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Childbirth

Elective C Section or trial of labour?

49 replies

KristinaM · 20/04/2004 10:47

Hi everyone! I?m new to mumsnet and really need your views/advice. I?m expecting my first baby shortly & my consultant has given me the choice of an elective section or going for a trial of labour. This is for non - obstetric medical reasons ? in his view the baby will be fine either way (as much as any doctor can ever say this). He says it?s really my choice - or mine and my partners - and that neither decision would be wrong ? the outcomes of both are likely to be good.

If the choice was between an elective CS and a normal vaginal delivery, with a small tear and a few stitches, it would not be an issue ? I would go for the latter. However, both of my sisters have had TERRIBLE experiences with vaginal deliveries. One had a long induced labour, mid cavity forceps to turn the baby and subsequent major internal damage. She became doubly incontinent and had to have colorectal surgery to repair the damage. Unsurprisingly she has chosen to have no more children because this. The other sister also had a ?trial of forceps? & a huge episiotomy and third degree tear, then an emergency CS. She has had another two children by elective CS.

I know there are probably lots of you out there who had these wonderful spiritual experiences during labour, or quick straightforward water births. I would love to have this too. But mostly these seem to be second or more babies, and often after a very bad time with the first. Or am I wrong? This is my first baby and because of some medical issues, it will be my last. So my heart really wants to try for that elusive normal delivery and I worry that I will feel cheated somehow if I don?t at least try. But then I?m very scared of having similar problems to my sisters. So I know in my head that the elective CS might be the sensible option in terms of damage limitation.

I know that someone out there must have faced a similar decision ? what would you do in my situation???

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musica · 20/04/2004 11:02

Welcome to mumsnet and congratulations on your pregnancy!

What a horrible thing to happen to your sister! I'm not surprised you're concerned - but it does not follow that what happened to your sister would happen to you. On the other hand, I can quite understand that you want to avoid that at all costs.

I have to be honest - I would go for the normal delivery, but perhaps if you were prepared to go quickly to c-section if things got difficult that would then avoid a risk of what happened to your sister.

You'll get some great advice here - hope things work out.

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SoupDragon · 20/04/2004 11:04

Welcome to Mumsnet You're bound to get a huge variety of responses to this.

FWIW, my 1st DS was a 10lb monster resulting in a ventouse delivery, episiotomy and 3rd degree tear. Repair work was extensive but only mildy uncomfortable afterwards and with no lasting damage.

I was offered early induction, "short trial of labour then c-section" or elective c-section for my 2nd. The lovely midwives ignored the "short trial" bit that the rude consutant had scrawled on my notes and DS2 was a straighforward vaginal delivery, 2 weeks early with no induction. I had an "elective" episiotmy with him when the previous tear looked vulnerable. Again, all healed well with no lasting damage.

There are no guarantees with any sort of delivery, as I'm sure you realise. A vaginal delivery can be easy peasy or a complete nightmare. A c-section can be a dream or you can end up in a lot of pain - I also had a friend who died of complications following a c-section. This is obviously extremely rare but a c-section is major abdominal surgery.

At the end of the day, go for whatever delivery you feel most comfortable with. There are no prizes for doing it "naturally", you shoudn't feel cheated. It does sound like maybe a "trial of labour" would be good for you if, as you say, in your heart you want to try for a "normal" delivery. You can avoid a lot of (but not all) problems by choosing the right positions during labour. OTOH, if you are genuinely scared by the complications experienced by your sisters then maybe the planned/contrlled nature of an elective c-section is the way to go. Do you know why your sisters had such big problems? What sort of deliveries did your other female relatives have?

There - I've been no help whatsoever It's your body, your baby, your choice.

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aloha · 20/04/2004 11:16

I loved my section, would have another one BUT it sounds as if this wouldn't be the thing that made you happiest. Why not talk to your consultant and say, for example, that you would want a section rather than forceps or a prolonged labour. I think forceps are utterly barbaric tbh. Your poor sisters.

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kiwisbird · 20/04/2004 11:21

Wow so many things to consider, firstly try to forget what others have been through, however close they are to you.
I had a very quick, simple and natural delivery with both of mine. That said I was lucky I know, I never contemplated it going any other way and exercised carefully and talked myself into it.
If your consultant is happy for a natural delivery then I would encourage you to try and work towards this, all things remaining normal up to expected dates etc. I would not risk an induction however, it is often inductions that end of as forceps, ventouse, prolonged labours and emergency c sections.
Lots to think about, I cna only offer my experiences
Good luck whichever way you choose

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KristinaM · 20/04/2004 11:23

Soup Dragon - you asked why my sisters had problems. Not exactly sure I guess. Does height have something to do with it? They are both quite short -one is only 5 foot and the other 5'2'' but they are size 14 & 16 so not skinny. I am taller but much narrower - size 8 is sometimes too big for me (not now I should add!!!!!).This worries my partner.

My sisters both put on about 3 stone during their pregnancies - again, does this matter? Their babies were a normal size - about 7lbs.

Both sisters were induced - one for pre-eclampsia and one for being overdue ( her baby was OP). Both times the babies just got stuck. Or maybe there's some proper medical reason I don't know????!!

Sorry i don't think this answers your question

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bundle · 20/04/2004 11:25

km, i've had 2 sections, the last one was a trial of labour - didn't get far as bp dropped dramatically just as the canula was being put into the back of my hand and I was rushed in for a crash c/s. my consultant had persuaded me to go for a trial though, and i trusted her judgment. she did my c/s too this time. whatever you decide, don't forget you are having a baby, not a birth
ps the pain goes quite quickly after the op, as I'm sure your sister could tell you, but you need to make sure you have plenty of help to start with and absolutely no lifting (maybe that should be for all mums )

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bundle · 20/04/2004 11:26

my sil has 3 boys - the last one well over 10lbs and she's a real skinny size 8/10, and was fine during her deliveries. i think it's more to do with the shape of the pelvic opening, I have positively size 14 child-bearing hips and yet they've never been used

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twiglett · 20/04/2004 11:33

message withdrawn

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SoupDragon · 20/04/2004 11:40

DS1 was an op baby which is why he got stuck. My gut feeling is to go for a vaginal delivery. Keep in upright positions, not on your back and you'll give yourself the best chance of avoiding what your sisters went through. It isn't a problem to back out of a vaginal delivery if things start going pear shaped but you can't back out of a c-section once it's underway!

It doesn't sound like there was really much in common between your sisters' labours other than the induction and if you're a different buildthen who knows...! I'm no expert but it could simply have been "one of those things" both times. One of our "pet midwives" may be able to give a more knowledgable response if they poke their head in.

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Helsbels · 20/04/2004 11:44

Hi Kristine
welcome to mn and congratulations! There is lots of advice on this site for things that you can do to assist a natural delivery, ie massaging perineum, drinking raspberry leaf tea from 36 weeks etc. My only gem of wisdom on this is that all births are different and just because your sisters had problems is no indication of what your birth will be like.Positive mental attitude is a big plus towards any situation whether you decide to take route a or route b. At the end of the day- you will have a beautiful baby - either a c section scar will heal or your 'bits and pieces' will heal. There is no easy answer you have to do what is best for you.

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mears · 20/04/2004 14:10

Kristinam - welcome to mumsnet. As a midwife I would suggest there is no reason for you not to attempt a vaginal delivery. Birth experiences vary from person to person as well as sister to sister. Avoiding induction of labour is a way of avoiding intervention like that experienced by your sisters. If going into labour on your own is a possiblity then I would opt for that. Labours that start on their own are usually better. Should you labour not progress well, or the baby is in an awkward position, a decision for C/S could be made then. It doesn't mean labour OR C/S. You could see how labour goes and if complications arise then you could have C/S.

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suzywong · 20/04/2004 14:16

Hi KiristinaM,
you have lots of wise advice here already
I would just like to add, that the labour is only a very very short part of your mothering experience, so try not to godown the road of feeling cheated or missing out. The important thing is a safe delivery for you both and after that the real work begins.
I tried for VBAC with my last baby and although I went in to labour sponatneously it was long and ended in a C. I was gutted but it isn't very long before you forget the feelings of 'being cheated of a natural labour' and focus on the happiness and hard work of being a mum.
So do what you feel is best, damage limitation is a wise course of action and if you should choose to go elective anyone EVER gets snidey or nosey about your decision to have an elective just come on to Mumsnet and vent your spleen and we will support you.

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Tex111 · 20/04/2004 14:26

Congrats on your pregnancy! I was all set for an easy labour as my Mom had three very quick and easy babies. It didn't work out that way for me and I ended up with the first section in our family's history! You just never know how it'll work out and you could have a very straightforward birth. It does sound like your sisters' experiences could make you feel quite scared at the thought of it so if you do decide to try a natural birth you might want to do some antenatal yoga beforehand. It's great for teaching you relaxation techniques and helping you stay in control. You also learn a lot of different positions for giving birth which could be particularly useful.

If you do end up with a section, they can be great too. Mine was a breeze and you shouldn't feel as if you've failed if you choose the section or you end up with one. Who said to remember you're having a baby not a birth??? That's brilliant!

Good luck to you whatever you decide.

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JanZ · 20/04/2004 16:31

I ended up having mid cacity forceps, with an episiotomoy and a tear - but didn't find it an horrendous experience.

In fact, when I went to see a physio about some internal problems that I have (which may be linked to the forceps but could also be due to a big baby with a big head - and anyway, can be sorted with special exercises), my first answer to the question about the birth was that it was a "natural" one. To MY mind that is what it was - because it wasn't a caesarian, which I desparately didn't want.

Hindsight is a wonderful thing - I was induced because my waters had broken over 24 hours before and the labour wasn't progresing and I was porbably pushing during transition rather than the genuine second stage, which meant I ended up exhausted (falling asleep DURING contractions!). Now that I know more, I would have resisted the oxytocinin as the baby wasn't distressed and I owuldn;t have started to push just because I was told to as by then I was 10cm dilated (I don't recall ever feeling a MAJOR urge to push - although towards the end I was probably too tired!)

BUT, at the end of the day, I had a healthy baby and a birth that I was happy with. It might have been assisted, but it wasn't a caesarian!

It sounds like you would like to at least try to give birth vaginally. Mears has (as always ) given you excellent advice on how to avoid the need for assistance - but at the end of the day, you need to be happy with what you decide. And then relax (!) and go with the flow, as it were!

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LadyMuck · 20/04/2004 19:45

Don't know where you're based, but if you've time it might be worth attending NCT ante natal classes, or hospital ones just to get more info as to what happens etc. My NCT classes covered c/sections as well, so I felt fairly informed of the options available, and what might happen.

Like Soupdragon ds1 was big and OP, and in the end he was an emergency section - but the most wonderful birth experience ever! (Not sure one of my birth partners agrees with me on that, but that is her problem). With ds2 I was offered trial of labour but went with an elective. Due to problems with a spinal I ended up under GA. Recovery was fine, but overall experience not quite as good as last time.

I was always fairly relaxed about whether the birth was natural or c/s - it didn't bother me that much. But if you do have a preference either way then go with your convictions.

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KristinaM · 20/04/2004 20:35

Thank you all for your words of advice. The antenatal classes DID cover different types of delivery. But I?m finding it hard to be in the position of weighing up all the risks of each when it?s my first time and I have NO IDEA how my body will react.

Mears ? thank you for the advice about trying to avoid induction. Would that also include a membrane sweep or only more intrusive forms of induction?

I do like the suggestion of trying for a vaginal delivery but then asking for a Cs if things begin to go wrong. How does this work out in practice? At what point do you say enough is enough? Sorry if I?m asking impossible questions here???

I am trying really hard to focus on the ? its just one day? thing, but I do have to say that for some women, including my sister, the damage sustained in childbirth causes problems for months and even years. One sister was incontinent for a long time & had to give up her job. Her marriage ended with the strain of her ill heath and the resulting financial problems & the total end of their sex life. Not trying to be dramatic here ? just honest. So you can see why I?m a bit apprehensive??

Thank you too for all the encouraging words from those of you who DID have a CS and found it OK.

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acnebride · 20/04/2004 20:37

Hi KristinaM, congratulations and best wishes. If there's anything to be sure of about labour, it seems to me that it is different for absolutely everybody. But just to say that certainly some first births are straightforward too - i was lucky enough to have 5 hours early labour at home followed by 1 hr 45 mins in hospital (with the birthing pool). I still wouldn't call it easy! but it certainly was straightforward. I really hope you find the birth a good experience - I would say that your sisters' horrible experiences certainly are unusual. Like mears said, take it one thing at a time and see how it goes.
Are you in touch with a support group/information website for your medical condition which might be able to put you in touch with other women in your situation? I'm assuming here that you and your sisters all have the same condition, is that influencing your thoughts? all the best.

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mears · 20/04/2004 20:50

I was thinking more about intrusive forms of induction KristinaM - however I am not that keen on the craze for sweeps either. Women often present with cramp pain afterwards thinking they are in labour when they are not. That in itself leads to more intervention IMO. Nature can work perfectly well when left alone.
Michel Odent refers to the birthing pool test for abnormal labours. If a woman goes into the pool when well established in labour, she should progress well in labour within a few hours. However, if she does not dilate well or the baby doesn't descend it is a sign that labour is not going to progress well. That in itself is a reason for a C/S in his opinion. I must say that I have noticed that women who do not do well in the pool go on to have epidural and often forceps. It is an interesting phenmenon. For women who do not use the pool you have an indication that things are not going well when progress is slow. However, sometimes a drip does the trick and progress is good.

You could discuss with your obstetrician the option of a C/S if the baby does not advance well if you get to second stage. There are lots of signs (too many to write down) that can be acted upon during labour. HTH.

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wilbur · 20/04/2004 20:50

KristinaM - I haven't been able to read all the messages here but I just wanted to add that I had an emergency c-section with my ds when, after a short-ish labour, they found he was twisted round and was not coming out. Like you, I have a non-obstetric medical history that made them very careful about my first delivery and so it had been agreed that no ventouse or forceps were to be used on my baby. They might have tried a ventouse to turn him, I suppose, but we went straight for a c-section as instruments were ruled out. It was fine, a bit dramatic, but fine and I am glad I went into labour with him, even though it ended up a c-section. I'm sure you would be able to refuse an instrumental delivery, under your circumstances. Your sisters' experiences sound awful and I don't blame you for being wary, but IME sisters are all different in their births - I have a friend who has v. dramatic scary labours, long and needed lots of pain relief (but fine in the end) and her sister just breathes heavily a couple of times and her babies fall out.

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kate100 · 20/04/2004 20:56

Congratulations on your soon to arrive bundle

I too heard lots of horror stories from people at work, huge babies, stitch ups in surgery etc,(I'm a teacher - everyone has had a baby), but I went for a natural delivery and did it with no pain relief and no stitches, despite a 9lb 110z baby who was OP (thanks DS). I have to say that the reason that I achieved this was down to my wonderful midwife, who stayed with me for her entire shift to make sure that I ended up in one piece. I'm glad I did it, but it was right for me, you must do what is right for you and of you change your mind during the labour, say you want a secion.

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aloha · 20/04/2004 21:01

My friend discussed this sort of issue with her consultant, and he was happy to give her a section when her labour didn't progress well. She was happy with the outcome and it felt calm because they were able to discuss it beforehand.

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tatcity · 20/04/2004 21:07

Kristina M - As expected huge amount of response to your post. I can totally understand your worries.

I had induced labour (unnecessary I thought) which led to episiotomy which led to 3rd degree tear. For second 3 years later was then advised to have C section because of damage suffered during first delivery. Was uncomfortable during C Section and then got an infection. I must say having been through both, I would opt for a vaginal delivery every time - even if it meant having another tear! I know this may sound weird though - but you have to bear in mind - I probably only had a tear because of the intervention. If you can avoid intervention you are more likely to have a better experience of vaginal birth.

I know all these comments may make it even more difficult to decide - but at least armed with other's experiences you'll be able to make an informed choice. Have a good chat with a midwife before you decide. Just because my experience of a C section was bad - doesn't mean yours will be - in fact everyone else I know who has had one - has said how brilliant it was. I think with your first a C section is "better" as you don't have the other child to look after as well - and can take things slowly and give your body more time to heal.

HOpe this helps. Congrats on the pregancy and good luck with whatever you decide to do!

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SarajaneA · 20/04/2004 21:19

Congratulations! My experience: my first baby was breech (now 19mths) and my Ob only wanted to do a CS. Was so nervous but it was like a trip to the dentist!! It was wonderful: I just lay there listening to classical music in the op theatre chatting to the anaethetist and my baby appeared. As I was being stitched up I thought "Ooh, I wouldn't mind having two or three more" but it did cross my mind that it may have been a bit early to judge the ease of it all. Back in my room holding baby I had a pump thing on the back of my hand to give me some anaesthetic when the epidural wore off. I was up the next day, feeling like I had done too many abdominal crunches but managed to get around slowly. Was determined to have another baby soon and got preg when DD 4mths. This time baby not breech but just wanted to sail into hosp again, lie there and be given my baby. I know it sounds lazy but I then don't have to face poss emergency CS, no issue of cord around the neck, becoming incontinent, etc. I thought childbirth was the most natural thing in the world but now I have had 2 CS I couldn't imagine doing it any other way. My sis in law had CS due to breech baby and then natural birth and said the recovery was so much quicker. I would say when my DS was 3wks I felt strong and normal so the recovery is pretty quick. My advice would be if you did have a CS, make sure the frige/freezer is full so you don't have to think about grocery shopping as lifting is a no-no. Also driving is a no-no for 6weeks but I drove after a week without a problem. I didn't take arnica or anything like that but I did take it easy, no housework, etc. By the way, who is your obstetrician - I think this makes all the difference.

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Clayhead · 20/04/2004 21:23

Hi KristaM, just wanted to answer one of your points about the better experiences being in second pregnancies. I had very striaghtforward deliveries in both (dd, first birth was op but that didn't prove problematic) and have only positive experiences.

My best friend is a size 6 (cow!) and has had 2 eight pounders without any trouble.

Good luck with your decision.

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KristinaM · 22/04/2004 10:31

Thank you all so much for sharing your experiences. I will be meeting with the consultant next week so will let you know how that goes.

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