Choosing an elective c-section

This post is about choosing a planned caesarean over a vaginal birth, why I've made that chose and the reactions I have had regarding this. #caesearean #csection #elective #plannedcsection #vaginalbirth #birthplans #planningforbirth #labour #twinpregnancy #pregnancycomplications #surgicalintervention #twins #twinmum #pregnancy #choices

First off, I am not an expert on pregnancy, labour, c-sections or anything else! I am just a woman with no medical education, pregnant with twins, who has made a decision with her husband regarding their preference to how their babies are born. This post is simply to tell you the reasons we have made this choice, and also to explain what we have been advised. It is also a firsthand account of how people have reacted to this choice. I've included at the end of this post a list of links to articles and sites I found useful to read when making this decision, and will make reference to some of the facts and figures I found in them.

If you haven't been reading this blog from the beginning, here is a little synopsis on my circumstances: I'm a 31 year old married mum-to-be. I am currently 27 weeks into my first pregnancy and am expecting fraternal twin girls. I have had no major complications during my pregnancy and have not been advised to have a c-section for medical reasons - the midwife and obstetrician were both all for me attempting vaginal birth. I have been suffering from PGP (Pelvic Girdle Pain - see previous post) but this has not incapacitated me (yet!), and shouldn't be a reason for vaginal birth to be a problem. I do, however, have a minor heart condition that, while not life-threatening or thought to be harmful to the babies, does cause me to have episodes that result in my being extremely fatigued for a few hours afterwards if severe enough. Currently, the baby that my obstetrician believes will be the first to be born is breech - but both babies have flipped around plenty of times for that not to yet to a concern, there should be plenty of time for her to turn around again and engage in my pelvis.

So, basically what I am saying is this: I do not need to have a c-section. However, I have decided to request an elective caesarean presuming that circumstances allow for this. My reasons for this are:

• My husband and I both feel more comfortable going into this with a plan! If we have a vaginal birth, there is still a chance of needing to have an emergency c-section and things getting complicated and rushed. Planning on a c-section feels safer. And one of the things every mother-to-be is reminded is to avoid stress - since discussing this option with my consultant and having it added to my records I feel much more relaxed about everything!

• Just under 5% of twin births result in the second twin being born by an emergency c-section according to my sources - while that is a low figure, the idea of having to recover from both a vaginal birth and a c-section is not a pleasant one. Less than 5% may not seem very high, but the NHS website warns expectant mothers off having a caesarean by listing risks that are far less likely to occur! That's almost 1 in 20 second born twin babies who are in distress or having complications that require surgical intervention in the birth. I don't want to risk my second born's health like that as I have a terrible feeling it will happen to me, and if anything went wrong, I'd never forgive myself.

• I have this "maternal instinct" ,as mentioned above, that something will go wrong with vaginal birth - which probably sounds stupid and my instincts have not been spot on during pregnancy. But I can't shake that feeling that I'd be safer with a c-section.

• The risks of having a planned c-section appear to me to be grossly exaggerated. On looking at the list of risks on websites such as the NHS's, I felt concerned about having one. But when I looked into it further, the actual statistics are much more reassuring, with the chances of the worst complications occurring being so slim that I am not worried about them at all. The risks involved in an emergency c-section are obviously higher due to the nature of the procedure being a rush job - so better for me to avoid this by planning one in the first place surely?

• My heart condition may not be dangerous - although I have never had proper reassurance from any doctor that my having a severe episode doesn't adversely affect the babies at all - but it is slightly debilitating. This is in the sense that when I have an episode I feel like I'm going to pass out, even when sitting down, my body begins to go into panic mode and I have to be careful to keep myself calm and my breathing regular else I have a full blown panic attack due to the feeling that I am not getting enough oxygen, and my heart rate sores for a little time - all this results in me being very tired and shaky for some time afterwards. After a bad episode, I often feel the need to sleep for a good few hours, and continue to feel fatigued well into the next day. As you can imagine, I don't fancy feeling that kind of fatigue on top of the exhaustion every mother in labour for any length of time feels. If I was to have a long labour, I am fairly certain I would have an episode from the strain of it all, which would leave me more tired out than the labour alone, and could result in my being too exhausted to push. This increases the risk of requiring intervention such as forceps or venthouse, or even an emergency c-section if the stress on my body causes the babies distress.

• Apparently, twin births (at least at my local hospital) always take place in the theatre anyway in case of complications - which makes me feel that the doctors feel the risk of surgical intervention is high enough for twins that they tie up a theatre, so planning for surgery is safer, surely?

Maybe those reasons are not strong enough, but for my husband and I, an elective c-section is just honestly feeling like the easier and safer option.

That said, we also know that there are risks involved. I have, as I referenced earlier, checked out some stats and dismissed some of the risks as being so low that I am unconcerned about them (1 in 10,000 doesn't seem like something that I should be focusing my attention on too much). However, other risks are higher and things I have considered and researched more thoroughly. The increased risk of post-natal depression following a c-section is of particular concern to me seeing as I have a history of depression. According to one study, the likelihood of post-natal depression is roughly 4% more with planned c-sections that vaginal, although I read a lot of conflicting information and statistics on this. However, the risk of developing post-natal depression is already higher with twins, so it is something I am already prepared to have to face, and both my husband and I know all the signs and symptoms so action can be taken early on if it looks like I have this.

Besides the risks of having a c-section (and I would like to point out that there are countless risks of vaginal births that seem to get far less attention by the NHS than those of c-sections...) I was also worried about how people would react to our choice. To be honest, I was very surprised and pleased to find that most people were completely supportive when I told them I was opting for a c-section if possible. I expected judgement and scorn, especially from other mothers who had been through vaginal birth. But the consensus seemed to be that given the increased risks of twin pregnancy and labour, a c-section was a perfectly acceptable choice for us to make. What people said behind my back may not have been so supportive, I wouldn't know. But so far, only one person has come to my attention as being negative, a close relative who made some snide remarks about it to my mother, which obviously got reported back to me. But other than that, people's reactions have been positive.

Once the hubby and I had tested the waters with telling family and friends that we were swaying towards a c-section, we decided that it was getting about time to discuss it with our consultant. I knew from my friend who brought it up with her midwife (who is also my midwife) that while she was willing to discuss options, she encouraged my friend to speak to her consultant about it and have them put it on her records. So at my last scan, while I was admitting that my heart condition has been worsened by pregnancy with more frequent episodes, I broached the subject of elective caesareans. I went into this consult with my list of reasons, a load of statistics and even a few smart retorts memorised in case I was in for an argument. My husband, who is usually very quiet at our consults and also avoids confrontation like its the plague, was prepared to back me up too. But as it turned out, we needed have worried.

Dr W. (my consultant and the lead obstetrician of the unit) simply pointed out that while our choice was absolutely fine, we needed to prepare ourselves for the possibility that we may not get a choice if labour started earlier than planned. While he was happy to put me down as a planned c-section around 37-38 weeks depending on how things are going, if I go into early labour they won't want to whisk me straight into theatre for a c-section if there is the smallest chance that labour will stop or slow to a point that we would have the babies safely inside me for a little longer. The problem there lies in that labour doesn't always go slowly enough for the decision to be made in time to do an elective caesarean, and if left too late, the surgery would be rushed and therefore more akin to an emergency c-section, thus riskier. In those circumstances, or when labour is so fast that I'm too far gone before I get to the hospital, allowing nature to take its course (as long as the babies are doing okay) would be far safer. I'm perfectly fine with that. Knowing that we have a plan helps me to relax, but I am also perfectly okay with the knowledge that these little girls may not want to stick to a plan!

One of the risks Dr W. brought up with having a c-section was that of problems with future pregnancies - but I made it very clear that this will be the one and only!

So, we are hoping for a successful, harm-free elective c-section around 37-38 weeks. That gives me roughly 10 weeks of maternity leave before the girls arrive and turn our world upside down - if they don't decide to come any earlier! Wish us luck...

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Reference Material

• https://www.nhs.uk/conditions/caesarean-section/

• https://www.cuh.nhs.uk/rosie-hospital/pregnancy-labour-and-birth/labour-and-birth/caesarean-section

• https://www.nottingham.ac.uk/news/pressreleases/2019/jan/new-research-to-investigate-a-common-caesarean-birth-complication.aspx

• https://www.ncbi.nlm.nih.gov/pubmed/21950660

• https://www.ncbi.nlm.nih.gov/pubmed/30322585

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC343856/

• https://www.babycentre.co.uk/a1029062/caesarean-birth-what-are-the-risks-and-benefits

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477251/

• https://www.webmd.com/baby/news/20080904/c-section-affects-moms-response-to-baby#1

• https://www.tommys.org/pregnancy-information/labour-birth/caesarean-section/c-section-benefits-and-risks

• https://www.webmd.com/baby/risks-of-a-c-section

• https://www.nhs.uk/conditions/pregnancy-and-baby/giving-birth-to-twins/

• https://www.womenshealthcaretopics.com/delivery-twin.html

• https://www.hindawi.com/journals/isrn/2012/616759/