Why would a doctor opt for a c-section?

“I thought long and hard about whether to go through with a vaginal birth,” says Dr Charlotte-Eve Short. But towards the end of her pregnancy, she decided to book in for a c-section – a decision many British obstetricians would also make. Here’s why…

Charlotte-Eve is mum to Nova White, aged 11-months – delivered by elective c-section.

(This article was originally published in October 2015)

I elected for a c-section in the last month of my pregnancy. I have a condition called pelvic floor dysfunction, which is experienced as pain and spasm in my pelvic floor muscles.

This is a syndrome that covers a wide spectrum of symptoms and is increasingly being recognised as a cause of long-term pelvic/groin pain, urinary symptoms, continence problems and sexual dysfunction.

It is most commonly caused by childbirth, however mine was a result of a chronic pain cycle set up by kidney stones. I was diagnosed with this the year prior to conceiving.

In addition to groin pain, I experienced the constant sensation of needing to pass urine (similar to having cystitis) and sex was off the cards. I had to take regular painkillers and have physiotherapy from a women’s health physio and thankfully improved to the point my husband and I were able to conceive our son.

There is much debate about how to manage childbirth for women who suffer from pelvic floor dysfunction as childbirth can tear these muscles and cause further problems. I thought long and hard about whether to go through with a vaginal birth but I had improved so much and did not want to go back to where I was pre intensive physiotherapy.

I discussed it with my obstetrician and even though there is not strong evidence for either section or vaginal birth, we decided to go for the route of least harm. There is some evidence that women who have c-sections are less likely to have long-term complications from pelvic floor dysfunction.

My recovery was great – I was in for one night and home the next day. Quicker in fact that some vaginal deliveries

During our training – as a medical student or O&G junior doctor – we all see vaginal deliveries. We are therefore more aware of how painful it can be in a way that the general public are not, and with this we are more aware of the options available for analgesia and planned c-sections.

Also, as doctors we are often more involved in the complicated deliveries so can get a skewed view of what constitutes ‘normal’. Many of my medic friends confide in me that they are traumatised by their medical experiences of birth to the point that they would opt for a planned section if they could negotiate this.

I am now a sexual health doctor so in addition we do see some sexual dysfunction patients as part of our case load that are the result of vaginal deliveries.

This is my non-medical view and I am not an obstetrician so this is not necessarily based on hard facts but for me, c-section was the option that gave me the least chance of causing long-term damage to my pelvic floor based on my history. It also has other advantages…

The BIGGY is that the delivery it does not hurt, there is some post op pain but this was very manageable and I felt I was in less pain and recovered quicker that the women in my NCT group who had tears post vaginal delivery (100% of them).

At 39 weeks when elective sections are booked, the baby is well developed and does not have an increased risk of respiratory problems (often cited as a reason to have a vaginal birth).

Baby comes out very quickly (15-20 minutes) after being anaesthetised so there is less chance of cerebral hypoxia, which causes cerebral palsy and can be the result of vaginal birth trauma. The rest of the time the surgeon is sewing you up. So I saw it as a safer option for Nova coming into the world.

You know exactly when the baby is arriving and can get a good night’s sleep the night before the initial rooming in with baby starts. This is very different from women who face their first night of baby’s cries and breastfeeding absolutely exhausted from a 36-hour labour.

Also, they are very good now at giving you skin to skin contact immediately so I felt really connected to him. They also let dads cut the cord and you can ask for the theatre staff to put on your own choice of music so in a way you can still have a ‘birth plan’.

I am sure I read that there was a survey of British obstetricians a few years ago in which up to 50% would opt for an elective section, I think this is very telling.

I frequently encourage women to be brave and ask for one if they want it

The downside: post op pain, increased length of stay (now less of a problem), theoretical risk of increased respiratory infections for newborn if before 39 weeks, other rare post problems including wound infection, blood clots etc, which are also a risk with vaginal births.

I don’t know what c-sections cost the NHS but you have all the theatre staff: anaesthetist, their assistant and normally a junior doctor, the obstetrician and their junior doctors and scrub nurse and auxiliary. Usually six-eight people in theatre. The theatre equipment all needs to be sterile and theatre is cleaned between ops.

Previously it might have been cited that having a major op leads to a longer hospital stay but there is a real push to turn patients around in 24 hours. Elective sections tend to be less complicated than emergency so post op recovery is more straightforward.

Women can opt to have a c-section on the NHS, as explained in these NICE guidelines. There are hard medical reasons for an elective section eg. breached baby, though mine was a ‘soft’ medical reason. However, you can request them for personal choice.

Most obstetricians would want to explore why you wanted an elective section to allay any fears and encourage vaginal delivery (there are now hospital targets to reduce elective sections, I’m sure partly cost driven but don’t know the ins and outs; I expect there is pressure to increase vaginal births as they are the natural option and advocated by all midwives).

I’m 100% pleased I made the decision I did; no regrets. There is a lot of pressure both through the medical profession (principally midwives), the media/NCT and other women to do it naturally, parading it as a badge of honour. However it’s such a small part of being a parent, who cares?

My recovery was great – I was in for one night and home the next day. Quicker in fact that some vaginal deliveries. I was taking painkillers for two weeks post op. It was slightly difficult to pull myself up the bed but this was fine.

It’s a bit of a pain that they don’t let you drive for four weeks but you can go to your GP before that if you want to drive to get their approval that you are medically fit, you just need to be able to safely do an emergency stop.

Breastfeeding can be affected by the operation. My operation was delayed by 24-48 hours but with great skin-to-skin contact, Nova latched on within 30 mins of coming out. I would definitely recommend this option to other pregnant women, in fact – I frequently do encourage women to be brave and ask for one if they want it.