Deciding how to deliver? Please help... Sensitive nature

[Bearberry]

Birth

Firstly this is really long, so greatly appreciate anyone taking the time to wade through. I did post on the topic a few months back in less detail, so apologies for the repetitive element - but I really want some help! In a nutshell my first pregnancy ended in April last year when I delivered our DD at 20 weeks at home. The pregnancy had involved a lot of scary moments and bleeding throughout. I went to two local A&E units the day I lost her, having contractions (first pregnancy as I wasn't sure at the time what was happening) and was turned away as cervix was closed, only for her to arrive a few short hours later. I am now pregnant again, currently 36 weeks (consultant led although no explanation found for what happened with DD1) and due another DD - almost exactly one year on (lost DD1 on 26/4, DD2 due 25/4, which is also unhelpful).

My main fears relate to the previous pregnancy, although I know so far this pregnancy has been very different. I've been having counselling for the last 6 months relating to the bereavement and the trauma I encountered. However the entire pregnancy has been a very anxious time for me, and I find I am constantly having to fight negative thoughts about the outcome. I basically feel terrified each day that something will go wrong and this baby will not survive. As a result of months of feeling this way, I know feel desperate for an end point, and some element of control over the delivery. I am very keen to reduce and chances of distress or problems occurring during the labour as I feel I am emotionally unable to deal with anything other then a straightforward situation. This in itself is very stressful for me as I understand things cannot be controlled in this fashion. My fear throughout the pregnancy has been that my body will once again inexplicably fail me, and the baby will come to early and not survive, so have spent the last few months willing her to stay put. Now I am reaching full term, and whilst I know she is ok, I want her out as quickly and safely as possible, before something has the opportunity to go wrong. Because of this and because of her expected size (measuring 95th centile) and problems this could result in for an overdue delivery I am keen not to go over due.

I spoke to registrar before about the option of an induction if I reach my due date and don't naturally go into labour before then. I like the idea of this in the sense I won't go overdue, and can have a date booked in and therefore an end date in my mind (which seems important for psychologically surviving these last few weeks). This also helps with the trauma I feel relating to actually labouring, and this will be undertaken exclusively within the hospital. My concerns however are that the induction is more likely to lead to a baby in distress, interventions or a emcs.

My concerns relating to a natural spontaneous labour are as follows:

1. I delivered previous baby at home, alone, with no pain relief - after being sent away from two hospitals with 'stretching pain'. The experience was hugely traumatic and life changing for me. Despite 6 months of specialised counselling I still feel very scared and anxious about going into labour and have a huge fear of not being able to make it to hospital and delivering at home and something going very wrong.
   
2. I am very scared of going overdue and encountering problems relating to that and/or her size
   
3. The complete lack of control over the situation is unsettling given the circumstance. I have no idea when I might go into labour or how this might work, I am very keen to avoid any situation where the baby becomes distressed. I appreciate that how a labour will go is basically luck and can't be predicted.
   

Regardless of the above I know that a natural spontaneous labour has a decent chance of being the best and safest situation for me and the baby, and that I have no reason to believe I won't have a straightforward, easy labour & delivery.

The last alternative as I understand it would be an elcs, which is what I am swaying heavily towards at present. I have read extensively about this and from egg I understand the risks of an elcs to the baby and a spontaneous natural labour are at a very similar level. The obvious downside is the recovery time as I appreciate this is a major operation. The elcs would offer me control in that I would have a specific date to work towards and takes away the concerns of a interventions which which could happen with an induction. I feel it's the safest way and offers the highest odds from this external position that the baby will arrive safely and in a non-traumatic way. I do appreciate that not all operations go smoothly and I could be one of the unlucky ones in that sense. I feel in some senses that I would be failing by having a elcs, and that I should be psychologically strong enough to push through for natural labour.

Right, this is basically the huge rambling circle my brain is doing re birth. I would REALLY appreciate any guidance here as I just feel at a loss as to what to do for the best. My DH is pushing for a natural labour as he wants me to avoid surgery. I understand that if I do decide to push for a elcs I need to be reasonably forceful in my choice, and I just don't feel I have enough conviction one way or another at present. My counsellor thinks I should go for the elcs and has totally validated my feelings but in her absence over the last week I have once again become unsure. Urgh.

I tried to make a midwife appointment to discuss options but they are totally booked up and not very helpful. I have a consultant appointment Wednesday (although may end up being with the registrar when I get to here) and I would really like to have a constructive conversation about it then, but at the moment feel like a total flake.

[Heirhelp]

I think only you can make that decision. For me I want to avoid all forms of interventions, including sweeps but if I was you I would be considering an elcs. Lots of induced labours end in emergency cs. I would rather avoid a difficult labour followed by an emergency cs.

I understand your DH Is concerned but this needs to be your decision.

[Bearberry]

Thanks for your reply heir. Yes you're right, it really is my decision, it just feels so impossible to make. I just want the baby here, as safely and a straight-forwardly as possible and for this whole hellish emotional nightmare to be over- or onto the next stage at least!

[dats]

I'm so sorry for what you've been through and am not in the least surprised that you're feeling so horribly anxious. A lot of what you said really resonated with how I felt approaching the birth of DC1 - without any of the trauma that you've been dealing with, so I can imagine how frightening it all is having already had your worst fears realised once. If it were me, I think I'd opt for elcs. There are myriad scenarios where this is the right choice - and I have no doubt it will give you some much-needed feelings of control. Don't be swayed by anyone trying to push anything on to you. Your body, your baby, your choice.

And you're not rambling, it was all very coherent! You've been through so much, you'll eventually get through this and things will seem less terrifying - hang in there xx

[chaosagain]

You are not a flake in any way. It sounds like you've been through hell. In your position, I'd really want to get your husband to understand that yes, there are pros and cons to each possible decision, but that you feeling as safe and in control as possible is really important, and possibly offsets the recovery period of an elcs. Most importantly, ask him to give you his support.
On weds, if you see the registrar, do you feel you can ask to see the consultant if you're not getting what you need? You're within your rights re the patients charter to do so, but may need to wait. Can you clarify a list of questions you need/want answers to ahead of that appointment? (E.g. If you do consider spontaneous labour could the hospital admit you from the first contractions/early rather than have you labour at home?)
Would it be useful to 'try out' each decision for a couple of days - e.g. 'Decide' you're opting for elcs for a few days and see how you feel?
It's your decision but you need the support of your DH and your medical team to help you through, especially in the absence of any explanation about what happened to DD1.
Also be aware that there's now a doctors strike 26& 27th April, so if planned induction /cs make sure they avoid those dates.
Lastly, the size estimates are really often wrong. She may not be that big. I've found a website called evidence based birthing helpful for info on particular issues like this.
All the very best, do what feels best for you, if you can find out what that is.

[Aus26]

Hi Bearberry,
I have just given birth last week via ELCS. Whilst my situation is quite different to yours a lot of the same thoughts and feelings that you have shared above was how I determined that an ELCS was the right method of deliver for me.

Firstly without going into too much detail I was expecting twins and one of my babies was very ill and we lost him at 28ish weeks gestation. So like you I have recently lost a baby but my experience is just a bit more squashed because its all happened through the course of the same pregnancy. Needless to say especially in the last 10 weeks of my pregnancy, and a bit before that when we were well aware of the complications that caused his life to end, I have had extreme anxiety over this pregnancy. My baby girl was breech so an ELCS was the consultants preferred delivery method anyway but even if she had been in the right position, we agreed that an early ELCS (37 weeks) was best for me for the same reasons it appeals to you because it was clinical and predictable. Note they prob won't deliver you as early as me without other medical reason- 37 weeks is early for a section, but is in line with timings for a twin delivery which is why the were willing to accomodate me. My husband supported me in the decision, like your partner he wasn't wrapped in the idea of surgery but left the decision up to me - I obviously was the one who had to endure it all - and supported me 100%.

So surgery was wednesday last week and I was a bit afraid of the fact that it was indeed major surgery, risks of complication, etc etc, but actually it was fine. Was sore for a day or two but I'm able to move about mostly normally now, I'm still in the hospital (baby has had some issues so we aren't discharged yet, but nothing major) so I'm still having to look after her by myself in the night times and my recovery is really not impacting that at all. I have no doubt that the decision for a section was the best for me and if your gut is telling you the same then you should push for it.

one thing to note, we were also being supported by a clinical psychologist and one of the things that she arranged was to give us a private tour of the labour ward the week before the section. I saw the theatre where I had surgery, the wards where I would be sitting before and after walked all the corridors and parts of the hospital that were going to be a part of our journey, including special care just in case (which was useful because she ended up there for 2 days). This isn't a widely available service at the hospital I am in but they did it for us because of our complicated situation so it might be worth asking if you could do something similar. It really helped us to visualise what was going to happen and honestly on the day nothing was a surprise, everything ran just as they had promised us. It might also help your husband to accept your decision if you go down the route of a section.

Goodluck & I hope you have a great birth no matter what you choose! You certainly deserve one.x

[Missingcaffeine]

I'm sorry to hear your story.

I think ultimately your decision is unlikely to make any difference to your baby, but it might help you manage between now and the birth.

I think if I was in your position from what you have said, I would probably choose the ELCS but if labour occurs spontaneously before this, go for a natural birth. ELCS is definitely the most controlled way to give birth and control seems to be what you need right now. This would not be a failure at all - so please don't beat yourself up if you do choose that.

I had a natural birth, but friends I know who had ELCS seemed to manage quite well after the birth.

Sending you wishes of strength.

[Bearberry]

Thank you all for such kind and thoughtful replies, it's so appreciated.

Chaos, my DH has said he will support me in whatever I decide and I do believe this. However I am fully aware it's his 'worse case scenario' and in some ways I feel like he thinks I should be stronger and able to deal with a natural labour. I also feel I am denying him the experience of a natural labour, cutting the cord etc... Which makes me feel somewhat of a failure and like I am letting him down. Our previous delivery was very traumatic for him to so I want to give him a good experience. I will explicitly say all of this is my shit, not his - he has not by any means suggested any of this and I know would want only what's best for me. His concerns about the elcs are the pain and risk to me, and he has a very simplistic and idealistic view of natural labour. I have tried to explain to him that there can be serious and enduring problems as a result of natural labour, but I think he views that as very unlikely. So in short whilst he says he will support me, and I he hilt believe he wants only the best for me, I worry if the dr is disagreeing he will see it as an opportunity to as well, and I will feel overwhelmed and ganged up on.

Aus26, I am so so sorry to hear about your situation and the loss of your baby. I can't comprehend how hard the pregnancy must of been and I hope that you have all the support you need now to grieve. Sending you a huge Unmusnet hug and .

I guess part of the problem with the elcs for me is I have no medical grounds for requesting and I worry dr will be dismissive of my situation and my loss. I know it sounds ridiculous but I don't feel like I have any business being this traumatised I guess, and so many people experience worse situation. I know this is totally unproductive and the majority of the issues hindering me in making this decision are my own unhelpful thought patterns. My counsellor has really validated my feelings on this, and I'm a psych postgrad myself, working in mental health so should I suppose know better. I just seem to manage to convince myself I'm failing somehow (myself, the baby, my family - although I would never think that of another woman making that decision) with a elcs or I'm being ridiculous in even considering that I need one.

This really is just emotional vomiting now!

[Bearberry]

Sorry for some many typos and grammatical errors, really should have checked that!

[sycamore54321]

I am so sorry for your loss, and congratulations and best wishes for this pregnancy.

Reading your post, I got about halfway down before thinking that an ELCS would be the best solution for you. I was confused when you mentioned induction and then almost relieved when you came back to ELCS at the end. While I was induced, and found it absolutely fine once things got going (I had epidural a few hours in), you should be aware that induction may not offer the element of control you need.

I was 5 days past 40 weeks and induced due to concerns about mildly reduced fetal movements. My consultant said she took account of my extreme worry about this pregnancy (having had late miscarriages in my previous pregnancies) when offering induction for me and made it very clear that as I showed lots of signs of readiness, she expected the minimum level of induction would be required and that there was a very high chance I might even go into labour myself in the hours between then and actually booking into the ward for the induction to begin.

Well I arrived early in the morning and got the first gel. Absolutely nothing. Half a day later, second gel still nothing. By 11 pm that evening I was out of my mind with worry and distress and lack of control and feeling like I had made completely the wrong decision by choosing the induction, as it was going to mean an overnight stay with nothing happening in the same hospital where I'd last been fo ERPC with my most recent miscarriage. All the veneer of control was swept away by my body simply not complying with the induction, despite showing so many signs of readiness.

It all turned out just fine in the end but I felt so lost and confused and betrayed by my body, as if everything were completely out of my control during those long hours. And that was with all the signs pointing to me being a very strong and easy candidate for induction. So while obviously everyone has different experiences and while my induced labour itself was absolutely fine, I would not see the offer of induction as likely to fulfill your very understandable need for control over the process.

I do think your husband is being very unfair to express any disappointment if you will not have a vaginal delivery. only you know how you feel. I hope your doctor is open to your concerns.

Best wishes, whichever you choose, I hope it is a very safe, healthy, uneventful delivery for you and your baby.

[isittimeforarainbow]

I really feel for you, you have been through so much.
In your shoes I would be pushing for an elcs, but as others have said above it has to be your choice. You DH can't push you either way

[outputgap]

I'm not sure you're right or being fair on yourself when you say you have no medical grounds for requesting an elcs. A friend of mine requested one for psychological reasons successfully, as she was simply scared of giving birth vaginally, which is fair enough. (I am somewhat irrationally scared of a c section and epidural. We all have our thing, right?)

But you have had a massive trauma and loss. You have done everything possible to address it in a positive and proactive way with counselling. Any doctor that doesn't see you have a completely robust reason for an elcs is unreasonable and failing in their duty of care in my opinion.

If you were able to see your story from a distance, you would see how completely justified you are in feeling traumatised. It's such a horrendous thing to happen. Why would it not haunt any normal person? You deserve any comfort and security that you can get, and it's clear to me why an elcs would help, so please please do that if it's what you want. Please make it as easy for yourself as you can.

[dats]

Brilliantly put, output

[Dannygirl]

I am so sorry for what you have experienced. I completely agree with outputgap ^^ Personally I have had an elcs and it was a brilliant experience. If we could wave a magic wand and promise you an elcs right now how would you feel? If relieved/happy I think you have your answer and you must try to push for that outcome and ask your partner to be vocal in his support of your choice. Wishing you all the best for a positive birth experience xx

[KittyandTeal]

💐 you have been through an utterly shit time.

I lost dd2 at 22 weeks however it was a tfmr so it was very controlled.

However, when I was pregnant with ds they basically said to me I could have whatever delivery I wanted (within reason). I was also considering an elcs. Sadly we lost ds at 14 weeks. However, I was definitely swinging towards a c section myself.

Forget what anyone else says. Do what you think it right for you.

[kiki22]

I can't begin to imagine how hard it it must have been to give birth early and alone it can be scary enough at hospital with all the right people there. I'm having an ELCS for my second due in Aug due to how terrifying and traumatic my first experience giving birth was, I was induced because my grandad was dying and I was terrified of it happening on the same day.

Being induced was a really scary experience for me firstly dp had to leave the ward at 10 I started getting proper contractions about 12ish from then til 6am when thank god my water broke I was alone in a dark ward in pain and with no one to speak to, once in the labour suite my contractions where to fast due to the induction and I wasn't dilating properly my body couldn't seem to keep up with the drugs, ds's cord was being compressed which led to a monitor on hia head inside with an alarm going off through most contractions because his heart rate dropped, finally we decided to go to theatre for an emergency sections, once down they got him out with forceps he was fine but blue and bruised I was cut to pieces and all I can remember is thinking I must be dying because of all the blood. It was an awful day one that still bringing me to tears and not in the right way.

I hope I'm not scaring you but that's how traumatic an induction was for me and the reason I'm having an elcs this time. I need calm and as much control as possible to give birth again. Watching videos of planned sections really helped decide it for me it looks so different from my last experience calm and happy.

[MsFiremanSam]

I'm so sorry for what you've been through. I agree completely with other posters that you have every right to request a section and in your position I would do the same thing. Wishing you a safe delivery and much happiness x

[Mrscog]

So sorry for your loss, I would consider an ELCS - my friends who've been induced have generally had a rougher ride than those who have an ELCS. Look up 'gentle sections', there's lots of places now where the Dad can still cut the cord etc. If it's a calm section, I'm not an expert but one of my friends had one - they let the baby emerge on his own (more or less), then Dad cut the cord, then they had skin to skin with the Dad straight away. It might help your DP with the decision too.

[runningLou]

This is totally your decision and I think you would have every right to request an ELCS on grounds of mental health - just as important as physical health. It is YOUR birth, YOU own it and you do what you have to do in order to be able to anticipate it in the most positive light.
Whatever option you choose, I have a couple of thoughts ...
Write a birth plan. Include anything and everything that matters to you, down to the music playing in theatre if you go for ELCS.
Make sure the plan includes a brief description of what happened to you last time. Not every MW, nurse or surgeon will read your notes, and you don't want to have to explain all the time. Print out lots of copies and give DH the job of handing one to anyone to attends you.
Have you considered a doula / birth supporter? I had 2 x early inductions for medical reasons. Both times I had a doula. It made all the difference having a woman in the room who had seen other births and could advocate for me. It also took a load of pressure off DH. It's not too late to book one.
All the best whatever you choose.

[PacificDogwod]

Of course you have a 'medical' reason to want to opt for an elCS!

You poor thing, I am so sorry for your loss and what you have been through

How much 'stronger' could anybody expect you to be than how strong you have already proven that you are? You came through every pregnant mother's worst nightmare and are here to tell the tale. You embarked on the roller coaster that TTC/pregnancy is again and you certainly are so far in this pregnancy that every expectation will be towards a happy outcome

How we deliver our babies is such a teeny-tiny part of being a parent, that I honestly don't think we should over-examine it. Think about it, be well informed (as you seem to be), weigh up pros and cons and then plan for whatever seems the right option for you at the time.

Fwiw I have had an induction, and early emCS at 31 weeks and 2x VBACs and ALL of my deliveries have been absolutely fine. IME it is not so much the mode of delivery that makes a happy memory afterwards, but the feeling of being in good hands and well looked after and, yes, control (control will mean different things for different people; for me it was allowing for spontaneous labour and VB after my previous CS and at an advanced age).

Any consultant worth their salt will listen to you and be very sympathetic towards your plight. If they advice against CS, I'd want to know very detailed and specific reasons.
Write your reasoning down, write questions down, states when you arrive at your antenatal appointment that you required to speak to your consultant and not to anybody else. Be assertive if you need to be. Broken record: "I understand that the consultant is very busy, but I need to see them today" "yes, you said they are very busy, but I need to discuss my concerns with them and nobody else" "Thank you for letting me know I might have to wait a long time to see the consultant, that is fine. I will wait" etc etc ad nauseam. Take somebody with you to support you.

Btw my CS was not an awful experience (other than our anxiety about how DS2 would be) and the postoperative pain was absolutely bearable. I was off morphine after 24 hrs, on Voltarol for a couple of days, then Paracetamol. I still preferred the almost instant recovery I had experienced after VB, particularly as I was going home to a toddler (DS2 was in SCBU for a few weeks). BUT - I had not been through what you've been through.
If you have decided that a spontaneous VB is not for you, then I'd recommend elCS over induction: inductions can and do work (as mine did for me), but so many end in emCS and I think that would be utterly terrifying for you.

V best of luck whatever you decided
I am really hoping that you will have a positive birth experience whichever way your DD2 arrives in this world.

[PacificDogwod]

Oh my, sorry for the essay

I feel strongly about the right of every woman to chose how she wants to plan her labour and delivery of her baby. Can you tell….?

[Strokethefurrywall]

I agree with everyone else and with you - I would absolutely go for an Elcs to give you power over your own birth psychologically. Knowing there is the date to aim for and knowing that you won't go overdue will be a massive help in helping you relax and hopefully enjoy your last few weeks of pregnancy.
You have every medical ground to request it so please don't think that you haven't experienced enough trauma to justify it. You have had enough and then some.
In your position I would go for an Elcs in a heartbeat

Best of luck

[madwomanbackintheattic]

I had ELCS, then vbac1 and 2. Vbac2 ended with dd2 being brain damaged. With my history, we discussed with the consultant what I should do in the future, and unreservedly they suggested ELCS for any future pg (there won't be any - the whole thing was so traumatic that Dh went off for the snip immediately).
In your situation I would opt for ELCS without a shadow of a doubt, and no backwards glance.
Ask for a spinal not a general, and Dh can be kitted up and in the operating room. I think they do allow partners to be as involved as possible, although in our situation Dh was at the head end and we opted for a screen.
ELCS is very calm, matter of fact, and by far the most predictable of all options available.
Good luck.

[PacificDogwod]

Ask anybody alive today and capable of speech whether they cared in what way they were delivered - nobody cares!
You want to have a healthy baby, be alive and well yourself and have a good experience - if you achieve all that, it's a success.
There is really no point in considering one way of delivering 'better' or superior than another. There is no 'failure' in whatever you do.

[MetalMidget]

ELCS is very calm, matter of fact, and by far the most predictable of all options available.
Good luck.

Aye, there have been a few studies that show that ELCS are actually the safest method of giving birth statistically. Caesareans are generally branded as being riskier with longer recovery times because the stats normally include emergency caesareans, which often have complications associated with them by the fact they're 'emergency'. A complication-free, easy vaginal birth is the best of all, but generally you don't know what you're going to get.

I'm considering an ELCS (currently 23 weeks pregnant with our first) - my two sisters in law both had very easy, complication free water births, but I did also work with someone who broke their pelvis giving birth, and my mother had pretty traumatic births with all of us (we were all induced, labour lasted 24-36 hours).

Given your history and the advice of your counsellor, I'd definitely go with the ELCS - obviously your DH is important, but when it comes to pregnancy and birth, your health (both physical and mental) and that of the baby's are the most important!

Good luck!

[OTheHugeManatee]

In your shoes I'd be pushing for ELCS.

Good luck whatever you decide.