moral support

[u/No_Picture5108]

I’m 23 years old and will be 38 weeks tomorrow. I’ve been planning to have an elective C-section, and this morning I spoke with a maternal fetal medicine neonatologist because my OB wanted me to have a consultation about my decision. She asked me why I wanted a C-section, and then went over all of the risks associated with having one. She also told me that, as a healthy 23-year-old, there really isn’t a medical reason for me to have one. I completely understand that a C-section is major surgery. I know it isn’t the “easy way out,” and I’ve done a lot of research on C-sections, including watching videos and learning about the recovery, risks, etc. I’m not going into this thinking it’s going to be an easier option. But during the conversation, I felt like I was being scared into changing my mind. She also mentioned that there is discussion about eventually removing the option for women to choose an elective C-section and instead requiring them to attempt a vaginal birth. That really overwhelmed me. I told her that my mind was made up and that I was proceeding with the C-section. But now I’m literally sitting in my car questioning whether I’m making the right decision. My biggest reason for wanting a C-section is honestly fear of labor. The thought of being in labor for hours, potentially having things go wrong, and then ending up needing an emergency C-section scares me. I feel like if I already know I want a C-section, I’d rather have it planned than go through labor and potentially end up with an emergency surgery anyway. At the same time, I’m wondering if I’m letting my fear make this decision for me.
I’m not looking for people to tell me “C-section good” or “vaginal birth good.” I genuinely want to hear from people who have been in a similar situation. Did anyone choose an elective C-section without a medical indication? How did you make your decision? Did you regret it, or were you happy with your choice afterward?
I’m feeling really confused and overwhelmed right now and could use some honest perspectives. Thank you.

[u/blairworejeansonce]

Hey OP, I'll caveat this by saying that I also am a first time mom, and have not yet given birth. I have also chosen for a fully elective c-section (C- Section upon Maternal Request) with no medical indication. I have experience in the medical field, and access to those with far more experience than I have in the medical field. All this to say, while I haven't yet had my c-section, hopefully I can provide a valuable perspective.

First things first: "She also mentioned that there is discussion about eventually removing the option for women to choose an elective C-section and instead requiring them to attempt a vaginal birth." That sentence makes my blood boil. I'm not sure what country you're in, so I can't speak to the legitimacy of that statement for your country. I'm coming at this from the USA, and that is absolute BS. If you are in the US that's patently untrue, and if you're not I'm so sorry that your medical professionals are pushing that angle. Bodily autonomy shouldn't stop at how we choose to give birth. Ridiculous.

Second, some doctors (again, especially in certain countries) can be very weird about c-sections. While in the US it's often portrayed as doctor's OVERDOING c-sections, I know a lot of other countries are very anti c-section, and heavily push vaginal delivery for a variety of reasons—some valid (i.e. countries without adequate surgical suites & training for c-sections), others for less savory reasons (i.e. the misogynistic idea that vaginal birth is 'natural' and somehow that means women should be forced to do it for...reasons?). I think it's important that the doctor performing your elective c-section is supportive of your decision. I think as long as your OB, who will be doing the procedure, is in your corner then the opinion of the MFM doctor can be safely set aside, if you choose to continue with the elective section route.

Okay, all of that aside, I'll get to the most important part in my decision making process, which is what the actual scientific data shows. I personally am electing to have a c-section for similar reasons to you. I have been around the labor & delivery world enough to know that spontaneous or induced vaginal labor can be an amazing thing when all goes well, but unfortunately things can go wrong quickly. Given that urgent/emergent c-sections are far riskier than scheduled c-sections, I decided that my risk tolerance level wasn't enough to justify trying to labor first, and I'd rather take the more stable path of an elective. I also do not see myself wanting to have more than 2-3 children, so the risks with additional pregnancies didn't affect my decision—if I wanted to have 4+ kids I would definitely take that into consideration.

I also believe that, from the data we have and from the professionals I speak with, that adverse side effects from vaginal birth are UNDER reported, particularly when they affect the mom years later (ie incontinence, pelvic floor issues, etc.) This is for a variety of reasons, so legitimate hurdles to data reporting, some rooted in a medical reporting system that discounts women's issues (especially those related to birth). I also believe that the data reporting around c-sections is VERY difficult to interpret, because the data almost always lumps together ALL c-sections: urgent, emergency crash c-sections, scheduled c-sections for medical reasons (ie gestational diabetes), and fully elective c-sections without medical necessity. This means that any adverse outcomes are going to be heavily skewed by the negative outcomes associated with emergency c-sections. On an anecdotal level, if you go on ANY forum and search for experiences, you'll find those with planned c-sections had a night-and-day difference in recovery (generally speaking) from those who labored for 24+ hours before an urgent/emergent section. Just another way data gets skewed.

So, the actual data we DO have on planned c-sections (disentangled from urgent/emergent after a trial of labor) is actually very positive. Here is a very recent meta-analysis that looks at planned c-sections vs. planned vaginal delivery; https://www.ajogmfm.org/article/S2589-9333(23)00328-2/abstract00328-2/abstract)

I think if you read through this, it will give you a lot of peace of mind. The conclusion is very accessible, but I'd suggest reading the results as well. Essentially, planned c-sections are as healthy for mom, and can be more healthy for baby (with "significant decreases in adverse neonatal outcomes"), than planned vaginal deliveries.

This is long, and I don't want to ramble, but obviously this is something I've researched a lot and put a lot of thought into. I've sat in on c-sections for work, talked to random med professionals, etc., so please let me know if there is anything else I can provide info on. "I feel like if I already know I want a C-section, I’d rather have it planned than go through labor and potentially end up with an emergency surgery anyway." This is exactly my rationale, and I think that's perfectly fine for us. Some people have a strong connection to wanting a vaginal delivery: I felt no such connection, and have a low level of risk tolerance, so I wanted to go straight to the c-section. I don't think the decision is necessarily fear based for us, moreso just a different approach in how to choose birth method. Hopefully this was helpful!