Elective Csection to avoid potential emergency one?

[MyDearSweetSummerChild]

I’ve been told this is a “first world problem” but please bear with me on this and I’ll try to keep it concise....

I’m currently 4 months pregnant with my second child. I have a high bmi but I am otherwise healthy.

Throughout my first pregnancy, I was adamant that I wanted a natural water birth, no drugs etc and wanted to avoid a section at all costs.
My son was not for budging and at 41 weeks he became completely stuck in my pelvis and also stuck under my ribs. (I have a very small frame versus my husbands gigantic one and baby took after his dad)

I met with the consultant who advised an elective csection the same day as “chances are, it would become an emergency csection”if I went into labour

Obviously my fear went from having a section to losing my child and so I had an elective section. Everything went well and I have a healthy son who was well over 11lbs!

I said to my midwife this time round that I wanted a section. She challenged this saying I was adamantly against one last time and it’s probably just my hormones?????
I explained that I’d realised my biggest fear isn’t a section. It’s an emergency section. It’s being put to sleep and waking up with a new baby. My midwife said that was “just silly” and is pushing for vbac.

I’m attending a clinic to try and encourage vbac but I really feel like I’ve made my decision...

Does the vbac pressure ever stop through pregnancy or will this go on til my second son is born?

I might be wrong, but I don't think emergency sections are always done under general anaesthetic.

I don't know about the rest of it, I'm afraid. But I imagine that once they've tried to convince you they'll have to let you have a section if you want.

I personally think in that situation I would do the same. My family have all had hideous births amd I have the same physique with therefore potentially the same problems ahead of me. Don't be pushed into anything. Sending love. X

I had an emergency c section with my first. Son had problems breathing when he arrived and was wheeled straight through to NICU. I gave birth at 7 and didn’t get to see him properly until the afternoon.

Next time, I am definitely having an elective. Like you say, anything to avoid an emergency for me again, which could be quite likely second time around.

Just stay strong with whatever you decide and don’t let anyone else tell you what you want. Only you know that!

Thanks for your responses.
I have asked if emergency sections could be done under local anaesthetic but the midwife said “that’s not an emergency” and that in an emergency it’s about getting baby out as quickly as possible so that’s why you’re asleep. I completely understand that and I just want to avoid that circumstance.

I think what really struck home for me was when we (all 3 of us) went into the recovery room after my section and there was a man sitting alone with a baby in his arms in the cubicle next door. I think that shook me and my husband quite a bit and he’s 100% supportive of the plan to have a section.

The crazy thing is I’ve always wanted to experience giving birth so it’s not like I’ve taken the decision lightly, it’s the opposite of what I’d always thought I’d do.
I’m just really anxious about this clinic as I spoke to a few mums in the waiting room while waiting between scan and appointment and everyone said it’s very pushy etc.
I’d feel better if my husband could be there but he’s working away that week too and I can’t change the date!

Oops cross post.

Also - I had an emergency c section but didn’t have general. I had a spinal but it all happened very quickly

Emcs are usually done under spinal or epidural. Who said you need a General Anaesthetic and what reasons were given?

This has all been through my midwife. She’s quite old school and was SO supportive last time when I wanted a natural birth and now she’s really against elective sections. She’s mentioned every time about the additional cost and strains on NHS etc and I suppose I was t expecting it.
I haven’t had any appointments with my consultant yet this time round. Apparently that’s quite normal with a second pregnancy? So all my info has been from my midwife!

Your midwife is firstly talking a load of rubbish and secondly doesn’t have the power to decide whether you have an ELCS or VBAC.

I’ve had three emergency sections, including a category 1, and all three have been with a spinal (although there was talk of a GA with the cat 1).

You and your consultant need to decide how you will give birth, not your midwife, and if your consultant doesn’t support your choice you have the right to be referred to one who does.

Thanks @Zog
To be honest, I never thought I’d have this much challenge over it, I read on the nhs site that you have a choice and I mentioned that last time and she said that she hadn’t finished “informing me” of my choices. She definitely has a very clear opinion.

My emergency section was not under general anaesthetic. Obviously there's emergencies and emergencies and some women will have a GA, but certainly not all.
OP, do what you are comfortable with after undertaking as much independent research as possible. I'm in a sort of similar predicament myself (massive first DD, 2 weeks overdue, whole host of issues during an extremely long labour which resulted in EMCS) and I think I'll be pushing to go down the elective C section route next time. Due to the specific problems that I had last time (and which are likely to recur) and the fact that these were not picked up on during monitoring before labour began, I believe that this will be safer for any future baby and less risk of potentially life changing birth injuries for me.
Stick to your guns and just keep repeating yourself if you feel you are not being heard.

You need a new midwife! Most EMCS are done with a spinal block. I had one with dc1 (undiagnosed breach at 42wks ) then felt strongly that I wanted an ELCS second time around. Midwife was supportive so off I went to see the consultant (at 30 something weeks I think). Was expecting to have to fight for it, but they were fine with it, esp because I knew I'd only have two children.

Keep pushing for what you want.

Request a new midwife (shocked at what she's been telling you!) and request an appointment with the consultant. Be open about how you feel. You have the right to request an elective c-section if that's what you want.

As I understand it there are “emergency” C-sections which happen every day of the week when babies are not co-operating with labour and then there are “crash” C-sections involving running and professionally-controlled panic. Most emergency CSs do not require a GA, especially if you already have an epidural in place. Certainly when I had mine there was plenty of time for signing consent forms, general chat and for the surgeon to ask whether I had any preference as to birthday (it was nearly midnight).

Your midwife sounds like a nightmare or at least a bad fit for you. You’d be due at least one obstetrician appointment for a birth after CS wouldn’t you? I’d talk to them and also try and get a late scan to determine baby’s size.

You need to essentially demand an appointment with a consultant. They are the people who are there to help make your decisions in a none biased way.
Mine gave me the risks and benefits of all birth scenarios and then let me choose whatever I wanted as it's my body and my choice.
I had an elective c section with my first baby as I had high anxiety and a very high BMI was making me worry about a natural birth.
I am now 26 weeks pregnant with baby number 2 and I've had my elective c section booked since I was 13 weeks pregnant.
Your midwife cannot make you to anything you don't want to and only a consultant can sign off on any procedure so you need to speak to someone to get you an appointment with one.

I had a section under GA but that was because of a rare complication; I’ve met lots of people who had emergency sections but no one else who had them under GA.
However whether it’s under GA or local that doesn’t make your choice any less valid. There’s a process to requesting one which you might want to contact your hospital about if your midwife is less forthcoming then at least you can talk to about the potential for a section being needed

If you had an 11 lb baby last time, I don't think she knows what she's talking about (Google macrosomia nhs). Very big babies makes a vaginal delivery much higher risk. They changed your care in my trust for DC2 if you had a very big first but I don't know anymore than this as my DC1 was under the 4.5 kg cut off.

In your situation, def an elective

I’ve had an emcs where DS was not coming out any other way, but wasn’t distressed. All quite calm, easy recovery. Spinal block, quick and easy recovery.

I’ve had a crash section because I haemorrhaged and dd’s heart stopped. General anasetic. Panic, running, DH left alone in corridor, then handed the baby and left whilst the surgical team went to address me.

Is there a terminology confusion? It sounds like you might be ok with the first scenario, but not the second. If you’ve been referring to “emergency” rather than “crash”, then are you sure she knows what you want?

Your midwife is wrong. An emergency is done under a spinal anaesthetic and baby's (or mums) life isn't in immediate danger. A general anaesthetic section is when they need to get the baby out NOW and knock mum out to effect that. That is a crash c section.

If you are not keen on a vbac then I would push for the elective. Crash sections are awful but ime so are emergency.

Its your body, your baby, your choice! Simply tell her you have made your mind up and wish to go for an elective. You dont need that kind of pressure or stress placed on you.

Sort of similar situation, my sons head got stuck in my pelvis and after 27 hours of labour I was pushing for three hours before they realised this! He wasnt in distress or overly big but they said forceps and/or vacum would have been too traumatic. I had emergency cs although it didnt feel like an emergency at the time as I had to wait for an hour for it and I has a spinal block and wasnt under anaesthetic.

Now Im 31 weeks with my 2nd and have only just made my mind up for an elective this time.I am classed as low risk for a VBAC but the midwives and consultants haven't pressured me either way thankfully. Its been a difficult decision to make as a part of me does want to experience and give VBAC a go but after weighing it all up, an elective is my choice.

You have every right and free choice in this matter so stand your ground!

The majority of emergency C sections are done under spinal anaesthetic - general anaesthetic is rare and is only done as a last resort if there is absolutely no time to do a spinal and the patient doesn’t already have an epidural in that can be topped up.

However if you’ve had a previous CS you should be able to request an elective one this time around without too much argument as there are some risks associated with VBAC.

I've had two emergency sections, first was a crash section under GA and it was horrific.
Second was a standard emcs with spinal block, fine.

In your position with previous 11lb baby and CS last time I doubt you will struggle to get an elective arranged when you speak to the consultant, take the mws advice with a pinch of salt.

Yep the midwife doesn’t have the power to decide or dictate what you choose, I hate all these stories of medical staff refusing to accept that women have a choice! Good luck with whatever you decide

@MyDearSweetSummerChild your midwife sounds alarmingly ill-informed to me. I had a Category 1 emergency C-section with my son. The definition of a Category 1 Casarean is 'immediate threat to the life of the woman or the fetus'. My baby was in distress - his heartrate had dropped twice to something like 35bpm, and his oxygen levels were too low. And despite the urgency of the situation, I was NOT put to sleep! I was given a spinal and was conscious for the birth. Yes, in some cases, people do have to have generals, but that is NOT how it always happens in an emergency - even in a fairly serious emergency, as mine was.

My midwife this time round has been very supportive of whatever choice I want regarding the birth. She booked me an appointment with the consultant to discuss an elective C-section when I was 20 weeks. I was fully prepared for a fight, but the consultant simply told me that the risk for VBAC and for a second C-section was roughly the same, and that the choice was entirely mine. I opted for an elective section because I don't want to be in the situation where my baby's life is in danger again.

Please ask your midwife to book you an appointment with the consultant to discuss the possibility of an ELCS. It's your body. And your midwife sounds appallingly biased.

I had a cat 1 EMCS due to DS heart rate slowing (I can't remember the rate but it was hardly beating) and was given GA directly into my neck rather than the cannula already in my hand due to the urgency. I'd had an epidural 15 mins prior to the crash call so I was already numb. It has always been referred to as cat 1 EMCS, never a crash section.

This time around I'm consultant led, she talked me through my options and gave me some reading to do. I make my choice at 34 wks with her complete support whatever I decide.

It sounds to me like your midwife is trying to push her own agenda on you. You can refuse to take her 'advice'. She cannot force you into doing something you don't want to do.