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Pregnancy

Talk about every stage of pregnancy, from early symptoms to preparing for birth.

ELCS - why wouldn’t you?

221 replies

apples83 · 01/03/2020 06:41

I’m due to give birth to my first child this summer and am feeling nervous about labour. I’m concerned about the pain, the tearing, that it’ll permanently wreck my body, that sex will never be the same again due to stretching down there.

I’m therefore wondering whether to go for an ELCS to avoid all this. Several friends have done just that and all have had very easy, positive experiences and been back in their feet in no time. An ELCS is surely safer for the baby too as they’re whipped straight out, rather than having to go through hours of labour during which time they could potentially become distressed if there’s complications.

My question is - if you can have an ELCS then why on earth wouldn’t you?

OP posts:
MeadowHay · 01/03/2020 12:22

I have one child who was a ventouse delivery with an episiotomy. I did consider an elective due to anxiety around childcare but also more rational concerns regarding the high risk of a FTM not achieving a spontontarous, unassisted vaginal delivery and the significant complications associated with a 'difficult' vaginal birth most scarily incontinence. As PP said for a FTM you're talking 50/50 chance (in absence of other health things that could reduce the chances!). I decided that was worth the risk as I would much prefer a straightforward vaginal birth and I was young too which I hoped would help me. I was also classified low risk right til the end of my pregnancy (I didn't find out I had been moved to high risk until I was in labour at the hospital - perhaps I would have changed my mind if I'd been told this before this point though tbf). I found my birth traumatic and had a long, slow recovery from the perineal trauma of the episiotomy. I had pelvic floor physio which did help and I don't have any functional symptoms since about 10m PP but I am very aware of how weak my pelvic floor now is, even in the absence of symptoms. During pregnancy I could hold my pelvic floor muscles up tightly for 10 seconds before fatigue. Now I can do 4 seconds. I consider my history and my current abilities to put me at significant risk of prolapse with subsequent births and/or menopause etc. In hindsight now of course if I had known this I would have picked an ELCS. But I didn't know this, and I wouldn't say I regret my decision.

We are planning to have a second child in the not too distant future and I have been assured by the hospital that it would be easy for me arrange an ELCS mostly based on the psychological impact of my first birth. However really I just want a straightforward vaginal birth, which I know my odds are much better for that second time around too. On the other hand, the risks re:POP/incontinence seem bigger for me this time . So I'm really not sure what I will do and will consider this a lot when I'm next pregnant. I suspect tbh at the end of the day that I will take my risks and try for straightforward vaginal. I am not sure if I would consent to a second instrumental delivery though and I understand how that would make things riskier so...it's such a hard one.

ClubfootMaestro · 01/03/2020 12:26

why would anyone want major surgery when there is no need

Have you read the stories on this thread and plenty others about the condition some women are left in following a VB? and you wonder why some women prefer a routine operation? I’m pleased it went well for you but it doesn’t for everyone. Also trying for a VB doesn’t mean you don’t end up with surgery - you could have an EMCS, need surgery on a severe tear, need a hysterectomy, or you could need surgery to repair damage eg Fentons, prolapse repair etc

Of course a section is a big deal with significant risks and hardly anyone has said it is easy, but comments like that are so dismissive or the birth injury and trauma which can occur with VB.

HJWT · 01/03/2020 12:28

I had a very hard labour with my first but delivered her healthy, really great labour with my 2nd loved every minute even though I was induced and had hormone drip! Breathed through the contractions (then screamed through) as had an amazing midwife... but pushing him out was HARD, I thought I was not going to get him out, I was pulling on the bars on the bed and pushing as hard as I could! He was finally born 9LB 9 and no ripping at all, then I haemorrhaged and ended up in theatre!

But through all of that I still would not chose a c-section over a natural birth UNLESS medically necessary.

tiddlerthefish · 01/03/2020 12:30

I would take ten ELCS's over my awful first assisted birth. Three long horrible days, drip induction ending in several forceps attempts and a shoulder dystocia. Injuries for me and baby and I almost bled out too. Yuck.

ELCS after was a calm and pleasant experience in comparison. Recovery was nowhere near as bad as it was after my first birth. It was sore for a few days afterwards yes, but it took me months to recover from the first birth as opposed to a couple of weeks with the second. I was also home after two nights, in comparison with five after the first. The cost of putting me right after the first, with all the physio and the prolapse i need surgery for - not to mention the week in hospital during and after birth would have been more than the cost of an ELCS!

Not all CSs are straightforward, I was fortunate. But if I was ever going to do it again (I'm not!) I would have no hesitation in asking to book myself in for another ELCS the moment I got into my booking in appointment - same as I did last time.

HJWT · 01/03/2020 12:31

@ClubfootMaestro But if you have been through any of that then there is clearly a need to request a section the next time round, but if its your first there is no need to ask for one unless your own doctor recommends it!

MirkwoodMiss · 01/03/2020 12:31

I laboured for hours at full dilation, but had to have emergency c-section due to cord issues.

Having to deal with a wound, Major internal trauma and new born with is NO Picnic!

I needed a rope ladder attached to the end of the bed, as you cannot sit up, due to the cutting of muscle tissue.
My wound became infected whilst in hospital and so I had to have a longer stay.

Why anyone would elect to have this procedure is beyond me.

20viona · 01/03/2020 12:31

My body is not ruined. Yes it hurt like hell. Yes it's still sore to have sex 7 months on.
I was back in my jeans in 4 days.
Would I have another vaginal birth ... yes. Swings and roundabouts.

ClubfootMaestro · 01/03/2020 12:32

@MeadowHay I have had the exact same thought process as you. In fact I could have written your post! I’ve gone for ELCS but I’m really nervous and disappointed, I would prefer VB but given the damage from birth 1 I don’t feel I can chance it.

I did just want to say that it’s hard not to consent to an instrumental. This is one of the reasons I went for ELCS. If baby has started descending into birth canal and they can’t get them out, it may be the only option. Possibly they could push baby back up into the womb but not only is that incredibly risky, it apparently absolutely fucks your pelvic floor so wouldn’t necessarily avoid the damage you’re concerned about. I had this exact conversation with my consultant when discussing my options. Good luck with number 2 and hope you have a great birth whatever you decide Smile

ClubfootMaestro · 01/03/2020 12:33

@HJWT some people want a caesarean to avoid ending up like that. I think it’s wrong to tell women they have to take risks to their body of such complications of VB and only when they materialise can they ask for a section next time. The damage is done.

SinkGirl · 01/03/2020 12:42

I'm not sure what Country you're from but I don't think you can opt for an ELCS on the NHS unless there's a very good reason for you to have one (correct me if i'm wrong)

You are wrong. NICE guidelines say you can have a maternal request c section. The doctor doesn’t have to agree but they should then refer you to someone else

However, many trusts are giving out letters at booking appointments saying MRs will not be granted.

If anyone is having trouble, have a look at the Birth Rights site.

Very few women request a CS “for no reason”. Those considered to be “for no reason” are usually for MH reasons, phobias and anxiety. Unfortunately many consultants and trusts do not take this seriously.

MeadowHay · 01/03/2020 12:48

@Clubfootmaestro - yes, I am thinking that if I am dead set on not consenting then yes it would end up being much safer for both of us to just have an ELCS and in fact consultant would probably advise me to do that in that scenario anyway. We are not planning to TTC until nearer the end of 2020 so awhile away and will put more serious thought into it all if/when I am actually pregnant but I do understand what you mean.

Hope your ELCS went/goes much better than your first birth and thank you for taking the time to respond to my post :)

BadCatDirtyCat · 01/03/2020 12:55

I'd also suggest looking at the NHS maternity statistics. They're not perfect in the way they split things out but they do give an idea of the likelihood of certain outcomes.

IvinghoeBeacon · 01/03/2020 13:14

Hmm well the implication in the OP that those of us who felt attempting a vaginal delivery was right for us and our babies are bonkers and unnecessarily risking the baby’s health as well as our own did feel a little insulting, but I chose to let it go in my response. we all have different ways of managing the risks according to our own personal circumstances and I don’t think that my own decision has any bearing on what another woman might choose

FloreanFortescue · 01/03/2020 13:18

Had an EMCS and VBAC, much preferred the VBAC even with the stitching. I had a better bond with my baby and produced milk at the right time (took a week after the EMCS). My body from the surgery has never been the same again. Yes it's different down there after the vaginal birth but sex is as good as it ever was. I'm far more self conscious about my "c-section pouch" than my "dog leg" episiotomy scar.

okiedokieme · 01/03/2020 13:19

Ac-section is major surgery and carries higher risk plus the possibility of long term complications. There's also evidence though still being researched about bacteria transfer (or lack of). Recovery time is much longer, I went shopping 24 hours after giving birth, this isn't possible with a c-section. C-sections save lives and prevent long term disability BUT an elective one where not medically required is silly in my opinion, contrary to what is put in tv programmes, giving birth is not difficult for most women, it's one day of pain and even that wasn't bad in my case

HarrietM87 · 01/03/2020 13:37

It’s just about weighing up risk. If you opt for an ELCS you will definitely end up with a scar, and you will have to be on painkillers and have restricted movement for some time. You may have more serious complications.

If you opt for a natural birth you might still end up in that scenario (if you have an emcs) OR you could have some injuries (ranging from mild to serious) OR it could be completely straightforward and easy. You just need to make the decision that you’re comfortable with.

For me it was worth the gamble and I had a fantastic natural birth, left hospital less than 24hrs later. Had a minor graze that healed quickly. I also felt completely euphoric about the experience - it’s still my proudest achievement.

IvinghoeBeacon · 01/03/2020 13:40

It is very hard because regardless of statistics you just don’t know how any of the potential pathways and outcomes will affect you personally, particularly first time round. I can see why an ELCS has the attraction of minimising some of the unknowns. But of course it comes with its own unknowns, and pregnancy and birth are just the start of parenting where one learns very quickly that input does not guarantee a particular output

fedupandlookingforchange · 01/03/2020 13:58

I had a very long labour (a week) ending in an emcs. I lost 1 pint of blood in theatre, baby was fine came out howling, scar was numb for about year, sex wasn't great for 18 months, pain immediately after lasted about a fortnight and I was fine on paracetamol & ibuprofen, urinary incontinence lasted after 6 weeks post section but Id had issues during pregnancy, stomach is flat now and no issues with scar any more, I was driving 2 weeks later, I only got stuck in bed a couple of times.
If I have another it will be an elcs, I would rather have had a vaginal birth but Im the wrong shape and will apparently grow another baby too big to exit. Labour was fine until the last 24 hours when I was exhausted and in agony despite the drugs, the emcs ended all of that and it felt like i had little pain after. I might not say the same next time when Ive not laboured for days.
Unfortunately we don't get a crystal ball to see how labour will go.

Mamabear88 · 01/03/2020 14:02

All we can do is talk about our own not generalise

That's exactly what I was doing @Dinosauratemydaffodils

And just for the record the NHS website says the following:

The average stay in hospital after a caesarean is around 3 or 4 days.

But you may not be able to do some activities straight away, such as:
driving
exercising
carrying anything heavier than your baby
having sex
Only start to do these things again when you feel able to do so and do not find them uncomfortable. This may not be for 6 weeks or so.

SinkGirl · 01/03/2020 14:08

C-sections save lives and prevent long term disability BUT an elective one where not medically required is silly in my opinion, contrary to what is put in tv programmes, giving birth is not difficult for most women, it's one day of pain and even that wasn't bad in my case

Please stop trivialising women’s fears, it is not acceptable.

Many women have experienced sexual assault, rape, or traumatic gynae procedures - personally I’ve experienced all three, and what was a fear of labour before pregnancy morphed into something all consuming once I was actually pregnant. Mental health is generally not considered a “medical reason” but it absolutely should be. This is not “silly”.

And I’m glad in your case a VB wasn’t bad, but for many women it is and there’s no way to know how it will go for you especially if it’s your first. In countries without access to adequate healthcare, women die in childbirth (even in this country some women still die, although it’s rare) - it’s not always a straightforward process. Many many more have traumatic experiences, longterm birth injuries and so on. It’s perfectly reasonable to be concerned about this.

I work as a patient representative within maternity so I speak to women about their birth experiences all the time. I hear positive stories about VB and CS all the time, and I hear negative stories too. Most of the HCPs I work with choose ELCS because they have seen a huge number of both and the results of them.

The most heartbreaking cases for me are women who have lived with severe trauma and / or physical injuries from VB for years or decades. Women who have not had further children despite really wanting them because of their experiences. Women who’ve lived with incontinence, fistulas, severe prolapses, unable to have sex etc. These women exist, and these experiences happen. Not for everyone, of course, but they are not so uncommon that they shouldn’t be factored into decision making.

As a PP has said, it’s very difficult to find statistics relating to outcomes for elective c sections where there are no complications. I am told by the consultants I work with that overall, even taking this into account, c sections are marginally safer for babies and marginally less safe for mothers than vaginal birth. In multiple pregnancies, c sections have better outcomes than vaginal birth.

The midwives from my local unit recently did a birth debrief for a woman whose child is now 25 years old, as she’s still traumatised by it.

Please don’t use the term “silly” about legitimate concerns.

SinkGirl · 01/03/2020 14:11

Part of that NHS advice is bizarre - women who have VB are unlikely to be able to (or want to!) have sex “straight away” either, and shouldn’t given the large open wound in their uterus, let alone any stitches or injuries.

LisaSimpsonsbff · 01/03/2020 14:21

You are wrong. NICE guidelines say you can have a maternal request c section. The doctor doesn’t have to agree but they should then refer you to someone else

In my trust this means they refer you to a different hospital, not just a different doctor in the same hospital - and since the policy is the same at the next nearest hospital in practice that means to have a shot at a maternal request C-section you'd need to give birth in a hospital over an hour's journey away. They are apparently, in practice, quite sympathetic to maternal mental health cases but their stated policy is 'refuse and refer' for non-medically indicated caesareans. I've been told a few times on Mumsnet that this can't be the case because it isn't in accordance with the NICE guidelines but I promise it is!

Nat6999 · 01/03/2020 14:37

If you have to have any intervention like induction, your chances of needing a CS increases, the less intervention you have, the greater chances of a natural birth. If they want you to be induced, ask what the likelihood of a natural birth is, if your cervix is starting to soften & open, then you have a good chance of induction working,but if it is closed & firm, then the chances of a natural birth will be less. Some hospitals will only allow an induction to go for a set length of time before going to emcs, others may allow longer. You can look at the rate of CS & interventions for different hospitals.

Nowayorhighway · 01/03/2020 14:41

It was the best decision I ever personally made. I had two majorly traumatic vaginal deliveries and also a traumatic missed miscarriage experience involving near death and massive haemorrhages. A CS seemed so much safer, I loved the fact experts were there on hand dedicated to caring for me and ensuring nothing bad happened and if it did, they could help straight away. Just felt more in control too, it was honestly a blissful experience compared to my vaginal births.

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