Elective caesarean?

[kara000]

So I’m considering asking for an elective caesarean. This will be my first baby. I realise that an unassisted natural birth is the ideal option, however in the UK 15% of births are assisted (ventouse or forceps) and in most cases with assisted births the doctors do an episiotomy. I’m more concerned about the baby though as I have read some awful things about forceps being used and in most countries they stopped using them a long time ago. The UK has the highest rate of infant mortality in Western Europe, partly because of the use of forceps. This is why I want an electivecaesarean as it is the only way to guarantee that forceps won’t be used. I know people who’ve had very long labours and ended up having an emergency caesarean anywaywhich is more dangerous than an elective.

I spoke to my midwife and she said I can’t have one as it’s too expensive for the NHS however on the NHS website it says it is a women’s choice and if one consultant refuses you should be referred to another one who will. I have a telephone appointment with a consultant soon to discuss this as I had to tell my midwife it isn’t her decision it is the consultant’s. Any advice on this would be appreciated, thanks!

Midwives told me it was a no go, consultant told me "your body, your choice".

They did refer me to the psychology service (!!!) to make sure I had a reasonable understanding of the relative risks of caesarean and vaginal delivery, (I
wonder how many men the NHS refers to psychologists before surgery ) and to "offer support" for antenatal anxiety. The psychologists were awesome, and very clear that their role was to help me make the right decision for me.

At the time I could cite a lot of stats on the risks - e.g. that CS babies are more likely to require breathing support (but that study compared CS babies born before 37 weeks with full term vaginal deliveries and the numbers were something like 3% and 2% respectively, I've forgotten exactly). I also think a lot of the data are skewed towards CS appearing riskier because they almost always include emergency sections, when the baby is already in distress/ something has gone wrong, or sections planned because the pregnancy has risk factors already, and the vaginal deliveries, by definition, are those that went well enough to avoid EMCS. I tried very hard, and never succeeded in finding a large-scale study that assessed outcomes for low- risk planned sections.

Among other things, I wished to avoid an assisted birth and birth injury. It turned out that dc was back-to-back and had the cord twice round neck, so I very much feel I dodged a bullet. Of the 6 in my NCT group, only 1 had an easier recovery than me, and they all attempted vaginal delivery.

Well done on sticking up for yourself. I think a lot of midwives especially minimise the risks of vaginal delivery and overstate the availability of postnatal support for birth injury. But then the psychologists diagnosed me with tokophobia, so I guess I would say that.

Woah, there. Episiotomies are by NO MEANS standard practice, but I did have to have one and it was... absolutely fine and saved my son's life. There were absolutely no issues with my recovery from that and I was very glad to have had it. Recovery from a C-section would have been much more difficult.

You are absolutely entitled to a C-section under normal circumstances, but with up to 1/3 NHS staff off sick in some areas, if they can't do it, they can't do it. One really good reason not to have one is that there will be a lot more people in the room and at the moment, that's definitely something to avoid.

I had a vaginal birth the first time around, back to back baby, episiotomy, shit load of internal/external stitches, forceps delivery. Post traumatic stress after the birth, prolapse and took almost a year to feel somewhat normal again.

We have just started TTC second 6 yrs later because I couldn't face having another one and I will be requesting a c section. I am simply too scared to go through that again.

Of our NCT group of 8, 6 of us had vaginal births and all of us needed intervention and took a long time to recover. The other two had elective c sections and recovered really quickly and had very positive experiences. That told me all I needed to know!

Having said all of that, you could be absolutely fine! But you just don't know how it's going to pan out. On paper you'll no doubt be 'low risk' as I was. But when it came to the crunch that meant jack shit.

The NICE guidelines say a woman should be able to choose, but as a pp pointed out it might be harder than usual rn. When are you due?

I had a planned section and hearing what a lot of women I’ve met went through I’m glad I did. It was a lovely calm experience.

Thank you everyone for your replies, definitely food for thought! I’m due 29th Sept

Nice guidelines are guidelines not law. They also come second the the emergency pandemic regulations. Most hospitals (not all) are refusing maternal request ELCS due to the lack of staff and lack of anaesthetist cover.

You are able to decline forceps if that’s the issue, it’s high cavity rotational forceps that have stooped being used in most countries and are rarely used here also. Low cavity forceps don’t carry the same risks. You’re not obliged to accept either.

Like someone else mentioned it’s high cavity rotational forceps that are no longer routinely used, Instead of immediately opting for a c section which although you can push for, is a major operation and also carries its own risks for yourself, baby and future pregnancies, you could consider all the things you could do to reduce the risk of forceps being used such as an avoiding an epidural if possible, try to remain as upright as possible through labour, encourage baby into a good position antenatally.

I was really keen to avoid forceps but wouldn’t have elected for a c section because of it as there is a really good chance you’ll have a normal delivery without returning any assistance, imagine
everyone elected for a c section for a fear of what may happen in labour. Forceps would only be used with your consent and you could include this in your notes that you don’t consent to there use, I would say do some research Into ways you can avoid there use in labour and don’t listen to horror stories, a lot of women have an episiotomy and an assured delivery without any problems at all

Requiring any assistance* assisted delivery* I really shouldn’t reply on MN during the night feeds!

2 planned sections here. Best days of my life - a pain free, really pleasant way to meet my babies, and recovery was a breeze. I had it far easier than most of my NCT friends, even those with 'unassisted' births.

I had an ELCS for my first baby a few weeks ago. In my experience you have to repeatedly ask for what you want and be adamant that a natural birth won't be acceptable. I also wrote all my reasons down so that I wouldn't forget anything (mine were a mixture of anxiety reasons and also the stats on interventions etc). They will highlight all the risks of a c section but you just need to say that you're happier with those risks than the risks of a natural birth. At your appointments keep asking for a referral to a consultant to discuss the ELCS, my midwives kept saying let's see how you feel at the next appointment and i ended up being referred quite late.. you really have to push them! When you see the consultant make sure you say that if they won't sign off the ELCS then you want to be referred to another consultant that will do it.
It's a bit of a battle and depending on your hospitals policy it could be more or less difficult to get. I have no regrets at all and I had the exact birth I wanted. Good luck!

Just to let you know, they sometimes use forceps in planned csection too. I had a planned csection about a month ago and the cosultant use forceps to get the baby's head out and apparently that's very common. The reason they use forceps is because they make a very small indecision and there is not enough space to put both hands in and get the baby's head out. It also depends on the baby's position and how heigh it is. Just Google "using forceps in csection".

For a first birth the rate of assisted instrumental deliveries is over 60 percent. The stats are skewed if you look at them for all deliveries. Most people have instrumental or emcs first time.

I had your concerns too, made it clear in my birth plan I wanted c section rather than instrumental delivery if it came to it. They just did a ventouse delivery anyway, against my wishes and without bothering to ask for consent. Wasn't an emergency, I had just been pushing for a long time.

Ended up with very severe ptsd and it ruined the first year of my baby's life for me.

Had an elective section with my second a few weeks ago. Much better. No problems getting it agreed- it was agreed at 12 weeks and scheduled at 20 weeks. The doctors I met with each time didn't question what happened the first time--it's quite commonplace I think.

Recovery so much better this time. Not taking any pain relief at all after day 10. I remember the birth this time only when I choose to rather than having intrusive thoughts about it 100% of the time.

Had an elective [email protected] honestly say it was no drama at all from the actual pain post-op(minor, managed with ibru) to actual recovery time being far better than id been advised. Id do it again in a heartbeat. After the scores of friends who've experienced some truly horrendous 'Natural" VB,injuries and lengthy recovery incl PTSD i would avoid VB at all costs and cant honestly see the point in putting Vag through the abuse when you dont have to.

Also had a forceps birth following a traumatic back to back labour. It was truly horrendous and caused long lasting physical and emotional damage. I was in therapy for over a year and was a very fucked up person for a while.
I know very few people who've managed an unassisted delivery. However, I know five people off the top of my head who've had ELCS and had a wonderful experience.
I would never put myself through that again and would absolutely request a c section for any subsequent births.

Just for a bit of balance I had a forceps delivery (failed rotational followed by OP delivery) of my son who was back-to-back. It was fine, everything healed well and I will opt for vaginal birth again if we have a second.

Not disputing your right to choose, just wanted to say that not everyone who has an instrumental suffers trauma or long term complications as a result.

I had forceps and an extended episiotomy with my first, he was 10 lbs and his size caused shoulder dystocia. Looking back I wish I’d opted for a caesarean. I had an elective c-section last time and it was so peaceful and wonderful, the recovery time was quicker than my first birth too (extended episiotomy is just hideous).

I’m having a c-section this time too and not worried about it at all. Natural deliveries really panicked me, it’s the thought of something going wrong again and feeling so powerless.

@kara000 I had two elective c sections. I had to fight for the first one, and saw a second consultant as the first dismissed me as being a 'nervous first time mother' but actually I had deeper issues. Second consultant u understood my issues (husband was large baby, family history of birth to a child that didnt develop as it should in utero, genuinely had nightmares about the birth process and could not envision life with a baby after birth as couldnt believe it would be successful) and he agreed but transferred me to a birth counsellor- appt came through for that when baby was 4 weeks old.

Push for it if you really want it. Good luck

Thank you everyone for your replies! I know the NHS push for natural birth and tell you all the risks of a caesarean but don't really tell you the risks of assisted births. From reading stats even in other countries in Western Europe, US, Australia forceps are still only used in 2-3% of births in those countries, in the UK it's so high in comparison! From reading other forums there have been women during this lockdown who have had their ELCS cancelled, I've considered going private and paying, I'm not sure if even this will guarantee an ELCS though.
I understand the can use forceps in a CS but the stats on the damage it can cause the baby after are nowhere near what they are when they're used vaginally.
I know not everyone can have a CS but if I have a choice which the NHS website says I do then I'd rather go down the CS and route as I feel that is the option I will feel most comfortable with.
If I was in a situation where the baby was too far down to do a CS and the baby couldn't be pushed out of course I'd agree to assisted birth to get the baby out if they were struggling but I'd rather avoid this scenario ideally which I could with an ELCS. I mean the NHS perform a lot of emergency caesareans, I'd also rather avoid this if I have the choice.
If I were giving birth in a country that doesn't use forceps/ventouse as much then I would feel more comfortable trying a natural birth.

Ive had a vaginal birth and ELCS.

My first birth was vaginal, was in labour for 30 hours, pushed for 90 mins and the baby was rocking back and forth under my pubic bone. Room was flooded with people and she was immediately delivered via ventouse and i suffered a large PPH. Had various transfusions after birth and took weeks to feel normal again.

My second was ELCS due to previous shoulder dystocia (rocking motion under my pubic bone) and large PPH.

The delivery was much more calm and straight forward but I really want to bring to your attention that the recovery is MILES worse. Despite the previous trauma and transfusions, I would definitely say im in more pain this time which is harder with a newborn.

I have lots of support, DH looking after my first born and my mum cooking and cleaning etc but without this I would definitely struggle.

Be mindful the sections are major surgery and not easy.

I had an emergency caesarean four months ago and I found the recovery okay, I didn't need my pain medicine at home and took it easy.

I wish I had pushed for an ELEC.

My waters were broken after pessary and gel (six days of these on a very busy and loud ward) and because they were so busy, it went 48 hours with me labouring with hormone drip. The baby and I caught an infection hence the emergency section.

He had to be taken straight to be cannulised and have a spinal Lombard puncture because they had left us so long. In hospital nearly three weeks. It was horrible.

I wanted an ELEC but was told no and it's not in my nature to push for what I want.

I will be having an ELEC if I ever dare to get pregnant again.

8 NCT mums in Peterborough area, 5 emergency c sections, 3 natural (all natural had extensive tearing and two had blood transfusions).

You have to do what's right for you. I wanted an ELEC originally after reading about incontinence post vaginal birth.

I really want to bring to your attention that the recovery is MILES worse.

Congratulations on your baby

Can I ask how far into your recovery you are?

Speaking again of my NCT group - at 1 week pp the vaginal deliverers (sorry about the awful phrasing) were probably more mobile than I was. Now that we're 11-14 weeks pp, I'm in better shape as issues around prolapse, incontinence and un- healed episiotomy drag on for them. (I've got the scar, obvs, and a patch on my tummy that's a bit tender, but am otherwise fine and back out running).

I'm due my first baby in 7 weeks and am having an ELCS at my request (no medical reason). I researched the risks of both types of delivery as well as the pro's and con's and felt most comfortable with a section over a VB.

I mentioned this to my midwife at my booking appointment and she referred me straight to a consultant after my 20 week scan. The midwife said that they try to be as supportive as possible of maternal requests.

I was nervous going to my meeting with the consultant as I'd heard you really have to fight for an ELCS but I didn't find this to be the case. I took along notes from the research I'd carried out to show that I was fully aware and understood the risks. I also wrote a letter to the consultant which I gave her on arrival (it outlined my wishes and reasons for my request). She was more than satisfied with this and signed off on it there and then.

The NICE guidelines are there for a reason and the NHS website also states that you are entitled to the birth you want. It even says that if you are refused by a consultant then you should be referred to another one who is willing.

I’d probably wait a little bit to ask for one, at the moment I’m finding that they aren’t too keen to agree to them during the pandemic..

I have several issues (gestational diabetes, Polyhydramnios, breech baby, scar tissue on my vagine from pervious surgeries non pregnancy related, anxiety and depression) to name a few and they still haven’t actually agreed to one yet, although they’ve told me it’s quite likely now, and I’m 32 weeks. I feel like you’d have better luck asking in a couple of months once some restrictions have hopefully been lifted!

I had elective sections for my 2 and it was the best decision of my life. No damage down there, quick recoveries, no chaotic unpredictable births.

@Ilovethekittehs don't feel bad for asking for what you want, you are entitled to an ELCS as per the Nice guidelines. However I do know it's scary not knowing what reaction to expect as hospitals don't seem to be consistent in how they handle these requests. Just keep reminding yourself that it is your right to have one, go in with all your reasons written down (I even listed the risks of a c section and stated that I was happy to take those risks) and say you will move to a different hospital if they won't approve your request. It's your body, you're the one having to go through it, just remember that!

@MentholChill it sounds like you had a fab experience, I wish all hospitals were like this. It would really remove all the stress and anxiety of not knowing whether you'll get it approved it not!