Should elective C sections for no reason be allowed?

[Dori92]

Just curious on people’s opinions on this.

Would like to point out I’m not opting for an elective section.

Thanks 💞

It's not like choosing a pair of curtains or a car, you know, OP.

For my second birth, I was recommended induction quite strongly on my due date if the baby hadn't arrived by then. Having researched the potential complications quite thoroughly and well aware that my local maternity unit was at that time a complete horror show that couldn't even offer effective pain relief to labouring women but was instead fobbing them off with paracetamol, I made it clear that my preference was for a c-section if it came to that. As it was, I held out for a couple of days and went into labour naturally. I was offered no effective pain relief, vomited constantly throughout and found the whole experience utterly traumatic, but at least it was over fairly quickly.

I find it offensive to talk about "choosing" a c-section as if it's a more expensive cereal brand, when really women are often picking between several shit options as best they can.

Yah I had my c section because 10 out of the 12 women in my NCT group had appalling births ending in 3rd degree tears, labouring for days with no pain relief, emergency c sections.....thank fuck for maternal choice! Birth may be natural but so are a lot of other things that go horribly wrong with the human body. I have never regretted my choice for a second.

Yes, maternal choice should always be available although there are times when it cannot be accommodated (eg labour is too established by the time the woman turns up at hospital or else the theatre/s have emergencies in them, such as a breech - although there are already categories in place to accomodate this).

A c section is typically a guaranteed cost and whilst some vaginal births are cheaper, many are not and the ongoing repercussions/physio/mental health ramifications etc for others means they cost the NHS more overall.

This. I had two c sections I wanted one due an awful violent crime against me in my 20s. I wasn’t queried at the time 20-30 years ago. I needed one in the end.

You should be given a right to choose.
Women put their bodies through so much medically to have a baby and have the right to make an informed choice.

My sister chose a c section - no medical reason but she was a surgeon (not obgyn) and she got one with no drama.

I think this is actually quite tricky. Given we have universal free healthcare with limited resources, decisions are regularly made about how best to spend the NHS budget. Drugs which improve people’s quality do life and reduce their risk of developing life threatening conditions are not available to everyone who would benefit from them. Most people on WLI, for example, have to pay for them because the NHS can’t afford it. CSs are usually more expensive so I don’t think it’s wild to say that they are shouldn’t be available to everyone, if there is no medical need. That being said, I can totally understand that someone who had a traumatic birth would not want to vaginal birth the second time around and I think this would need to be taken into account. As ever, if you are drawing a line then some people will feel aggrieved that they are on the wrong side of it. I don’t accept that we are entitled to a surgery we don’t need though, just because we have a preference.

I had a third degree tear with my first and a generally traumatic experience. But still opted for a natural birth again second time round and didn’t have a tear. Things can go wrong with c sections and the aftermath of it too. It’s not a case of c section is safer or better than natural birth.

Of course they should be allowed. I don’t have children but if I ever had any I would definitely have been too posh to push.

I've not had an elective section, nor would I ever choose to have one unless it was the absolute last resort. However, it is a woman's right to choose how she gives birth. I might not understand it, but I will respect it.

I do see there being future problems though.

Lack of staffing, and distrust in the system means more women are opting for this choice. However, there's only so many hours in the day, so many beds available, so many staff, and only so much operating space.

Elective C-sections are obviously extremely time sensitive. They cannot be pushed back by weeks or months. They have to go ahead. Then there's the recovery stage, which is at a minimum 24hrs. On top of this the average pregnant woman is older, heavier, and likelier to have risk factors/co-morbidities affecting her pregnancy than ever before. Even if a woman doesn't want an elective C-section, she is still more at risk of complications and/or needing an assisted delivery.

Somehow, even with the birth rate at historic lows, the workload is increasing. Midwives are leaving the profession faster than they can be replaced. Years of underfunding into obstetrics and hospital infrastructure and investment in training are coming to fruition, and something is going to have to give. And I worry that maternal request C-sections will once again become restricted. Or worse, will only be available privately.

As long as the resources are available then anybody should be able to have the birth that they want, including C sections.

I had a footling breech baby and a bicornuate uterus, so my baby couldn't be turned with an ECV manouvre.

I was told that I would be in the elective section list, however if I went into active labour then I would still get a C Section, I would just be put onto the emergency list instead.

They're 2 different resource groups operating, however when there are resource and staffing issues then of course emergency sections take precedence.

However, if there are the resources there, then absolutely everybody should be able to choose the birth they want provided it's optimal for the stage of labour they're in.

Who judges whether a woman "needs" a c-section or not?

Women are often the best judges of what they need. Look any of the recent maternity scandals and you'll see a trail of dead and maimed mothers and babies with a common theme of medical professionals not listening to women telling them that something didn't feel right or was going wrong because they thought they knew best.

To ask women to place their blind faith in the clinical judgment of doctors and midwives rather than advocating for themselves and what feels right for them is really a step too far in the present system.

The state that the NHS is in, I'd worry that allowing this as an option to all women could lead to there being a lack or resources available for when an emergency C-Section is needed. I've had a C-Section and there was a surgeon, anesthetist and 3 midwives/nurses. There will also be additional prep for the theatre. I also had a vaginal delivery which was just midwives popping in one at a time until the last 30 mins when 2 where there for delivery.
Realistically, I can't see there being enough surgeons and anesthetists to meet the demand and that could lead to delay for those most in need, so no, I don't think it should be an option on the NHS.

Induction rates have increased for many reasons. Medical risk factors such as diabetes, raised BMI, maternal age, IVF, obstetric choleostasis and raised blood pressure requiring medication have increased hugely.

New guidelines from medical research has also suggested induction is prudent prior to 41 weeks.
Sadly I have known of women who are wanting the pregnancy to be over and have reported reduced fetal movements to their midwife to be offered induction by medics. This again pushes the induction rate up.

Induction can be a long drawn out process which both physically and psychologically takes it's toll. Women need to be thoroughly counselled on the risks and benefits of induction and that it may be ineffective which then leads onto them having what we would term a Cat 3 CS.

Opting for induction or elective CS warrants an in depth discussion with the woman and her consultant. After the discussion it is then the women's decision how she would like to proceed.

Yep- exactly what happened to me. Plus a baby in the NICU for a week after getting distressed during labour. I basically told the midwife who came to see me after my first I'd be having a ELCS next time (she was quite bemused- lol). There was no way I was being induced again- which would have definitely happened being older and having hypertension. I had a ELCS on my due date with no sign of labour being anywhere near so it was the right choice! Lovely calm birth, very healthy baby and no problem with recovery or breastfeeding.

Absolutely things can go wrong with a section, but thankfully there's a doctor present and your numb at the time, and in the right place to fix you up! Compared with getting a third or fourth degree tear* with no pain relief, after labouring an agony for hours, I know which I choose (and chose!)

*Then there's people that say they didn't feel the tear at the time, like it makes it any better that you were in so much agony overall that you didn't notice your most sensitive bits ripping apart!! 😱 A friend of mine ripped her clit in two! Hell no.

I've never understood why someone would actually want to go through a Caesarian if there is no medical need. It's not an easy option, my neighbour had two emergency C-sections and would rather not, however she had no choice. Why choose to have your abdomen and uterus cut open and then stitched up?

This is also true.

I had a fantastic ELCS, but at 4 weeks PP, on the exact same day, DS developed meningitis due to E. Coli, and I developed sepsis.

We lived in Sheffield at the time, so he was whisked off to the childrens hospital, and I was whisked off to the Northern General.

I was told that developing these complications was an increased risk during C sections. I didn't really have a choice in having a C section, because although it was classed as elective, he was footling breech, and my physical anatomy meant that he could not turn and it would not be safe for either of us to attempt a vaginal delivery.

The separation at just short of 1 month PP and the worry that my baby could die, in a different hospital to me, and they had attempted 3 lumbar punctures on him before they had any success was extremely traumatic.

I'm sure my story is extreme, but nobody chooses an ELCS lightly, or rather, they shouldn't, but I still support their choice and their autonomy over the type of birth they have.

Induction rates have gone up because hospitals are risk averse, and so they are offering them earlier and earlier. It is cheaper than offering a c-section or additional daily monitoring.

And - it’s more convenient for the hospitals to be able to plan when patients will come in vs the unpredictability of labour.

Look at the US where everything is hyper medicalised - they all seem to be induced by 39 weeks.

Nearly everyone I know who has been induced has just been for being slightly overdue. In my second pregnancy they were agitating me to book one in from 38 weeks - no known health problems.

IMO for some trusts induction is just the next action if you hit 40 weeks without giving birth - despite this being most women…!

Because you consider that set of risks and benefits preferable to the set of risks and benefits you choose by attempting vaginal birth.

💯 yes as someone who had 4 normal vag births then went on to work in delivery and mat wards having seen all types of birth. Just my opinion but I’d rather have a clean incision wound than a raggedy perineal tear or episiotomy which is difficult to keep clean.

as someone who had an "emergency" section with my first, and an elective with my second. id say 100% yes. maternal choice is a valid reason. it was my reasoning.

Have you had a four day induction with no sleep, on a shared ward, with limited pain relief, followed by an emergency c-section or forceps birth anyway at the end of it, followed by a long recovery period including corrective surgery?

As that might help give you some insight.

Because I like future functioning of things such as
Bladder
Anus
Sexual function

• Because it was virtually pain-free delivery and recovery. I recovered much faster than most of my friends with vaginal births. I've genuinely had more painful periods month in month out.
• Because most women that I know 10 hours before having a baby were in agony with contractions, whilst I went for a car meal with my husband and had an early night!
• Because I don't cope well with unpredictable medical situations.
• Because if the stress of it all got too much they promised they could have me out cold very quickly! Not an option with a vaginal birth.
• because 90% of first-time mums end up with stitches, I'd rather mine on my abdomen than sensitive genitals!
• Because I enjoyed meeting my babies whilst being pain-free and reasonably rested, compared with knackered and just relieved it's all over.
• Because I'm a wimp with pain, and didn't see how I could manage a long labour.
• because I didn't want to put myself through the agony of childhood when there was a much less painful option.

Those are just a few of mine.

I don’t understand why anybody would want to labour on an nhs maternity unit, they’re not fit for purpose. My c section recoveries were brilliant. I was up and walking with 12 hours unlike many of the horror stories I’ve heard from friends who had vaginal deliveries.

If the nhs was to remove the option of elective sections they’d need to offer far better care and start listening to women in labor.

If your vaginal birth was like that, it was one of the lower resource ones. Attempted VB doesn't always work out that way. EMCS and instrumental birth are both resource heavy, we have high rates of each, they're both consequences of attempting VB and they're harder to plan for due to unpredictability.

Comparing a straightforward VB to a section is the wrong metric.