Elective C-section - the right choice?

[CalFairy]

I have an elective c-section booked in a few
weeks for a number of reasons, not limited to but including:

• I have ulcerative colitis and I am concerned about going into a flare post-partum after tearing, the stress of labour on my body etc.
• The vast majority of friends/work colleagues/women I know had a traumatic vaginal birth with some kind of intervention (forceps, days long labours, emergency c-section, theatre post birth due to haemorrhage or placenta issues etc).
• I’m 35, a FTM, have terrible SPD and baby is currently back to back, which I know all increases likelihood of tearing and intervention or it being a difficult labour.
• I’m high risk for preeclampsia, although currently stable.
• I’ve read many positive stories regarding planned sections, and I like the idea of knowing what to expect from birth and recovery.

My issue is that I keep having doubts that I’m making the right choice, for myself and for the baby. Will it all go to plan, will baby suffer any
negative effects due to my decision (allergies etc). But I’m equally scared that I’ll end feeling as though I should have a vaginal birth because it’s the ‘natural way’ and it all goes horribly wrong and I regret it.

I’ve kept the csection mostly to myself, but the few people I have mentioned it to have been opinionated - questioning why I’m not doing it vaginally, I’m missing out on the experience, I must be scared of the pain, it’s what women are meant to do, why would I want surgery (which baffles me how people can be so strongly opinionated on something that’s not their body or baby).

Has anyone been in a similar boat? And did you regret your choice in the end either way?

I agree, both my sections were easy recovery. My friends with forceps births… not good .

I had an elective CS due to chronic illness, a fairly awful first experience and the need to control things more 2nd time round. I have never regretted it one bit. It was so much less traumatic, less painful and quicker to recover from than my induced, prolonged first attempt that I actually think it helped with baby bonding.

@PurplePansy05 @Mumaway thanks both for sharing. Good to know that recoveries have been smooth. I’ve had abdominal surgery before, although much more minor, and for some reason the thought of recovery from that sits better with me than the thought of damaging down below.

I'm in the opposite boat - I'm planning on a VBAC and many people (both friends and medical professionals) have been a bit judgy asking why I'm not planning on ELCS, wouldn't that be easier, etc.

People will make unhelpful comments no matter what you decide! And you'll probably have a wobble no matter what you decide. So go with your gut feeling. Although I'm planning a VBAC I very firmly believe every mum should be able to choose a Cesarean if that's what she wants - even without any medical "reason" - it's your body and that's reason enough.

You also don't have to tell anybody (friends and even family) - you can just say that you feel private about the birth and don't want to talk about it.

I had an elective , best choice ever made , all calm (not like an emergency that’s a different thing ) the scar doesn’t bother me I don’t even know, honest it felt a controlled and calm environment for me . All the best .

I've done both. I found labour a hellish and unworldly experience. Recovery from my vaginal birth took only a slightly shorter time to get over than my CS. You don't know how long your labour will last, how things will go, if you will tear, if you will need forceps or deliver really easily. I agonised over my decision to have an EMCS and when I was in recovery right after and could hear women in labour down the hall, I knew I had made the right decision!

Ask the people who are trying to make you feel guilty if they are willing to go through labour for you? You're the one who will have to go through the experience and recovery. My priority is get the baby out ASAP.

Elcs fucking brilliant. Very annoyed at how hard they pushed for vagjnal for my first. Why?! So many more variables for the baby and so many more post birth injuries. Fuck right off with people selling vaginal.
My second was elcs and bonding was easier, no post injuries, so much better in all ways. Just not traumatic like the first, which by the way was textbook tralala lovely water birth. Still horrible. 2nd degree tear. Nothing the same since. Pain of labour on gas and air was awful. So, elcs all the way.
The drawbacks - having to inject self for 2 weeks after to prevent blood clots. Baby having horrid cough for first week due to not being squeezed out of birth canal so fluid on lungs. Hurting to pee for first few days due to catheter after effects.
Still preferable to the pain of birth and the mild prolapsing.

Oh and I forgot to mention that with my vaginal delivery, I ended up with a lot of stitches, front and back, which all flare up every time I get my period. Its not painful but they get very engorged, and the engorged sensation happened the whole way through the end of my next pregnancy. Not nice.

Theres no right and wrong choice here. We don't have a crystal ball to look into the future and make the "right choice". You could have the most text book perfect vaginal birth with no side effects and a quick recovery time, or you could have a difficult labour resulting in interventions which could lead to life long complications and a hard physical and mental recovery. Most likely though is you'll fall somewhere in between like most women who have vaginal births.

C Section is major abdominal surgery and comes with risks, do those risks outweigh the uncertainty of a vaginal birth for you?

Personally I find those risks the same with any other surgery and the risk of unknown is more of a risk than certain, if that makes sense? At least that was the case for me. I was desperate for a vaginal birth right times but never worked out for me. C section was so simple in comparison!

Truly, The people you’re taking to sound like they are incredibly incredibly stupid. I couldn’t put any value on their opinion, let alone bear to talk to someone so dim and rude again.
if you’re inviting opinions though, stop it.
no one can tell you what will happen, all they can tell you is the risks of each and their own experience. so just make the decision that’s right for you.

Yes, I had placenta accreta in my third pregnancy, with my placenta implanted into the scar from a very straightforward planned section in my first. I was lucky not to need a hysterectomy. I'd had a uncomplicated pregnancy and vaginal birth in between so thought any risks from my section were long gone, but I was wrong. I could have died in fact.
Complications like this are still rare of course but should be discussed more in my opinion. I was given lots of information about the immediate pros and cons of a section but the long term effects weren't really discussed. I also have post op bowel adhesions, the risk of which may be relevant to the OP.
I don't regret my section as there were good reasons at the time and it was a good birth experience with an easy recovery but I do think that anyone making this decision needs to think about the longer term risks more than we're generally encouraged to do.

Absolutely this, increased risk of RDS and lots of other things that the very pro CS camp often seem totally ignorant of while massively inflating the ‘risks’ and perceived damage of normal birth. I work in maternity care and have many friends that have had children and I hardly know of any who have been ‘damaged’ by a normal birth. This is not to say there is not the odd case but this is really ‘the odd case’. Yes certain research will say x % of women suffer incontinence but that often includes very mild short term issues within those statistics, really not seeing this as a major issue on the ground. By all means I absolutely believe in it ultimately being the woman’s choice but I can’t understand the very blasé attitude to what is major abdominal surgery. By all means I’m fully supportive of a woman who feels strongly she wants a caesarean and who even if she did know all the potential downsides would clearly have still have chosen that option. In my mind not even having the knowledge I have I would have assumed such a massive intervention would have some potential rather far ranging consequences. I’ve had to have treatment in my pregnancies that which carried risks but the alternative would have been horrendous so I’m quite comfortable with the decision.

increased risk of RDS and lots of other things that the very pro CS camp often seem totally ignorant of while massively inflating the ‘risks’ and perceived damage of normal birth. I work in maternity care and have many friends that have had children and I hardly know of any who have been ‘damaged’ by a normal birth. This is not to say there is not the odd case but this is really ‘the odd case’.

What do you in maternity, admin work? Because respectfully, this is nonsense. There are plenty of issues arising from vaginal birth. Prolapse, incontinence and diastasis recti are very common and none of it should be brushed under the carpet, they are not minor issues at all. Worse so, they are underdiagnosed because many women suffer in silence thinking it's not that bad or well it is how it is, I chose to have children. I cannot stand attitudes like yours because they majorly contribute to the problem. It doesn't have to be this way and it shouldn't be.

RDS risk is primarily increased in emergency C-sections and this is because the baby is likely to already be in respiratory distress when it's performed. Please provide credible and verified sources to the contrary.

What do you refer to as "lots of other things"? Please list specifically and let's discuss.

The risks of planned CS are discussed pre-op, you clearly don't know it because you haven't been through it.

I am on board with PP who mentioned the scarring and sadly this is a risk which isn't obviously identifiable, there could be scarring to any internal organs located nearby and complications arising from that, and I'm sorry to hear some of us on here have experienced that. However, as PP said, the risks really are relatively low. It is a major life event and a major surgery, it isn't possible to completely eliminate any and all risk. But since it's a common procedure, the level of experience tends to work in our favour.

Oh and let's not pretend that working in a maternity unit makes anyone informed on what the mothers are going through as part of recovery - maternity doesn't deal with that, we're shifted to GPs, women's physiotherapists and most likely have to deal with any issues ourselves or pay privately, so there is that.

I’ve given birth recently (vaginal, no pain relief). I wouldn’t recommend it, it was pretty unpleasant. However, I think I’d still rather that than a c-section, mainly due to the recovery. I was find the next day and I haven’t had my stomach muscles cut. Each to their own though, it sounds like you have good reasons for your decisio.

No not admin but a role that involves talking to many postnatal mothers and taking the obstetric history of mothers embarking on their 2nd, 3rd, 4th pregnancies. Of course come across the occasional woman who says she does or did have an issue but genuinely most women report to have been absolutely fine. Yes I’ve read and come across really sad cases which are very much highlighted in the media where that hasn’t been the case. Even acquaintances tend to disclose their experiences and would stand by the fact the vast majority of people I have spoken to professionally and personally have not had issues. The older first time mothers do seem to experience far more issues than any other group and I do wonder if this tends to be your peer group or local demographic then would not surprise me that your going to hear about these issues much more.

BTW I haven’t come across any woman who had a normal vaginal delivery (even with a 3rd degree tear) who requests a caesarean for a non medical indication (not that this doesn’t happen) and almost all the women who have had a normal delivery then followed by a caesarean (for e.g breech) request to have a VBAC if no other medical indication. When I first started most women who had caesareans first time requested VBACs (despite always being given the choice) but now the majority request elective caesareans. I really don’t care what decision women make as long as they are happier with the outcome but just seems a shame these decisions sometimes seem to be made on skewed perceptions and not necessarily the decision they would make if more knowledge or experience
As for RDS the most severe cases I have known of were after elective caesareans and if you had any knowledge of fetal physiology you would be aware of why that would be the case

I had an section literally because I wanted to have one. I went into labour myself 2 weeks early and ended up having an emergency section (don’t get me started, hospital were pathetic to the point where we’re going private next time) but having experienced labour and a section - section every single time. Whilst I was in labour I actually grabbed my husband and said I’m never ever doing this again. As soon as the baby was out via section I turned to him and said well i’d definitely do that again

I am past mid-30s, but had DS before I became what you call within the NHS 'a geriatric mother'.

There are multiple studies about short and long term risks of CS but not many, if any, differentiate between a planned CS and an emergency one because health services records worldwide do not necessarily allow for that differentiation. It's comparing apples and oranges. Cutting a woman open at haste when there's a risk to her or baby's life is not the same process and bears different short and long term risks to mother and baby. This is fundamental in assessing the risks linked to scarring of the womb and placental issues - however, it is true there is an increased risk of placental issues due to CS in subsequent pregnancies. If we have separate studies regarding planned CS and EMCS, then we can talk. The reason why we don't have the right records is because many health services, UK included, try to put mothers off planned CS.

The studies don't take into account prior maternal history of miscarriages either, for example, because they aren't fully recorded, certainly not in the UK. Therefore automatically any estimated figures regarding 'subfertility' and risks of loss after C-section in future pregnancies are inaccurate. Moreover, many women deciding to have a planned section would have had prior history of fertility issues which is likely to continue or get worse as they become older, regardless of prior CS. There are too many variables here to measure the risks objectively and the current figures are skewed.

@Stephne2

Most of my friends had first baby between 29 and 32. Not that old.

Amongst them:

• elective Caesarian second time due to prolapse of back wall due to very bad first birth (advised by consultant after several scans)
• elective c section second time because of bad birth first time/pandemic issues
• 3 VB women who wet themselves after sneezing despite extensive physio.
• 3 very easy VB
• 3 traumatic VB (but no significant issues afterwards)
• 1 fine VB, but who has paid privately to be restitched twice because a crap job was done both times and it was very uncomfortable.

This really isn't a big sample, but I honestly think that if you actually work in the NhS and don't come across a mixed set of experiences, you genuinely are not looking for them and you have to wonder whether people just aren't speaking to you about them. I have found that the NhS really doesn't want to hear about tricky VBs and wants to persuade people into VBAC. If the NHS worked harder to understand why women have bad experiences, they might find women trust them first time around. If the NHS did more aftercare, it would also be much better.

@Stephne2

The other reason, I'd imagine, why lots of people go section after first section rather than VBAC is because of the severity of the drop in standards of maternity care due to understaffing and poor practice. You can choose to blame geriatric mothers and their more difficult births if you like, but it is just the case that many of us have far worse experiences than our mothers did - I barely saw a midwife when I was induced, not even a wave as I did laps of the ward throughout the night.

I wouldn't have told my GP or HV how I felt about my first VB experience and it didn't dawn on me until much later how bad some of the failings of care were. How little empathy I got. How much of a piece of meat I felt.

Hi Op! I also have UC, it was a factor for my decision, but there was another issue which meant I had to have an elective, but I would have asked for one anyway.

I went to labour a week before the planned birth, but just had to wait a couple of hours before I got my slot.

Hands down the most magical experience ever. Weirdly I wanted to experience labour, but when I did I wish I hadn’t bothered (not that I had a choice!). The body was so calm, had my own music, skin to skin until I left and they latched as soon as they came out. I was discharged in under 15hrs (part was overnight as I gave birth in the evening).

Had a lovely platter of soft gooey cheese, cured meats and bread and glass of champagne when I got home. Next day we went for a short walk around the local park, and the following day we went out for lunch. No issues with recovery, I would definitely do it again.

I’ve never actually once heard the term geriatric pregnancy or geriatric mother ever used within the NHS or by an NHS professional in over 25 years and I also say that as an expectant mother now in mid forties and having had 2 previous babies after the age of 35. As for the NHS trying to put people off elective Caesareans, that’s rubbish too. I know of women who have said to me they’re worried they will have to argue their case for an elective caesarean and they almost without fail return and say their request was not an issue at all. The consultant is of course obliged to discuss the risks of any procedure and other options whether it’s having your tonsils out or a caesarean and if you wish to interpret that as coercive so be it but fortunately most of the women I come across see that as simply the doctor doing their job. As for there being no research that distinguishes between outcomes of elective and emergency caesareans with relation to RDS or many other outcomes that is complete codswallop too

29-32 is considered young in todays society but in terms of child bearing I find women having their first babies around/above this age range do have more physical and mental health issues. It’s not about blaming these women, it’s just something that is noticeable. In the area I work I would say most women have their first children in their 20s and would say the majority of these women get on fine and regardless of the age they come back for baby number 2,3, 4, 5 they are usually also fine and usually always report to being quite happy with their care. The older women and those who have had emergency caesareans usually report to being quite happy with the care too. Women are asked about their experiences and physical and mental health symptoms several times after the birth and in subsequent pregnancies about their previous experiences. In fact the questions on pelvic health have recently become even more detailed and certainly in our area women are made aware of the opportunity to be referred to the physiotherapist several times. Having usually seen women through the entirety of their pregnancies, postnatally and often for their 2nd and 3rd pregnancies, the women we care for usually seem to feel quite comfortable discussing most issues with us. Yes there are cases where women weren’t happy or had longer lasting physical symptoms but this doesn’t seem to be common in our area but we still have multiple services available for women to have those needs addressed e.g. birth trauma counselling etc. Certainly in this area I’ve not had the impression women are pushed towards VBACs, either through talking to women professionally or to friends. I’m an expectant mother, I’ve had babies recently, many of my friends are having babies so I am seeing this from both sides of the experience. At the end of the day any improvements that can be made are definitely welcome, but seems like the demographics and standards of care are wildly different in your area

@Stephne2

It seems so (London and the South East, where it is pretty unusual for a professional woman to have a baby under 29). Incidentally, I don't think that I've ever had a medical professional or NHs worker who asked me about my birth experience with my first child, I mean qualitatively as opposed to "did you have a VB or Caesarian" - I have only ever given that information as background for why I wanted a c section with my second (and I had to get a new midwife, as the first community midwife just couldn't accept it and kept telling me it wasn't true!).