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Elective Cesarean, would you choose one ?

rebeccaplamondonrebeccaplamondon member
in November 2022 Moms
My OB has suggested that since I have a 97th percentile baby or large baby confirmed by subsequent ultrasounds, that I should consider and elective cesarean to preserve pelvic floor etc. What are people's thoughts on this ? I'm conflicted. I've done medical study research suggestions pros and cons etc. Have you had both? What would you prefer? Why ? 
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Re: Elective Cesarean, would you choose one ?

  • sejicasejica member
    I had an unscheduled c at 41&2 after going into labor on my own with my first 90+% baby and scheduled c at 39w with the next two. Recovery was so much easier with the scheduled c because I had not labored and strained my abdominal muscles. With perfect hindsight I would have induced at 39weeks, and been happy enough with an unplanned c. You also need to consider how many children you want total as drs tend toward rcs for future deliveries and most cap that at 5 rcs.

    The immediate recovery from vaginal delivery is just so much easier than recovery from abdominal surgery, so even if you have to do longer term work on pelvic floor, I'd give it a shot, especially if you're planning on a larger family.

    Also, the most important % in terms of successful and non-traumatic vaginal delivery is head circumference. Belly can squish, long legs and arms deliver fine, but big heads are what cause big problems. All of mine are 95%+ head, so cesarian has worked best for us, and if you are going to end up with a cesarian, recovery is much easier without having labored first.
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  • coldlife2coldlife2 member
    I have not had a CS, and I would not choose an elective CS, especially if the only reason is a suspected large baby.  Also, I have heard that insurance sometimes (rightly, in my opinion) will not pay for an elective CS, so make sure you’re fully informed on that side of things. 

    Here is a link to the ACOG’s guidance on suspected large babies. Unfortunately, it is no longer available without paying for it (boo, this sort of thing should be available), but here is the link anyway, and my summary from a prior post when I was able to view it.

    https://journals.lww.com/greenjournal/Fulltext/2020/01000/Macrosomia__ACOG_Practice_Bulletin,_Number_216.50.aspx

    -If a provider tells you your baby is estimated at greater than 9 pounds, 15 ounces, that estimation is wrong more than half the time (first paragraph under "Diagnosis.") 

    -A physical exam (aka - feeling your belly and measuring fundal height) is about as accurate as ultrasound (last paragraph under "Diagnosis.")

    -Suspected macrosomia is not a reason to induce prior to 39 weeks (under the question that starts "is there a role for induction of labor..."). 

    -A planned c-section due to suspected macrosomia is controversial, and generally isn't recommended unless the baby is estimated at more than 11 pounds. Even then, it should be a discussion between the woman and her provider, including noting that ultrasound estimation is notoriously wrong (and, as referenced above, that it's wrong more than half the time at this weight) (under the question that starts "when should scheduled cesarean birth...") 

    -A suspected big baby is not a reason to skip attempting a VBAC and going straight to a c-section (under the question that starts "is suspected macrosomia a contraindication...")

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  • Gingermom15Gingermom15 member
    edited October 2022
    I was induced with my first due to complications (iugr so polar opposite of macro) and ended up with a c section because of prolapsed cord. I personally wish I had opted for a primary cs rather than induction with him. 

    I had a repeat c section with my second and it was a much easier recovery, as Sejica said. But with opting for a primary c section you do want to take into consideration the number of children you wish to have. There is increased risk with each c section if you were opt for repeats in the future, and providers generally don’t recommend more than 3-5 sections. This will be my third and I will be having a bisalp done so it works for me. 
     
    That being said, whichever type of birth you are most comfortable with is more important than the opinions of strangers on the internet. what do you feel is right for you based on conversations with your provider? If you are more comfortable with a c section without a trial of labor or an induction, there is absolutely no shame in that. It is a valid choice and how you feel as the person giving birth does matter. It is also completely valid to want to attempt labor naturally or be induced at 39 weeks and attempt to have a vaginal birth. 
    There is no easy choice or easy way out. However you choose to bring your baby out is valid and reasonable.  

    ETA fwiw I know scans can be variable in estimated fetal size, but both of my scans right before birth were on almost to the oz 🤷🏼‍♀️ 
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  • ravenhairedgirl83ravenhairedgirl83 member
    @Gingermom15 so well said. Birth is the one topic that I've deliberately avoided on any blogs or social sites. The reason being because it's so personal and uniquely situational that our experiences and preferences vary wildly. Home births, hospital births, midwives vs. fetal medicine docs, doulas, C-section, vaginal, VBAC, inductions, ECV procedure. You just need to decide what is the best situation for you, based on discussions with your medical team and your comfort level. That is the right answer.

    Personally, I wouldn't recommend asking for opinions in public forums. Other topics on the Bump have been helpful along this journey but not this one (for me).  -36 weeks
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  • Gingermom15Gingermom15 member
    @ravenhairedgirl83 exactly this. Birth and feeding are two things other moms will be most holier than thou about when their opinion doesn’t matter. We don’t need permission to do what we feel is right even if someone else doesn’t understand or agree. Their opinions don’t pay the bills lol doing what we are comfortable with and the safety of the birthing parent and baby are what matters. 
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  • coldlife2coldlife2 member
    Gingermom15 said:
    @ravenhairedgirl83 exactly this. Birth and feeding are two things other moms will be most holier than thou about when their opinion doesn’t matter. We don’t need permission to do what we feel is right even if someone else doesn’t understand or agree. Their opinions don’t pay the bills lol doing what we are comfortable with and the safety of the birthing parent and baby are what matters. 
    Yes, but a CS, all else being equal, is literally less safe than a vaginal birth, particularly for the mother. Yes, there are times when a CS is absolutely necessary to save the life of a mother and/or baby. But choosing a CS outside of that is literally choosing *against* the safety of the mother and baby.

    My post above was not intended to be holier than thou and or judgmental. I was providing factual information from a highly respected body of obstetrics to help her make a decision. Births are highly medicalized in the U.S., and women are often pushed into CS unnecessarily (our insanely high CS rates are proof) often because they don’t have good information in their hands. I don’t at all blame women for that. I blame the doctors and the medical establishment. 
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  • Gingermom15Gingermom15 member
    coldlife2 said:
    Gingermom15 said:
    @ravenhairedgirl83 exactly this. Birth and feeding are two things other moms will be most holier than thou about when their opinion doesn’t matter. We don’t need permission to do what we feel is right even if someone else doesn’t understand or agree. Their opinions don’t pay the bills lol doing what we are comfortable with and the safety of the birthing parent and baby are what matters. 
    Yes, but a CS, all else being equal, is literally less safe than a vaginal birth, particularly for the mother. Yes, there are times when a CS is absolutely necessary to save the life of a mother and/or baby. But choosing a CS outside of that is literally choosing *against* the safety of the mother and baby.

    My post above was not intended to be holier than thou and or judgmental. I was providing factual information from a highly respected body of obstetrics to help her make a decision. Births are highly medicalized in the U.S., and women are often pushed into CS unnecessarily (our insanely high CS rates are proof) often because they don’t have good information in their hands. I don’t at all blame women for that. I blame the doctors and the medical establishment. 
    My comment wasn’t directed towards anyone (you included) in particular, but towards the parenting/birthing community in general. As long as the birthing person is presented with the education to make an informed decision, which ideally comes from their provider and OP states they did research, as well, they should not feel shamed for what they choose. The birthing/parenting community is great at shaming birthing parents if they make choices they themselves would not. Also, c sections having more of a risk to the birthing parent than a vaginal birth doesn’t inherently make them an unsafe option. 
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  • coldlife2coldlife2 member
    Ok, but the OP came on here to ask. My issue is that it does not appear that her doctor is giving her sound medical advice to make an informed decision unless there’s a ton of stuff she left out of her post. The way she talks about the baby’s estimated weight does not sound like her doctor told her that those ultrasounds are highly inaccurate (“confirmed by subsequent ultrasounds”). Also, a 97th percentile baby is 10 pounds. The ACOG does not recommend an elective CS at that weight, and even at 11+ pounds, it’s controversial, so what her doctor is recommending is going against the ACOG’s guidance. 
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  • Gingermom15Gingermom15 member
    Ok, but I never said anything about your information or that it was wrong? I’m not sure what the defense is about. Validating the pregnant persons choice to birth their child in the manner they feel comfortable with shouldn’t be controversial. I apologize if you feel my comment applies to you. 
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