be your best option on balance. Good luck!

I had to really push for an elcs during my twin pregnancy. My consultant presented a natural birth as the only choice, at each appointment I had to reiterate my reasons for elcs.

I made sure I looked up the stats and risks etc, she really didn't want me to have the cs and eventually wrote REFUSED VAGINAL DELIVERY all across my notes.

I'm a firm beliver in trusting your instincts, I didn't have a fear of natural birth but I just knew something would go wrong. in the end I had an emergency c section anyway and had I attempted a natural birth would have lost both babies and possibly my own life.

Stay calm and stand your ground.