How to go about elective c section in low risk pregnancy

[BeckyG86]

Hello everyone.

This has probably been covered before and I apologise for any repetition, but I can't find a thread from before. I have just commented on another thread briefly mentioning this but as I want to ask advice and questions about this I felt a new thread was best.

A little background about me. I am 33 years old, married and am 32+3 weeks pregnant with our first baby. We are having a baby girl. I am not on maternity leave yet, due to finish work on 13th December (baby is due 2nd January). I work full time as an ICT tutor so my job allows me to sit and stand to my heart's content, so no manual handling or heavy lifting, so I am happy to work as long as possible before our baby girl is born to allow me to spend more time with her when she is born.

I have Emetophobia (fear of vomiting) that I am undergoing CBT for, and have been since I was about 5 weeks pregnant. This is due to finish in about 4 weeks time. I suffered with anxiety as soon as I found out I was pregnant (it was a planned pregnancy and I knew it wouldn't be easy for me with the Emetophobia). I was having some kind of anxiety attack at least daily. I felt sick but feel this was more due to the anxiety. I didn't want to go out, go to work, go in a mini break we had planned, couldn't plan things in advance or bring myself to feel excited in those early days even though I was as I felt I was asking for morning sickness (silly I know). I still did everything as normal though and this eased closer to the second trimester.

In the back of my mind I have had worries and concerns about labour, which I know is common and normal. Now that I am due in just under 8 weeks time it is getting to me even more. For months I have talked about the idea of opting for an elective c section as the anxiety and fear of nausea and vomiting in labour are so high. I know you can't guarantee anything but this option along with a load of anti-emetics feels like the best option for me and the one that would seriously reduce the anxiety and fear for me. I have been trying to think of things to help me with a natural birth but I hear too much about people getting nausea and vomiting during labour and when using certain methods of pain relief, and it just gets me more worried and the anxiety will start soon.

I am considered low risk. Our baby girl is healthy, all tests including the glucose tolerance test have come back clear, baby is growing well (I am on the smaller end but not under the lower centile line, and last time I was under the average centile line so there are no worries or concerns). The only things I have had as a sort of worry are a bit of slight discharge when I was about 6 weeks pregnant, but so slight it would have been easy to miss (I paid for an early reassurance scan and all was fine), one visit due to reduced movements (but she became more active on the journey to hospital and all was fine) and they took me for one additional scan as I have a small fibroid that was spotted on my 20 week anatomy scan (at 29 weeks they said there was no change and they weren't concerned so they are not doing anything about it). This is all good news and I know people would give anything for this and the chance to have a natural birth, so in that sense I feel bad for asking about elective c sections.

I asked my midwife at around 14 weeks when I would need to discuss birth options and she she about 34-36 weeks. It is on my notes that I am Emetophobic and have anxiety with it, but I feel that they wont consider this and just persuade me to have a natural birth. So far my notes for child birth just say give me anti-emetics due to the Emetophobia because I am scared to write anything and they say no.

I know we can choose an elective c section but i know they will discourage it unless medically necessary. I understand why, and I understand it is not an easy decision to make, but I feel it will help me with the anxiety.

Has anyone here gone for an elective c section for similar reasons? I don't mean because medically it is advised but for personal choice, and if so how did you go about getting doctors/midwives to agree with it? I suggested it to my midwife and she pulled a face!

Any advice would be greatly appreciated. I am going for an ante natal class on Thursday so I hope they can advise me but I feel lost, scared, worried about not getting listened to or what I want, and time is getting closer and closer!

Thank you in advance.

In all honesty have had 8 children, one c section and 7 vaginal deliveries I'd say you're as likely to vomit having a c section as you are with a vaginal delivery. And more likely to feel nauseous with the painkillers after a c section, which you will definitely need but may not need with a vaginal delivery. I'm not sure how having a c section will relieve your fear of vomiting and nausea.

I was also going to comment that C-section would make you sick. I had never actually heard that labour makes you sick so that's a new one for me.
I had 2 vaginal births and didn't feel sick for either. Had the drip on one, gas and air on both and eventually an epidural for both.
I wish you a sick free delivery whichever way you choose 💐

In my view, you do have a medical reason for a c section - mental health reasons are just as valid as physical health reasons. My midwife and consultant were fully supportive of my decision for a c section which was driven by PTSD/anxiety. And I had no nausea/sickness during or after my section.

In my view, you do have a medical reason for a c section - mental health reasons are just as valid as physical health reasons.

Agreed. Having mental health difficulties is neither choice nor weakness.

You can ask for a c section I had one due to a horrific first birth and I'm due to have another with dc3 I did feel sick during it especially when they applied p pressure on my stomach I thought I was going to be sick so if that is the only reason I think you would feel more sick with a c section.

It is hard to second guess the risks of vomiting. I never vomited in 4 labours but have vomited after an anaesthetic. I don't know if c-section under spinal block or epidural is 100% guaranteed not to make you fell nauseous, maybe it is.

I hope that you can get some sensible and open minded advice from your maternity unit and maybe some further CBT to prepare for the birth by whatever means.

I'm sorry for you that this is a shadow over your birth prep.

What makes women vomit is pethidine. Absolutely. It's not labour or delivery. It's the pain killers. And they'll give you an anti-emetic combined with the pain control meds, in any case. Make sure to ask about the anti-emetic at delivery!
They didn't give me one with DC1 and I vomitted a lot. I've had 4 vaginal deliveries in all, epidurals for 3, pethidine for two. I only vomitted after delivery with DC1. I was given an anti-emetic for the others. I distinctly remember with my last delivery being told I was being given an anti-emetic with the pethidine.

I would say you have valid reasons for requesting a C section. The hospital will do anything to persuade you otherwise, both you & your other half if he is there to support you need to stick to your request that you want a C section no matter how much they try to persuade you otherwise. The nice guidelines are that if one doctor is not prepared to allow your request, they must refer you to someone else who will. When you have your section, be sure to tell the anaesthetist that you are emetophobic, they can make sure you have lots of anti sickness medicine to prevent it.

I have nothing useful to add after the above comments, but I was extremely nauseous during my c-section. I don't know if it was the op or the anaesthetic. Although being sick in labour isn't great, it was a nerve wracking feeling so sick but knowing I couldn't actually move to sit up/move my head if I needed to vomit.

I guess what I'm trying to say, OP, is, ask your midwife about getting an antiemetic during labour.

You’ll struggle on the NHS, first birth. A section is a major operation & when everything is low risk, it’s safer to give birth vaginally.

I have quite bad emetephobia & ended up in theatre for forceps last pregnancy. I wasn’t sick at all during labour, didn’t feel sick or anything (or at least no more than usual) but I was really sick from drugs required for surgery!

My advice - go the none surgical birth. Labour itself does not make you sick. It’s the drugs that do. You don’t have to have them. I spent ages researching the drugs that can cause vomiting in labour - gas & air and pethidine stood out. I flatly refused pethidine. I battled through as long as I could with no drugs but eventually tried the gas & air - I was lucky. It didn’t make me feel particularly sick at all. If I overdid puffing on it, I got a whack of nausea but the minute you stop inhaling, it stopped.

Consider an epidural if the regular pain meds are a no go.. I had two (one failed) & when it worked, fabulous! No pain, no nausea!

Ask for anti-sickness. They gave me loads via my IV and for the first time all pregnancy, I didn’t feel sick!

Then I went to theatre.. the spinal block they added to the epidural made me so nauseous. They gave me some other bits & pieces for blood pressure and bleugh. Honestly, I felt so much worse in theatre than any other time in my labour!

The bit that made me actually throw up was the injection to get the placenta out. I had that & threw up about 4 minutes later. Grim. But then I felt much better to be fair. But I’d also advise considering not having that.. you can def ask to wait to deliver the placenta naturally with a vaginal birth. You’ll have no choice with a section, you’ll get all the drugs!

I know life can be such a worry with emeteohobia but you’ve got this far & you can do labour! Just make sure your midwife in hospital knows so they can give you the anti- sickness drugs & also know why you might be panicking, so they don’t think it’s baby related etc!

I am also emetophobic and I opted in my birth plan not to have pethidine or gas and air as these are the ones I knew could make you sick.

I ended up with an emergency c section. Honestly, I felt incredibly sick just after, and the day after and it ruined it for me when I should have been bonding with the baby. I don’t think it’s a given that you will be sick during a vaginal delivery, or that you won’t during a section. So please don’t base your decision just on that.

Ultimately if you feel it is right for you, then you need to sit down with your midwife and have clear, concise reasoning and be firm with it. Take your birth partner with you and have them reinforce it.

I had an elective c-section with a spinal and was sick after mine.
Sorry OP x

The pain killers I was given after my section made me feel really nauseous and I was sick a lot after I got home.

Also the sensation of the surgeon rummaging around my insides during the procedure was also pretty queasy

I had one natural assisted birth where I ended up vomiting because of the epidural/myriad of drugs I'd been given. And one ELCS next time where I began to feel really sick just after my baby was born but as soon as I told them they gave me some sort of other drug which made me feel immediately better.

It's the drugs that make you feel sick in my experience however you birth. But they can give you ones to counteract them.

I don't know many people who have just randomly been sick during labour unless they've had HG.

I feel for you as I have emet too, I had 2 sections and wasn't sick but really felt it during the procedure due to the spinal and my blood pressure dropping (although I think a lot was possibly in my head) they were really good though and gave me lots of meds and also sedated me as soon as baby was out to stop me flapping about it! What made it worse for me was knowing if I was sick I was stuck on my back unable to move infront of loads of people, I would much rather have been sick sat up if I had to be

I vomited during my section too I'm afraid, and I've never felt so sick in my life. I think if you genuinely feel that you can't handle a vaginal birth and you would definitely prefer a section then mental health reasons are a valid ground to request (and insist) on one, but in all honesty I think anti-emetics during birth are what you need rather than a particular kind of birth. A c-section isn't to be undertaken lightly.

I think mental health reasons are absolutely a valid reason to push for an elective c-section. However, like others, unfortunately I don't think a c-section will guarantee that you're not sick in labour.

I had a c-section and the actual section was fine but afterwards I felt sick, especially with painkillers but without pain relief was too much. There’s no guarantee either naturally or surgically it won’t affect you which probably isn’t what you need or want to here. Hope you find a solution.

I vomited endlessly during my section, and when there was nothing else to vomit I just gagged and gagged whilst feeling the most sick I have ever felt.... In comparison, I didn't feel sick or nauseous at all with my natural birth!

Oh god, pethidine is definitely evil.

The c section made me throw up so much afterwards. A combination of the painkillers and all the disruption to your insides. I haven't heard of anyone throwing up in a vaginal delivery however.

Echoing above - as likely, and probably more so, to vomit during ELCS, due to drugs, low blood pressure and vagal stimulation during the procedure. In your position I would try for a vaginal delivery with careful discussion and consideration of analgesia options pre-birth and anti-emetics during labour.

I chose an ELCS for my first low risk pregnancy and it was absolutely the right decision for me. However, I was nearly sick after the spinal block and was actually sick afterwards in recovery when I attempted to eat. I would have thought attempting a vaginal delivery without pain relief would be your best chance at avoiding being sick but obviously there are no guarantees. I’d talk to your midwife and see what they suggest.

I have vasovagal syncope (I faint if I vomit) and spent my 1st labour vomiting (pethadine, gas and air) then fainting- in subsequent labours I avoided drugs and was fine, didn't feel sick at all and felt much more in control - you may find vaginal delivery better than a section