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Pregnancy

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

Elective C-section - the right choice?

103 replies

CalFairy · 26/01/2024 17:14

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?

OP posts:
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Ididivfama · 29/01/2024 16:39

Hopefully they’ll chat with you and make sure you have some decent pain relief depending on what you can take.

Stephne2 · 30/01/2024 00:06

ChatBFP · 29/01/2024 10:40

@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!

It does sound like you had some really awful and insensitive care 😞 I couldn’t say that would never happen in our area but I can imagine our local hospital staff would be horrified at that level of care and never saw care like that when I last worked in our local hospitals. I can’t imagine any of the staff in our area talking to you like that either. I have worked in healthcare in other parts of the country (not as a midwife) and the way people are cared for and talked to is a world apart the norm here, although I’d of hoped they was no longer the case but obviously not :( I think without doubt the women we care for would tell us if they were treated like that, like said before we get to know them and they tend to be very open about the things they have been happy or otherwise about so it would be unlikely we wouldn't hear about it.
No woman should ever be made to feel like a failure for not being lucky enough to have a smooth birth or treated with such lack of compassion, especially after going through such a traumatic experience. Honestly if heard one of our colleagues talk like that to a woman e.g implying she had a low pain threshold because she’d not gone for a VBAC following a traumatic birth, we would be not only shocked but having serious words with that colleague.

ChatBFP · 30/01/2024 09:23

@Stephne2

Thanks. You sound like one of the good ones 😊, but I am aware that it is also about system design and pressure on resources. The more pressure there is on resources, the more the woman gets out on a pathway and is a body and not an individual. We are in a very populated area in which it is going to be hard to get midwives, because housing is quite expensive locally so then midwives might have to travel quite a long way for the "privilege" of doing their 12 hour shift (and then some, potentially, with paperwork). I'm very sympathetic to the strain that puts on individual staff and I understand that it's harder to care well when you are being treated badly yourself. It looks from the outside as if ward staff have to record every interaction with you, which I understand from a risk perspective, but must really demotivate them from interacting more.

It's a shame that women don't get to see in advance how their area compares to others. Because I do know quite a lot of women here who have accepted less good care knowing that the system is stretched and it is just how it is.

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