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.

Mental health is absolutely a good enough reason to have a section. But informed choice is key and as others have said, you can often vomit after a section. I have seen it a lot. It sounds like you have really faced your phobia and are taking excellent steps towards coping with it through your CBT. Ultimately, the choice should be yours but I don't honestly think that a section is going to reduce the chance of vomiting, and vomiting following major surgery is not much fun at all. If you vomit during or after labour then you have the mobility to be able to take a little more control yourself.

I'm sorry but I have had 2 c sections and vomited after both (and felt sick during). It was the pain relief that did it.

I agree it's not the labour itself, but what painkillers you take. I've not had a section, but both labours I had just gas and that made me vomit uncontrollably after delivery. Both times they were trying to do skin to skin, and I had to ask them to take the baby as I needed to vomit. I've also had a general anaesthetic, and again this made me vomit profusely. So I don't think either will make any difference sadly.

When I had my ds5 (only child) I was literally you. I've suffered emetophobia since I was about 7 years old, deciding to get pregnant was a massive decision for me because of the potential morning sickness.
I spent the majority of my pregnancy like you, having a panic attack nearly every day and receiving therapy during it. I did throw up a handful of times during my 1st trimester but it didn't serve to help me get over my phobia at all, it just made me more of a quivering wreck who was barely making it through work each day.

I was terrified of throwing up in labour because I knew I couldn't manage the pain as well as the panic attack at the same time. I told my midwife and she put in my birth notes that I was to receive an anti emetic injection during active labour for mental health reasons.

I researched every pain relief and any that caused nausea as a side effect were refused including gas and air. So I had paracetamol and a tens machine until 6cms dilated and then I had an epidural. I was given the anti emetic around 4cms dilated.

I had no nausea during labour at all. About an hour into pushing after 19 hrs labour altogether, I started to feel sick and within about 3 minutes of the nausea starting I threw up. Completely out of nowhere, despite the anti-emetic and despite avoiding the painkillers. After the birth I was furious after all my preparation! What a waste of time/energy.

Here's the weird part though, for the first time in my entire life... I threw up and didn't give two shits. It was like my brain literally could not summon the strength to care about it because of what my body was in the middle of doing. I threw up and then just kept pushing.

My phobia is still there I'm not gonna lie, but I now know what my mind is capable of. Also dealing with kid puke over the last 5 years, something I never thought I'd cope with, it's a struggle but I do it and don't run away or burst out crying because I'm strong for my son, that's what motherhood just does to you.

Id really recommend just trying for a natural birth and still ask for the anti-emetic anyway, as I'm sure it works for many but not all. Your body will take over and you'll be massively shocked by what's it's capable of without you even thinking about it.

A c-section or induction is more likely to make you sick due to the drugs provided. A natural delivery with or without an epidural should be fine.

Have 3 dc, hyperemesis with them all but I was only sick during childbirth with the emcs the 2 Vaginal births were vomit free

Just echoing what all the others have said, I don't think a c-section is for you if you have a fear of vomiting.

I was sick after my first c-section. Thanks to the induction drip I had, the pain relief while I was in labour beforehand and then the pain relief after my section.

With my second c-section I wasn't sick. But I refused all morphine based pain relief. And because it was an elective I hadn't actually been in labour for 12 hours beforehand. The MW thought I was mad refusing morphine and I was pretty sore for the first day or two. But it can be done.

I think you need to have a good chat with a consultant to explain properly all of the pros and cons with each method. Obviously your recovery time and need for pain relief with natural labour should be less, but it doesn't always work that way unfortunately.

The failsafe way to have an ELCS for a low risk pregnancy is to pay. You can choose your surgeon, your anaesthetist, your midwife and your after care support.

You’re still probably going to puke though. Anaesthetic and painkillers and blood pressure fluctuations will make you feel sick and the anxiety is going to be terrible.

Have you had hypnotherapy or self-hypnosis treatment? It’s very, very effective for treating phobias.

As pp have said, the chances of you vomiting in a section are as high as in labour. For one, in labour, you can choose not to have any drugs and deal with any nausea with an anti emetic. In a section, you will definitely have drugs in higher doses than you would in labour. A lot of places routinely give high risk women an emetic and antacid in labour anyway. I'm sure they wouldn't mind giving it to someone low risk because everyone has the chance of needing to go to theatre.

For the above reasons, if I were you and still wanted a section, I'd focus on the risks of an elective section vs the risks of a vaginal birth and mention the vomiting phobia as an additional factor rather than the main one.

There is a very real argument for choosing an elective over a vaginal birth, largely because the elective has known risks which are planned for in advance whereas a low risk vaginal birth has many theoretical risks and you can't predict which one will strike with accuracy if there is nothing to indicate some over others. Many obstetricians choose an elective caesarean. Especially if they know they aren't after a particularly big family.

So I'd say that I understand the advantages:

• predictable date - practicality and reduces anxiety
• known risks which can be minimised
• anaesthetic team on hand to counteract vomiting + routine drugs given anyway

And that you understand the risks:

• damage to nearby organs (potentially long term/life changing) *haemorrhage
• cuts to baby
• risk to future pregnancies (reduced fertility + miscarriage + uterine rupture)
• breastfeeding obstacle *breathing difficulties in baby

I know it might look like from that list I'm putting more risks of section because I want to sway your opinion but they'll really want to know that you understand the risks but still feel it is the best option for you.

Thank you everyone. I really appreciate your honesty and you sharing your experiences with me.
I am in a quandary! I really don't know what to do and all I know is that one way or another this baby has to come out!
With vaginal birth and anti-emetics (the one thing I am insisting on) did anyone find that after giving birth it all stopped? My midwife did say different people feel sick for different reasons, some its pain, some it's the drugs/pain relief. Would they give me some for after the birth in case whatever pain relief they gave me was still in my system?

No pain relief is a good one for me too because I am one that doesn't take medication if they can help it- I don't even take paracetamol for a headache, but all I would say is plenty of strong anti-emetics. They can even sedate me as well as give me those if they want!

The hormones also can make you feel sick.

I always puke when I get to fully dilated. My contractions will stop and I'll puke a bit and then push the baby out.

Im on baby no3 and had natural births wirh my other 2 and have never felt sick or been sick, never heard of anyone being sick either so mustnt be as common.
Never had a c section so cant really comment on that but all you can do is ask for one.. if they say no for whatever reason then nothing can really be done i suppose x

Do you have low blood pressure or anemia? That can often be a good predictor of being sick - I do have low bp and can feel very sick even with minor dehydration (was told specifically by mw to ensure I bring electrolyte solution with me).

Gas and air can make you sick if you don’t use it properly or the taste of the plastic makes you gag - some hospitals can provide a mask to be used with it.

Out of curiosity OP what worries you about being sick?

Agree with other posters that you're probably more likely to vomit during/ post c sec. You're putting yourself and your baby at greater risk and increasing your recovery time with a c section too. Not to mention the cost to the NHS.

i had a natural birth - gas and air etc foreceps - i didnt feel sick once, or throw up.

I would have a natural birth every time.

Every woman and their birth experience is different. Some women vomit during labour, some don’t. Similarly some women vomit during a cesearean he issue of nausea and vomiting can be caused simply by the physiology of being pregnant (your own body’s organs need to move to accommodate your growing baby, and they get compressed and causes issues such as reflux, indigestion and vomiting ) and the weight of the uterus/womb hormones, anxiety, pain and medication that cause vomiting and nausea

Some women have issues with nausea and vomiting throughout their whole pregnancy and also whilst in labour, some women have issues in the first trimester they then may or may not vomit or suffer from nausea in labour, and some women don’t suffer with nausea and vomiting at all.

Ah. Posted too soon...

Another one here who was sick throughout the c section and after due to the meds I was given.

I’m another one who had no vomiting during natural labour and delivery, but horrific vomiting post forceps delivery caused by the drugs. Honestly I think you’re better off from a sickness point of view trying to avoid c section

I had maternal request c section. No vomiting, breastfed baby in recovery room. My consultant didn’t try to talk me out of it and talked me through the relative risks of both c section and a vaginal birth (frequently people highlight the former with considering the latter). I have no idea of comparative vomiting risks but ask to discuss it with a specialist and if you want to request an ELCS then you shouldn’t have to jump through hoops.

I was repeatedly sick after my first c section and had to have an anti sickness injection. Sorry op, you really arent better off having a c section.

My first emergency c sec made me vomit. Childbirth of whatever means can make you be sick, to be honest.

Another one here who felt sick all the way through the section then vomited a few times afterwards due to the meds they give during surgery and for aftercare.

I wouldn't want to be sedated in labour, it slows everything down!

I think you need to get some coping mechanisms for the potential sickness. Anti emetics aren't fail safe with either birth as PPs have said.

Talk through your options with a constant. From the annecdata here, you'll be better off vaginally.