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've also never been asked if I want pelvic physio, or indeed any physio. I have never been asked if I am ok by a HV either, just baby!

@Stephne2 I think you must realise from the comments that your experience within the NHS is unusually limited and not representative of what happens on the wider scale.

NHS professionals absolutely are reluctant when it comes to planned sections and to say otherwise is denying the reality. That's one.

Two, I agree with PPs - not one NHS professional has ever asked me about the quality of the birth itself or the recovery. Maternity and obstetrics top my list of the least caring NHS professionals (with some exceptions, but it is that - exceptions). You post on here as if you or your colleagues had some debriefs with mothers who gave birth previously but you never do. It's not part of the process and it's wrong. Most mothers know the NHS is not to be fully trusted or relied on so they won't tell you how it really was after a period of time because they know you'll do nothing for them anyway.

Care sounds so different down there 😞 although can imagine the staffing issues and challenges of working in London must be very difficult for the staff too. We see a woman from her first appointment at 8 weeks and so come our first time seeing them after the birth we’re of course asking, how did it go??? Obviously they know we’ve already had the details of what type of delivery, baby, etc but we’re both eager for the proper catch up and usually find women are quite descriptive about the good and the bad, usual theme is that the delivery suite staff were amazing but depending on the hospital care can be a bit hit and miss on the postnatal ward (in honestly the staff are equally lovely on both but the staffing levels are completely different but most women do appreciate this but obviously does affect their experience) We’re lucky we get to see women for several weeks afterwards and it isn’t a very transient community so we tend to see them in subsequent pregnancies and they often ask for whoever has cared for them previously. It’s always the consultant’s decision regarding caesareans in partnership with the woman ( and have never known a request to be declined) However women do ask us for extra information and advice and we try to give that in a balanced way and have specialist staff that can further counsel if needed but to be quite honest it’s not a discussion usually eager to get into let alone direct one way or another. Obviously if your friend or relative is less of a minefield giving your true opinion.
It is very sad that at such a special and fragile time women don’t always get the care they deserve

Where do you work if you see women with continuity of care from 8 weeks until after birth and you debrief with them? That's not the UK surely? It's like a different planet!

I'm not in London and regional standards are bad too, let's not use convenient excuses of being understaffed as a cover up for bad attitudes and substandard care.

I’ve worked in a few trusts and lived in different areas and have never known of a woman I have come across professionally or as a friend or acquaintance who had their request to have an elective caesarean declined or even heard of when I talk to friends living elsewhere or them talking about their friends or relatives. I can imagine it was more common many years ago. I’m not saying it doesn’t happen now or discounting your personal experience but it is not something I have ever come across or an anti caesarean leaning at all. In fact caesareans seem to recommend to women for almost any slight risk factor these days, most local hospitals I know of have CS rates or 40-50%

Yes in England, no not the south east, staffing does have a massive impact on the care that can be provided without a doubt. It’s impossible to give the same quality of care if you’ve got 10 compared to 30 minutes for an appointment or you’re doing 15 visits in a day compared to 5. The same in the hospital.
Each GP surgery has an allocated midwife and so with exception of e.g sick leave women will see the same midwife for every appointment there. Postnatally if the woman’s named midwife is working she will visit her which is usually several times but at least once. When she’s not working other members of the team will visit. Obviously even in a unit which is sometimes adequately staffed (which obviously in itself and the supporting retention initiatives attracts even more staff) and most women report to be happy with care there are still lots of things that we constantly look at how we can improve, especially for those who have not been so happy

I’m almost 37 weeks and I’ve never met my named midwife nor have I seen the same midwife more than once. They’ve barely discussed anything with me in terms of birth plan, breastfeeding etc, unless I’ve prompted them and even then it hasn’t been a lot - they’ve mentioned ‘you’ll learn that in the antenatal class’ that’s sort of thing. Previous friends have mentioned they’ve been offered a tour of the hospital unit and that hasn’t been mentioned to me. In all honesty I expected more as a FTM, but maybe that’s usual now. I think if I wasn’t going for the csection and a vaginal birth I’d be feeling apprehensive about the care I’ll receive, despite my hospital having decent reviews.

Also thank you every else for your comments, just been reading through this morning. It seems the majority feel as though I’m making a good decision which has further reinforced it in my mind.

@Wictc thanks for sharing your experience as someone with UC. Sounds really positive. I think it’s hard to relate unless you have UC/Crohns and understand how a flare can be! Were you well post-partum?

I was fine, no issues at all. I had a flare up in pregnancy and took my usual octasa and pentasa for 6weeks and was fine. I also had a flare up some time after and took them again and they were fine to take breastfeeding.

I asked for a section based on the UC as a few of my friends have had awful time with tearing and being seen up and I couldn’t face that with UC. The consultant said that was fine and they would just check with the lead, who came back and said I needed to have one any due to recent uterine surgery (they couldn’t take the risk of tearing the uterus when pushing), but they said I could have one for whatever reason I wanted.

I honestly highly recommend it, it was the best experience of my life. I would definitely have another.

It’s a shame more areas don’t offer more continuity in the antenatal period at least as it shouldn’t be a difficult thing to arrange. Just have the same midwife allocated to cover the same clinic every week. As for chance to discuss things in appointments, staff would love to have more time with each woman but there is barely enough time to do the required assessments, any necessary referrals, answer women’s questions about heartburn, backache, discuss smoking etc let alone time to start talking about the birth and feeding in any level of detail. Often find people on here wonder why they don’t get there full allocated appointment time but the reality is that some women in every clinic end up needing more than their allocated appointment time (maybe issue with growth and referrals need to be done or DV or severe MH issues become apparent during an appointment) so if that appointment then takes double the normal length everyone else has to be rushed. It’s not ideal at all and can guarantee the midwife usually doesn’t get 5 minute to eat let alone their ‘allocated’ lunch break. In our area we do have a longer appointment allocated to discuss the birth at 36 weeks which is helpful, however even then in an ideal world we would be much longer.
I too expected more as a first time mother many years ago, I think encouraged by books etc to think of a service and midwives who had endless resources and time to cocoon you through this precious time. In reality your in the same NHS where people are waiting for life saving surgery or hours for ambulances, can’t get a GP appointment for weeks. Maternity staff are under exactly the same pressures, in reality in most areas the midwife you see in clinic has no more time to start having an in-depth discussion with you about the birth or feeding than someone expecting their GP to start having an in-depth discussion about healthy eating or an exercise with someone during their busy clinic. GP’s, midwives, consultants etc are all trying their best.
Women are usually given a huge range of written information or signposted to online information as part of their care and some areas offer antenatal classes too. With such limited time it’s better that staff direct to this and then are there to answer any more specific questions

I had an elective c section and it's the best thing I ever did!

The stats say that only 1 in 3 women over 35 have a natural birth without medical intervention and I didn't like those odds. I read an amazing book about choosing caesarians and it really helped.

My ELCS was calm, lovely and wonderful and I'm so glad I chose it.

It wasn’t a difficult decision for me, I don’t think I’ve ever been asked how I gave birth 😳 I loved my c section.

Yes it hurts afterwards like you’ve done 1,000 sit ups but it was still worth it. I could move around fine- in fact we were all made to move and shower a few hours after surgery. It was the best decision for me.

The only weird part for me was being handed a baby- it does feel a bit disconnected? I suppose you don’t get that raw, emotional experience perhaps. I did say I didn’t want to know what the surgeons were doing though-normally you can watch, they’ll tell you when they break your waters, you can see the placenta and have your baby straight on your chest. I opted to have mine, cleaned and wrapped then given to my husband! (I am squeamish and will pass out). Felt like I’d gone in to a room and left with a baby! Bit of an odd experience but it worked for me. It was over in minutes!

Good luck with whatever you decide.

@Stephne2 I understand that, and I know the NHS is under pressure and stressed. I just expected more, especially with being a high risk pregnancy and a FTM. I’m usually in and out in under 10 mins with barely time to speak once urine and blood pressure are done. I wouldn’t say they’ve been unpleasant, they’ve all seemed like lovely women but just quite dismissive and rushed. I would say however, that when I’ve been to maternity triage for any concerns (reduced movements, had a period of headaches and vision issues) they have been fantastic.

@soberfabulous thanks for sharing! They are the odds I have heard too which raised my concerns. Glad you had a good experience.

@Missingmyusername yes I can imagine it feeling slightly disconnected especially as it’s quicker and more clinical. Im not squeamish, and if had the option I’d love a clear curtain as would love to see everything haha.

calfairy this is the amazing book i read - includes so much great stiff including stats around the amount of doctors/surgeons who choose a CS themselves!

https://www.amazon.co.uk/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110

also: the cost is often touted as a prohibitive reason for them on the NHS, but actually, if you look at the amount of aftercare botched 'natural' births incur, this is a total false economy!

It is a shame that’s all you ever receive. I do feel very lucky that work in an area where I usually am able to find that little bit of extra time for a woman who needs it, even if that’s booking her in just before my lunch break or last in clinic as I know well inevitably over run. It’s still a manic day trying to fit everything in, however have friends who work in other areas of the country and they have much less time which must be rubbish for them and the women.
With my previous and current pregnancies I know how much that has meant to me to be given that extra bit of time when have needed it and not to feel dismissed and an effective plan of care put in place. When we do have a bit more time, whether it’s being able to spend 2 hours on a visit with a new mother adjusting to first time motherhood, having feeding difficulties etc, women tell us how much that has been appreciated. Even a quieter day on the ward with not so many people to care for, we can see how much happier the women all are.
It sounds like an elective caesarean is the decision you feel most comfortable with, I care for many women who feel the same and it usually goes really well. The delivery suites are generally better staffed and at least with an elective CS they have time to delay if they are totally snowed under so things are usually quite calm either way. The staff on the ward will try their best and will totally depend how busy they are on that particular day but February tends to not be such a busy month so that is in your favour and hopefully you won’t be on there for more than a day or 2. One tip on the ward and once home is to ask for help if needed as staff often don’t have time just to check up on people regularly but do want to know if their is a problem or worry so they can do something about it for you. The earlier they know, the easier it is for them to prioritise and find the time to help.
Best of luck with everything x

@Stephne2

Aha, so you're a midwife! Bit coy on your part!

Yep, this sounds like another planet, let alone another part of the country. I think the midwife led units get a good write up here, but to be honest, only the women who will very likely have a very straightforward VB are referred there, so they should, iyswim - it's kind of the equivalent of selective schools getting amazing results! There's still not much follow up.

Giving birth (however you do it) was, I found, quite lonely and impersonal. I did have one midwife for much of my first pregnancy, but towards the end I was juggled around for her maternity leave - obviously not her fault. I was 30 and low risk, so I assumed I would have a VB, but there wasn't really any discussion, which was fine with me at the time. I had sweeps, but I got to 41 + 5 weeks with a baby that was measuring big and got handed a leaflet on induction. When I asked what my options were, I was told that I could hold on for Labour and risk my baby dying or get induced, there was no mention of a CS at this point. Which is fine - I would have chosen a VB, I'm just saying that it doesn't even get factored in as a possible unless you push for it. It's the guilty hidden choice that you have to push for.

I got induced, with a back to back baby - not one medical professional mentioned the presentation of my baby nor the growth scans for big baby that were obvious in my notes, most came in, checked baby and my vital signs and left again. My husband and I were broadly alone save for periodic health checks for 36 hours. When we moved to the delivery suite because I was 7cm and I had my waters broken, my midwife was very reluctant to discuss pain relief with me (I had one consistent pain, no breaks, like a big stabbing screwdriver into my spinal cord) and insisted I stayed close to the bed with a monitor on at all times, so I couldn't use a birthing ball, kneel down, walk around. I vomited once they put me on the induction drip to the point at which I was throwing up blood and was shaking and had to be put on an IV line as my teeth were chattering so much. I requested an epidural at this point, as I was basically confined to the bed anyway with the monitoring and IV line and the midwife who was looking after me got cross with me for giving up and went to look after someone "more urgent" in the next room. I got a locum midwife to sit with me through the night; she was not very caring, my teeth were still chattering and I had to ask for a blanket and begged her for some ribena so that I could get my blood sugar up a bit and get some respite from the chattering.

I had the pain in my back despite the epidural (but admittedly not so bad), so I couldn't sleep but I tried to rest. I was told that I would get new midwives for the early morning shift and if I was dilated enough I'd push. I decided to let the epidural wear off and no click the button, mindful of all the NcT classes that had told me not to have one because they mean you can't feel anything. I used hypnobirthung breathing to try to manage the pain. When I got the next midwives and pushed I was berated for not working hard enough. I knew that something wasn't working and told them this, because I had no pressure at all, just pain. They ignored what I said, told me that it was because of the epidural that I couldn't feel anything (which was rubbish, because I was in serious pain) to keep going and work harder - I later learned that they told my husband privately that I was doing a great job and that they would speak to a consultant because it was unlikely to work, but they didn't want to "put me off" in case I was in transition. But no one told me.

They brought out a junior doctor to read me all the risks of a CS and tell me that it was that or forceps (without reading any of the risks of forceps, or trying to pull a big malpositioned baby down the birthing canal!) and it was pretty clear that the junior doctor wanted forceps. I was wheeled down to operating theatre so a consultant could "decide" whether it was forceps or CS - he examined me and said "this baby is definitely not coming out, even if we used forceps, there's nothing wrong with your pushing". Junior doctor and midwives looked disappointed.

I had operation. I held my baby in a fog before she was taken away for clean up, had a haemorrhage, fell asleep. First sleep for several days. I woke up in the postnatal suite to the sound of being berated by my midwives for not having fed my baby yet. I was tired and I had no idea what I was doing. I had missed the lunch trolley and no one had told my husband he could take a sandwich for me before they took them away and we were told we had to fend for ourselves - in my trust, if you have a straightforward vaginal delivery, you get the hero's welcome of hot tea and toast at any point, whilst the midwives make a fuss of you and tell you how well you have done and you bask in your success. Welcome to being a second class citizen with your EMCS!!

I realise that I actually was asked about my birth at my 10 day appointment now I think about it - I told the midwife (let's call her Jane) who visited me that I'd had an emergency c section because baby was big and malpositioned and she was really kind, but I was actually in a euphoric state because I was so grateful not to have died and to have a healthy baby. I would not have dreamt of complaining and I wasn't ready to examine what had happened to me, I just accepted that this is how it was.

When I had my second baby, friends asked me whether I'd have another section and I said I had doubts and told them what happened the first time and they were really shocked. I turned it over in my mind and decided that I'd probably approach it such that if I went into labour spontaneously before 40 weeks, that would mean baby would be better positioned for birth and smaller so I could give VB a go, but otherwise I wanted a CS. First midwife kept telling me at every appointment that I didn't even need to consider a CS in my plan as "there's no real correlation between the first baby's size and the second", which is objectively rubbish (size of first baby is in fact the biggest predictor of size of second baby - you can read numerous scientific studies on it). I asked for a second midwife and changed the day of my appointments.

I had the birth choices clinic with the midwife - Jane did it (yay for continuity of care, but sadly I never saw her again!) listened to me, apologised that I had a tough time first time around, agreed that my view was probably a good one in the round and said "I have to read you the risks of the CS, so I am sorry, I'm not trying to put you off". I was then referred to second round with the junior doctor (you don't get to see a consultant for an elective section here, they sign off in the background but no discussion with them usually), who tried very hard to persuade me to go to at least 41 weeks "just to give you the best chance". She kept telling me that in our trust 2/3 of women who want a VBAC get one. I said "so 1/3 of women don't get one, which am I, in your view?", to which she admitted that she hadn't read my notes and couldn't advise me (she could try to persuade me not to have a CS, but not actually give me any medical advice as to what was best for me!!). Every person in the system uses the term "failure to progress" on repeat about birth 1, which might be the medical term, but it makes you feel pretty shitty about yourself and it's not a label that is helpful to the decision as to what to do the next time, because it has no "why" attached to it.

I didn't go into labour spontaneously, despite lots of yoga and had a CS just before 40 weeks. It was dreamy and straightforward. My child was 9lb and wedged in and the anaesthetist told me I made a good decision. It was in the pandemic and my husband had to go home to look after my child. The aftercare was pretty limited - no one asked if I wanted help feeding, no one helped me with my dinner tray - I was told that I had to go out and get it myself. I split my scar walking out to get my tray and was told off for "doing too much". They put the dressing on really tight to tape the wound up and prevent reoccurrence. My baby cried a lot in the night and no one came to check on me - I administered my own pain relief from a cupboard in my room and wrote down what I used on a sheet. I just used ibuprofen, as I was worried about how spaced I felt on the morphine on my own. I used the buzzer once to ask for colostrum that I had expressed from the freezer and it was delivered wordlessly. I was otherwise alone for 12 hours.

When I saw my midwife in the community at 10 days she had to take the dressing off and because they had put it on so tight to stop the scar splitting again, she basically had to wax my scar to get it off. It took a long time, whilst another midwife held my baby. They were both kind, but at one point my midwife said to me that she had not expected me to cope with the pain of the removal so well as she had thought that maybe I didn't have that high a pain threshold because I had requested a CS. I think she thought this was supposed to be a compliment, but it really confirmed to me the judgement that you feel as a woman trying to make a good decision for you and your baby through the system who isn't confident of a successful VB.

If I thought that I could have a straightforward birth, I would have had one. And I would have been treated as a hero by comparison. Instead, I felt like I was supposed to feel like a failure. Some of your rhetoric even here sounds the same, basically "I don't know why these women don't try again, they used to in the past".

Apologies for the long post, I'm just trying to explain how it works from a perspective you probably don't get to hear!

(And as you can see I didn't actually "choose" a Cs as such, in that I'd have had a VB if I'd gone into labour before the date, but I will be recorded in the statistics as if I never even considered a VB!)

And super good luck OP. I found my recovery very straightforward and easy and I could bf as I wanted to. I have no regrets!

@ChatBFP Yep they never talk about the risk of forceps and those I know who had forceps had a much worse recovery than those who had cs and were quite surprised about how it was harder. My friend has requested an elective cs this time as she is still traumatised from it.

Also if it helps op I had my second c section 10 days ago and I’m already off painkillers…

@ChatBFP sounds like you had such a tough time! So sorry to hear that. It’s easy to see why some women are completely traumatised by their births.

@Ididivfama thats wonderful to hear. Did you just take paracetamol and ibuprofen? I can’t take ibuprofen so hopefully can have some kind of substitute if needed.

@CalFairy

In my trust they give you ibuprofen and morphine or the paracetamol/codeine stuff if that helps?

They gave me codeine and told me to take paracetamol and ibuprofen too. I may just be lucky I know, but I honestly think compared to a bad vaginal birth (like you might have experienced with complications!) it’s more manageable.