Every woman in the UK has the right to request an elective c-section
NICE guidelines advise that women have the right to ask for an elective c-section, even if there is no medical need for one.
Even so, getting one on the NHS might be hard
If there are no clear medical reasons for a planned c-section, getting a consultant to agree to your request could prove to be difficult on the NHS. Indeed, research by the Birthrights charity reveals that it's something of a postcode lottery. My own journey to securing a c-section was much harder than I would have liked, despite having been given the green light in writing by a consultant at my previous hospital. In fact, the NHS trust where I ended up having my baby explicitly informs women in their pregnancy notes that their policy is to not agree to elective c-section requests. After some difficult conversations, my consultants eventually agreed to my request due to my previous trauma. Once I'd scaled this huge hurdle, everything became much easier, but I had to work hard to increase my mental resilience with the help of some counselling and the support of a doula.
If you're granted an elective c-section, you’ll likely have to wait until 39 weeks to have your baby
NICE guidelines state that "babies born by planned caesarean section at term but before the due date are at a higher risk of respiratory complications", so they therefore advise that planned c-sections shouldn't take place before 39 weeks. If, like me, you are having an elective c-section partly to avoid the trauma trigger of going into labour, this could result in a nervous period leading up to the c-section, with the constant fear of a natural birth looming over you. My own c-section ended up being performed at 38+5 weeks to enable a certain consultant to perform it, but any date pre-39 weeks is very unlikely on the NHS.
Writing a birth plan for your c-section is well worth it
Birth plans - or birth preferences - aren't just for women who are planning natural births with as little intervention as possible. My doula advised getting all my concerns and wishes out of my head and on to a page, and it made a big difference to my mental wellbeing. It also meant I was taken extremely seriously by all the healthcare professionals I met in the run-up to the birth, As a direct result of my birth plan, in which I stated that I wished to meet the team who would be performing the surgery, we had a wonderful meeting with the consultant anaesthetist who was due to be present on the day. This reassured us that everyone was aware of my unusual medical history, which was hugely helpful.
The pain of trapped wind
After my c-section, my stomach was literally undulating as the bubbles of air passed through my system; it felt as if my baby was still inside moving about! Apparently it’s caused by air entering your body during surgery and unfortunately it’s not the kind of pain that goes away with painkillers - the air just needs to work its way out. I'd advise stocking up on peppermint oil and taking it to hospital with you to encourage the wind to pass...and do let it pass - holding it in will make things worse, so parp with pride!
You’ll still bleed down below
Even though lots of lochia will have escaped during surgery, you’ll still experience postpartum bleeding, so definitely pack some maternity pads and expect to bleed for at least a week. And don't be scared if you experience a bit of a gush when you first stand up after surgery - it's simply gravity doing what it does after you've been lying down for a while.
They bring a whole new meaning to “big pants”
Everyone advises you to buy big granny pants to wear after the surgery, but going one or two sizes up simply doesn’t cut it, especially while you're still in hospital. Go at least three or four sizes up to accommodate your wound and swollen belly, or do what I did and buy the largest disposable incontinence pants you can find which are stretchy yet soft around your tender stomach and perfect for hospital and those first days back home. These also have the added bonus of built-in absorbency so you don’t have to bother with separate pads for postpartum bleeding.
People recover at different rates
I got incredibly frustrated with myself the day after surgery as I was unable to stand up without my blood pressure plummeting. Seeing other women on the postnatal ward up and about before me - even though they’d had surgery after me - was very demoralising, but eventually I understood that my body simply wasn’t ready and it needed more time to reset itself. After an extra night in bed with the catheter still in place I was able to finally walk about the next morning, and I was home that evening.
Don't be a hero
You'll hear it a lot, but a c-section is major abdominal surgery. You'll need help at home and you'll need pain relief - make sure you stock up on paracetamol and ibuprofen for when you get home as the hospital won't provide this. I also took arnica tablets following the c-section, a homeopathic remedy which is supposed to aid healing. I have no idea if these made a difference but I had no issues with my wound and it healed quickly.
Movement begets movement
Striking the right balance between activity and rest is hard, but immediately after surgery even little things like wriggling your toes helps to keep the blood flowing while you're still confined to your bed. One tip I wish I'd known before the surgery was tying a dressing down cord to the foot of the bed to help you pull yourself up for those first few days.
Your dressing will be removed after just a few days
I presumed the dressing would be changed regularly once I got home, but no: once it’s off - usually by day five - it’s off. To ease removal of the dressing you could rub a little oil around the edge. Sadly I'd not had the foresight to do this so I got a bit of an unscheduled wax....! I couldn’t believe how small and faint my scar was on the day the dressing was removed by the community midwife. In my case you also couldn't see the stitches as they stitched from the inside to knit everything back together, but it might be worth asking what kind of technique they intend to use for your specific wound so it doesn't come as a surprise.
Lactulose is your friend
You might be given dihydrocodeine pain relief in the hospital, but what they won't tell you is that one of the likely side effects of this is constipation. Sure, they'll give you lactulose to help things stay as 'soft' as possible, but if you continue to take codeine-based pain relief at home be prepared for something like this legendary poogate tale.... I'm reluctant to go into details but all I can say is that I can vouch for the anecdote.
C-sections can be overwhelmingly positive and empowering birth experiences
Finally, and most importantly, I now know just how positive a birth experience an elective c-section can be. The birth was so calm and peaceful, and has helped me to make peace with the difficult time my family and I went through in 2015. A huge thank you to everyone at St Thomas' Hospital in London for giving us the experience we so painfully missed out on before.