Wednesday, December 7, 2011

The Justifications for a C-section This Time Around

My reasons for wanting a planned c-section at term with my first pregnancy were very rational. I was very well informed about my options, and had found an OB who I thought would respect my wishes. I was looking forward to meeting my baby in a calm environment and avoiding the physical changes that can be expected when a woman undergoes a normal vaginal delivery.

This next time around (which isn't even on the cervical horizon - so might not even happen), I cannot ignore that my body has been subjected to a normal vaginal delivery - no matter how unwanted it was. I cannot undo those physical changes, no matter how much I may want to. No more so than a woman who has undergone a c-section can undo the c-section. No obstetrician will ignore this fact either - and it's likely to make finding one to agree to my request for a planned cesarean harder than it was the first time.

In a second delivery, labour and delivery tends to be much faster (typically half as long as the first, which for me would be about 3 hours). Further the risk of emergency c-section is greatly reduced when the first pregnancy resulted in a spontaneous vaginal delivery. If I go into labour spontaneously (as I did last time), the risk of c-section is 2.3 percent, if I'm induced the risk is 7.5 percent (source: BC Perinatal Services Annual Report).

As such 2 of my reasons for electing c-section last time - avoiding a real and significant risk of emergency c-section and wanting to avoid the physical changes of a normal labour and delivery - aren't really valid this time around.

So what is there to gain by having a c-section this time around?

1. Avoidance of labour pain - given an expected labour that would be very short 2.5 to 3 hours, there's a good chance there might not be time for an epidural the second time around. Labour pain is hell on earth - before I suspected that it might be hell on earth, which is why I wanted to avoid it in the first place and now I know it is hell on earth.
2. Avoidance of further physical changes.
3. Avoidance of the experience of a second 'normal' birth.

And at what cost?
1. There's a good chance I won't find an obstetrician to agree to my request locally - as such I'm looking at travel expenses, and medical expenses. I should anticipate that acquiring a c-section this time around might be around $20,000.
2. Increased length of hospital stay and a longer recovery.
3. Increased risk of maternal morbidity and mortality.

From a physical standpoint - there's not a lot of justification in requesting a c-section this time around. Going through a c-section isn't going to reverse the physical changes that resulted from the first delivery and is unlikely to resolve any of the psychological issues. I know this.

And yet the idea of subjecting myself to another 'normal delivery' is deeply disturbing to me in part because I would be doing so because my right to choose was violated the first time I gave birth.

My situation logically sucks...


  1. What about the psychological component? There is some literature on tokophobia and postnatal depression and PTSD relating to traumatic birth experiences. For someone terrified of vaginal birth, being forced to have one, especially without adequate pain relief, could definitely have adverse psychological effects. You may be able to enlist more support on those grounds. The recent change in NICE guidelines suggests that hcps are more open to those arguments than they have been in the past.

    And yes, I do think it's absurd to have to justify it on those grounds. There's no reason it can't be considered a sensible, respectable evidence-based decision, but since people aren't there yet... well, this is another avenue. I think some doctors are more compassionate about this than others. It's definitely worth it to shop around. Good luck! I was in your shoes not that long ago and things didn't go so well for me. The last few years have been a blur of severe anxiety, terror, depression, counseling, medication, reconstructive surgery. You know so much more than I did then though, so I'm more positive about your chances of getting what you want and need.

  2. The psychological component is quite big to me...if I knew things were going to go sideways last time, knowing the psychological impact it has had, I would have done things differently (ie. gone private/another province). I had no idea that after asking for a csection from the first prenatal appointment onwards, finding an ob to agree to the request and being clear that if I were to go into labour that I would want an urgent c-section that I'd still wind up with a 'natural' birth.

  3. ....on the evidence, for a second birth, the only real ground is psychological.

  4. Of course, babe no. 2 could cooperate, and be breech.

    Seriously, this is crazy. You should be able to get a c-section because it is your body, and you want it. Same with an epidural. Same with denying an epidural, and wanting a "natural birth".

    Why do people who claim to support a woman's "choice" only support that choice if it is a drug-free vaginal birth, but not if it is a maternal-request elective c-section??

  5. If a few hours of pain isn't worth a second child, maybe you shouldn't be having one.

    And choice? Go elsewhere and fork out the cash. I don't want my tax dollars going to your elective, totally unnecessary planned section(and whatever complications of your "choice" are for your baby, I don't want to pay for those either).

    1. That's a ridiculous comment! We all pay tax dollars!

    2. Your taxes also pay for the treatment of long term damage due to vaginal delivery, like prolapse and incontinence; and for the treatment of postnatal depresion due to traumatic childbirth experience; and for the compensations paid for babies who suffered oxygen deprivation during birth

  6. @ Anonymous, "If a few hours of pain isn't worth a second child..."

    Yes but WHY does she need UNNECESSARY PAIN???

    You are clearly against the idea of elective C-Sections, but let me ask you this. What does a woman's choice - in general, in other situations - mean to you?

  7. I don't think that the psychological issues are your only route. You could take a look at the UK NICE guidelines for C-section. Although they don't give a women the "right" to one, they do say that a women should be offered one if that's her choice after counselling. More importantly they provided a fairly balanced assessment of the risks, so I think they set out the advantages of C-section which might help. There is evidence showing a reduced rate of fetal injury for example. I'm sure you're aware of the advantages, but NICE is internationally respected and should carry some weight. I assume you've found this resource: which might also help you with your justification.