Can I INSIST on having a caesarian?? also how are caesarian op dates decided?!

[MissDelighted]

I am 5 weeks pg with DC1 and am due to see the doctor next week. I wondered if it is possible to insist on a caesarian (in a normal NHS hospital) or if it is down to the doctors/midwives/hospital/postcode. I am certain I do not want a natural birth and want to make this clear as early as possible to the medics.

I am so set on a caesarian birth I am prepared to use savings to go private as a last resort, although I don't wish to have to do this.

Also, for anyone who has had a Caesarian - do they perform them bang on your due date or is it down to the baby's development nearer the time, or even beds available on particular days? How is it decided?

I would really appreciate any info/advice prior to seeing the doctor as I want to make sure I am armed with enough information not to be swept away with what she thinks should happen. Thanks in advance

Without reading the whole of this thread I have to say that it appears Treeny speaks alot of sense.

I have given birth vaginally and via elective caesarean. Neither were a bundle of laughs both had plus and minus points.

I certainly have not been left with a huge gash from my CS. I have a neat but visible scar. Equally my scar from the natural birth is hidden but in actual fact hurt for longer than the CS scar. Recovery was tough for both and a week later I felt in a similar physical state which was knackered but ok.

Yes you can request a CS, it depends on the personality of your consultant as to whether they will try to persuade you out of it. I was fortunate, mine was a sensible individual who felt I was able to make my own decisions based on informed choice. I am going to write to him to thank him for being so humane.
Oh by the way, at my 20 week hospital appointment I presented him with a 3 page letter outlining my justifications for a CS and my reasons were mainly non-medical. I do not regret my decion to have an elective cs at all. Also ironically, 2nd baby (cs) had fewer problems with phlegm than my 1st baby (natural) and fed straight away. However I was proud of my 'struggle' and eventual natural birth but cs is uber quick.

So there you are in my opinion its 'horses for courses'if you really want an elective cs you are unlikely to regret it because its your choice.

Just had another quick look at some of the earlier posts - oooooh dear! So glad I did not ask for 'support' re making a decision about elective cs. I read some old threads and quickly realised what a verbal punch up they become. Really ladies there is no need for it!

izyboy, that's just it, you made an informed choice and stood by it - no one has any issue with women who make a choice informed by research and who can back it up and are ready to take responsibility for the risk, OP would have been jumped on if she had come on 5 weeks pg insisting that she was going to freebirth , it's not the decision, it's the lack of reasoning that's the issue.

Well the fact is that before the operation the op will be asked to sign a statement outlining that she understands the risks involved. So, she will have to take resposibility for the decision.

Still feel that there is a pack mentality on some of these threads and one that I am happy that I avoided when I was feeling vulnerable.

I have to say that having researched the whole cs/ natural birth argument, there really was not alot in it. Y ou can find statistics and research to back either case.

The cost element-well I am sure there are costs involved in repairing bladder problems for women in their later years who have undergone natural childbirth. Yes NCT will tell you that your pelvic floor is affected by pregnancy but natural childbirth does affect it the most-as backed up by my consultant.

I had a full and frank discussion with my consultant who is a lovely man.

As you say, you can find evidence either way, to a certain degree. My friend had her bladder nicked by the surgeon's knife during her second CS. I'm pretty sure cost wise that 'side effects' of natural birth probably still don't come close to CS costs.

Well Suzi we do not know as there is no research that uses long term case stuies to demonstrate the effects that cs or natural labour have on womens bodies as we age.

However huge numbers of women suffer bladder incontinancy issues in later life and often need operations to rectify it. The most likely cause of the incontinancy is natural childbirth.

My consultant explained to me why this was but not being of a medical background I am unable to now reliably repeat the biological details (sorry)! However he has over 30 years of working in the field of obstetrics so I trust he knows his stuff.

NICE and Cemach have got a hierarchy of risk worked out, from least risky, to most (Cemach are soley concerned with crunching the mortality and morbidity stats so no financial imperative either, just the bare figures)
1: Vaginal birth without intervention(including VBAC)
2: vaginal birth with intervention (inductions/instrumentals/augmentation,also mincluding vbac)
3:Elective section for medical reasons
4 Elective section for maternal request
5 Emergency section

Izyboy - the most reliable and up to date research found that incontinence has no significant connection to mode of birth -it's a consequence of pregnancy

Again Jamila - I would say that of course vag birth without intervention would be least risky - stands to reason but not many women are lucky enough to get away with it on their 1st try.

Elective section for maternal request could still have some medical complications involved at the outset. Look you know the saying 'there's lies damn lies and statistics,'

At the end of the day - the risks are very small for cs and I for one was happy to accept them! Gotta go for my bath now ladies enjoy your evening.

Sorry Jamelia - not according to my very knowlegable consultant are you an obsetrician by any chance?

no, just a very experienced research wonk -with a deep and abiding interest in women's health

Just back from my bath and wanted to post one last time before bed (see addicted - pesky threads).

I realise that the above question sounds abrupt and rude (dont mean it to) - my point being if you are in the medical field can you shed further light regarding the biological process of birth and how the baby's head affects the bladder and pelvic floor?

It always baffled me in NCT classes how the stats you mention came to that conclusion regarding pregnancy being the main cause of damage to the pelvic floor (but does that include bladder?)

I certainly found that my bladder and other 'functions' were in better shape after cs which seemed to confirm my consultants opinion.

It's to do with the increased weight of the uterus and contents plus the effect of relaxin on the muscles and ligaments -the numbers of women with problems later in life are nearly equal -which was actually a surprise to the researchers ,befause they thought that mode of birth was the clincher - in fact it's parity,the chances go up the more pregnancies you have hence the exhortations to do your pelvic floor exercises daily for the rest of your life that are coming through now, personally My mum taught me when i was about 12,and I've only ever had leakage in the last month with #4 , 5 months on - I never accidentally piss myself laughing (or coughing, or jumping on the kid's trampoline )
the only connection with incontinence and VB is if a woman gets a 4th degree (through sphincter) tear, that's nerve based not pelvic floor, but conversely, nerve damage during C/S can do it as well

BTW Izy -
I am an addict I have been MNing for 18 months

I can see this regarding the pelvic floor which I understand acts like a cradle that keeps the other organs in place.

However my understanding is that in natural delivery the head as it lowers and rotates down the birthing canal has a severing action on the way the bladder is attached to the pelvic floor.

This of course heals itself but can cause later incontinence as age has a general weaken effect.

I did mention the research you have looked at to my consultant at the time and he raised an eyebrow. (I hasten to add that I am no medical expert and have a terrible memory so the above biological details are reliant on shaky recall)

My feeling is that stats can be used to support most points of you are setermined to make them. However it is imortant to look beyond them and see the overall picture. Sure the initial cost factor is important but in the overall scheme of things we have no real idea how a cs v natural childbirth adds up.

Just back from school run - now I know why I rarely post I would get nothing done! There's porridge hardening on bowls as we speak! Just to show I am neither pro vag delivery or pro cs just pro choice - there is something that really made me question whether cs was for me and nobody else seems to have mentioned it.

Lesions. Now my understanding of lesions is that they occur as an after effect in 90% of all abdominal cavity operations (even key hole). The vast majority are benign but it is serious if they cause your uterus to stick to your bladder 5 years after the op. (This is what I mean about the larger picture). However my circs meant that I was still prepared to take the risk and go for cs!

Look cs is a major op - but horrible things can happen in natural childbirth. As I say I rarely post but it really galls me that people come on these threads (not necessarily you Jamila) shouting 'are you for real?' revealing the gory details of their experiences and expect the OP to take them seriously.

OP make your own decisions but look at the overall picture carefully that's my advice. Thanks for the chat Jamila.

One last thing while I have the time-OP statistically speaking you will most probably be fine whichever birthing mode you choose!

Thank goodness this is not 17th century Britain whereby the mortality stats whould be against you and your baby even surviving! Good Luck OP I wish you well.

I had a private c section because I wanted one.

I got a great consultant who advised me that the risks in a planned c section were negligible.

My baby had a apgar score of 10, she breastfed immediately, I have had no trouble bonding with her and no sign of PND.

I was walking around same day, out of hospital after 48 hours and the pain was very manageable.

My friends who have had natural births have had broken pubic bones (seriously), 4th degree tears, severe trauma and PND, have been unable to walk or sit down etc.

DON'T BELIEVE THE HYPE. If you are certain you want a c section discuss it with a consultant. It is a valid choice. There are a lot of very judgemental women around who should have better things to do than decide what strangers should or should not do with their vaginas!!!

Oops just one more thing Jamila - you know the case studies mentioned your research?

Were they direct comparisons between women who had CS and never laboured v those who went through full labour and natural birth?

I only ask because I am assuming that most CSs occur as a result of failed natural delivery and therefore the physical effect of labour on the bladder and pelvic floor would still be present in those ladies who ended up with a CS.

You see I think research and stats regarding chilbirth have so many variables that I find it hard to take them at just face value.

I can't put my hand on it right now,but I think they did separate in labour ones out -not 100% sure though, but the research in question was quite groundbreaking and was a long term study conducted in retrospect, and there might have been faulty memory as a confounding factor. trouble with all research is that the people who should, don't often have time to read the full thing, so rely on abstracts and hearsay, one thing I've learned in 16 years of nursing is to never assume you know everything
re the bladder , it's suspended on ligaments within the pelvic cavity and the urethra passes through an opening in the pelvic sling -it's not attached to it though i believe it occupies the same part of the peritoneal sac as the uterus, hence having to free it and retract it even at first section - they're not fastened together, just closely associated. the hole in the pelvic floor can enlarge and weaken during pregnancy, so at root, the cause of incontinence is a weakening, allowing a slightly prolapsed bladder to leak when the intraperitoneal pressure goes up, ie, by laughing, coughing or jumping up and down

Crikey no wonder I had a problem following all the biological details. So are we saying that natural labour does have an effect on the bladder?

I mean surely the pressure of the baby's head in the birth canal must at least cause weakening to the ligaments attached to the bladder? Having been through natural childbirth I have to say that things were definitely weaker after that event than the cs. Although I must say I fully support your post regarding pelvic floor exercises being crucial.

I would say that my consultant was aware of the research you mention but I think having seen alot of ladies with incontinency issues (over his 30 years in obstetrics) the raised eyebrow meant 'no comment'.

don't know about that one,izy, I'd assume so, but your badder being lifted away from your uterus and held with retractors probably has as much , if not more effect, If the issue is long term damage, what they found out does make sense in that everyone who has a baby carries it for 9 months, they know that ligaments and muscles are more prone to stretching during pregnancy, so that's pretty much equal -the hypothesis they set out to prove was that women who have a C/S were less likely to have long term bladder problems and prolaspses etc than thos who'd had VB's , they found no significant difference, so concluded that mode of birth has no effect - what they saw was that more babies =more chance of problems, which also makes sense, if you don't work your pelvic floor inbetween. The raised eyebrow, may have been more of the 'that's their opinion' type which so often blocks progress- after all most guidelines are decided by commitee, to try and reduce the chance of individual bias informing policy (the fact that they usually end up kicking stuff into the long grass if it offends the commmitee's egos is a whole nother can of worms )The trouble with maternity services is that they are run by two groups of practitioners and the male dominated group very much like to keep the status quo -if they didn't they'd be out of a job!

I think I need to bow out of the biology debate not being medically trained and I don't wish to misrepresent my consultant.

I genuinely think he had an open mind - I was pleasantly surprised - his opinion was that as long as I had done my research and was ok with balancing the risks then he was prepared to sign off the CS.

I thought he was refreshing and supportive, actually, as other consultants at the hospital were very anti CS (for maternal request) and did not want to enter into debate - it was 'their way or the highway' so to speak. That sort of attitude is more likely to block progress and at the end of the day does little to promote maternal well being.

Sorry Jamila having said I was bowing out of the biology debate just want to query something (not trying to be annoying I just question everything - thats probably why my consultant was happy to sign off my CS!)

I can see why having your bladder lifted away from your uterus may cause trauma - however CS is ultra quick. Most 1st labours are not.I pushed for 3 hours for example. So for most of that time my baby's head was putting pressure on my bladder attached ligaments- I assume (I was also cathetarised at this point to prevent further trauma). This must have repercussions surely?! Mine was considered a fairly straightforwad delivery.

Just wanted to balance out the CS scenario you desribed.