C-section vs Vaginal birth - Advice needed

[Bisquick]

I'm currently 25 weeks pregnant and expect to discuss birth options with my consultant in a couple of weeks.

If there is any medical reason he suggests a c-section I'd just go for it immediately.

Absent any medical reason I'm torn between both options. Any advice welcome particularly regarding recovery etc (Detailed circumstances below which will be relevant).

We had a stillbirth at 37 weeks in January. I went into labour naturally then - waters broke went to hospital, was told to labour at home, came back at around 5cm dilation. They couldn't find a heartbeat. Dilated from 5cm to 10cm and gave birth to our stillborn son vaginally all within a space of about 30 mins.

Extensive investigations haven't found a cause for the stillbirth or why my labour was so sudden and quick.

I didn't have an epidural despite begging for one (long story) and had some first degree tears which healed up quickly.

On c-sec I'm worried about needing GA (I'm so freaked out and anxious about birth I would like to be awake and have my DH in with me), worried about being groggy and nauseous during first days, establishing breastfeeding etc.

But obviously main priority is just getting this LO out safe and sound.

On vaginal birth I'm worried about my pelvic floor, but mostly worried about my ability to deal with labour. Obviously when I am calm I can handle it and am grieving but it is manageable. I wonder if I'll just freak out mid labour if it reminds me too much of last time. I worry about baby undergoing stress (perhaps that's what went wrong with our son?) and so on.

FWIW we've gone private this time so hopefully a much lower chance of all the endless fuckups with pain relief and monitoring that we had on the NHS. I'm not specifically blaming anyone but if we had been monitored better this wouldn't have happened, and the emotional pain of delivering my dead baby was only compounded by their continuous fuckups with regards to the epidural.

I've tried to make this as unemotional as possible following multiple rewrites, but you know what I mean? I want help making a decision and right now I'm struggling to do so.

[Ceara]

I'm so sorry for your loss.

It's such a personal decision, and very hard. I would follow your instinct (which may change as your due date gets nearer, and that's fine too). If it helps any, I chose ELCS - for other reasons, but related to PTSD/not knowing how I would respond during labour. The CS was a very calm experience, all the clinicians (NHS) went above and beyond to manage my anxieties, and my recovery was pretty easy - nothing like the horror stories. I was on my feet by the first evening and never needed more than ibuprofen and paracetamol for pain relief post-op. Driving again from 4 weeks, with GP and insurers approval. I think it's unusual to require a GA unless there is any medical reason why you are unable to have a spinal?

[ClownsAndJokers]

I came on thinking I'd say vaginal birth every time, but then I read your post and changed my mind. I've had both types and the elcs (due to medical circs) was under a general. I was able to decide on the day what anaesthetic I wanted though. It was fine, recovery was totally different but not too bad if you take it slowly. I think if I was you I'd go for c section to be honest, for peace of mind. But it's whatever you're happier with, I don't think either is right or wrong as such.

[Bisquick]

Thanks for the replies ladies!

No particular reason for a GA just one more thing I'm anxious about. I'd hope to just have local anaesthesia with a planned CS.

And I'll have my mum with me for at least a month or two after to help out hopefully, and don't drive, so hoping recovery will be helped along by that!

[Ceara]

Oh yes - I should have noted that my mum stayed for a couple of weeks after my husband's paternity leave ended. Invaluable - if only to keep reminding you not to push your recovery and try to do too much! So great that you have that support, whichever way you give birth.

[Ceara]

Also a helpful thing I was advised while deciding, was that the (small) statistical increased risks of an ELCS over a vaginal birth lie with the mother, not the baby, with the exception of the slightly elevated risk of transient tachypnea, which would be managed if it occurred.

Slightly increased risks to me, I could reconcile, weighed in the balance against the mental health benefits, so that made it easier. Accepting increased risks to the baby is obviously harder.

Ironically, it was a friend who had a VB, and had been totally relaxed about the whole thing, whose baby had transient tachypnea and spent a couple of days in SCBU. At least we'd been mentally a little bit prepared for the possibility of a hospital stay, if it happened.

[DeadButDelicious]

We lost our first daughter at 20 weeks and when I found myself pregnant with our second I couldn't handle the thought of a natural birth. I had an elective section and it was absolutely the right choice for me. We had it at 38 weeks (I had some kidney issues and baby was measuring a touch small plus mentally the longer it went on the more freaked out I was getting so it was agreed that it was better all round for it to be done then) and it was great. A very calm and positive experience. I went in on the Monday and was home on the Wednesday. Recovery was good, I felt back to normal in a couple of weeks.

I brought up the subject with my consultant quite early on. They were very good and were scanning me every two weeks for reassurance and I made it quite clear that natural birth was not something I felt I could do. I won't say I had to fight for it but they did try to talk me out of it a bit but I just kept on insisting (may have cried a bit but you know, hormones) and they agreed and set the date. If for whatever reason your consultant says no (and I can't see that happening given your experience) he is required to refer you to someone who will do it. It's your choice. Your mental well being is just as important as your physical. When you get your date, ask about the PICO dressing. I found it really helped with my recovery. It's a special vacuum dressing that really helps with healing time. Great bit of kit.

I am so sorry for your loss. It's a pain like no other.

[Bisquick]

That's really useful to know Ceara - thank you for such a detailed reply too! Yeah, I'd do anything to keep the LO safe - would be happy to balance out slightly increased risks to myself vs putting myself and DH through the process of labour again which is likely to be anxiety inducing to say the least!

[LittleMissMankyPants]

OP so sorry to hear of your loss.

I have had two C-Sections. The first was an emergency and the 2nd I extensively researched and planned for (although in the end was emergency as was 27+5 weeks)

The 2nd was 5 years ago so the research I read then may well be out of date now.

I found various published research articles which showed a c-section birth to statistically be 200% safer for the baby.

For the mother yes it's a big procedure and although a c-section brings different risks and challenges over a vaginal birth, actually a vaginal birth is also a big deal and not without its own risks and challenges - so for the mother it's 6 of one and half a dozen of the other.

The traumatic birth of my first baby, and reading all the research going at the time, is why I chose to book a c-section for my 2nd. And actually when it came to it the consultant wanted me to have a vaginal birth (to get me through theatre quicker as he was on his way) but I told him I knew a c-section was by far the safer option for my baby so that's what I wanted. He didn't argue with me!!

A c-section birth is actually quite a convivial, calm procedure. After a spinal fed anaesthetic (I don't know the technical term but apparently it's not an epidural) you remain conscious and have an anesthetist with you up the 'head end' feeding you any gas and air you need. You're screened off from the action and can't feel any pain but can feel some tugging around. A bit like having a tooth out I suppose.

There's usually some nice chit chat and your partner gets to watch everything (or not!).

Once they've checked over the baby he/she will be shown to you then likely given to your partner to hold whilst you are sewn back up.

The whole thing takes 20-40 mins maybe. Once you're in the recovery room you'll be handed the baby to feed. Then you'll be in hospital for 3 nights.

Afterwards you'll be uncomfortable and stretching, twisting and turning is difficult. But all going well you'll be fine to walk around once you leave hospital and after a couple of weeks will feel normal.

I have no experience of a vaginal birth but also no illusion that it's the utopia some people like to make out.

If you are nervous about having another vaginal birth, especially given you're history, there is most certainly nothing wrong with requesting a c-section.

[AntiHop]

So sorry for your loss.

There's growing scientific evidence that being born vaginally is important for the baby's gut bacteria (microbiomes). This is important for reducing the risk of a huge amount of diseases. So for that reason, I'd personally only choose a c section if medically necessary.


mobile.the-scientist.com/article/47600/infant-microbiome-vaginal-delivery-versus-c-section

Apparently you can do something called vaginal seeding if you do have a c section. www.newscientist.com/article/2075768-boost-c-section-babies-by-giving-them-vaginal-bacteria/

[morvoren]

Also, sorry to hear about your loss.

I had a stillborn daughter at 28 weeks in 2014. In my next pregnancy I was offered induction at 39 weeks. The main benefit to me was continuous monitoring throughout labour and delivery. They literally never took the heartbeat monitor off and really looked after me. No complications or pain or significant healing to do once baby was born. It was a good option for me.

[Bisquick]

Delicious and morvoren sorry for your losses too. It really is the hardest thing to bear.

and thank you for the detailed description of a csec LittleMiss - I'm going to save that down!

I have read about the benefits of vaginal birth - although seeding is still in unproven territory - but weighing it up against all the other issues at play is what is on my mind.

I wish it were a simple decision. In reality if someone told me I needed to deliver her vaginally with no pain relief in order to keep her safe I'd do it in a heartbeat. It's just hard to figure out what's best - and obviously following a loss you tend to second guess every decision - whether it's the birth or even trivial things like having a cup of coffee a few times a week!

[cheeriosatdawn]

Our consultant strongly advised an ELCS because, in his view, whilst it might introduce the possibility of complications for me (which it didn't), it was the safest option for our child. After five miscarriages, that was really the only data point I included in my decision making -- given my history I'd had a very hands-on, very closely managed pregnancy, and an ELCS felt like the best and most seamless (...) way forward.

I was not under general anaesthetic, but did have an epidural. Baby stayed with me from birth barring about a minute for a test of alertness and a weigh in and, the next day, a quick evaluation from the neonatologist.

However: at the risk of breaking some sort of unspoken rule about not really telling the truth about caesarians to anyone who hasn't had one: I have a (very, very) high threshold for pain, but found it an extraordinarily painful procedure (if remarkably quick). (This, I suspect, might have had to do with my not having been given quite enough anaesthetic, which would be a function of my being too cavalier when asked whether I could still feel sensation on my stomach or not. Error.) Bottom line (from my POV at least): it was no panacea, but I'd do it again without any hesitation.

Breastfeeding was no problem at all: started as soon as we got back to the room (with determined effort from DC if not great results from me), milk came in properly about 24-36 hours after that. Health visitor who came by a few days later confirmed (with surprise) that DC lost no body weight, so production clearly wasn't hindered by the procedure.

EBF until 6 months, BF + food introduction through 1 year, continued nursing through 2.5.

My recovery was straightforward: the incision didn't interfere with my ability to care for my DC, though it did make stairs and rolling over a bit scary for the first week or so. And it healed well.

Anyway. Haven't ever posted before, so apologies for lapses in form, etc.. Still, wanted to send support and information your way if I could. So sorry to hear about the loss of your son, and cheering for you and the baby to come.

[Bisquick]

Thank you for sharing Cheerios! It really is so useful to hear people's experiences and is giving me some perspective on what to expect!

[LittleMissMankyPants]

cheerios you're not breaking any unspoken rule because it simply isn't any kind of truth that a c-section should be painful. Just like any other kind of operation. Something must have gone horribly wrong with your care. Sounds horrendous.

[FuzzyOwl]

I'm sorry for your loss.

I think you just need to talk through everything with your consultant and go with what you want. One thing I would suggest is that it might help for you to be booked in for an ELCS and see how you feel about having it on the day if necessary but knowing it is booked might make it easier for you to consider giving birth vaginally if you wish. It is usually easier to arrange an ELCS earlier on than at the last minute.

It is also my understanding that our bodies tend to do the same thing when we labour so if you go into labour early and it is quick, that is likely to happen again (it has been true for me). As you gave birth at 37 weeks last time, you might find a consultant isn't willing to book you in that early (generally it is around 39 weeks) and you could go into spontaneous labour before your date. Whilst this would often mean you have an EMCS instead, you could expect to be prioritised and if someone else is more urgent you could end up giving birth vaginally despite being booked in for an ELCS.

I've had two EMCS (the second was supposed to be an ELCS but I went into labour at 37 weeks) and recovered better from both than some women have from vaginally. It really is all about what will be best for you and the baby. I hope all goes well.

[Bisquick]

Yup, exactly. We don't know why I went into labour spontaneously at 37 weeks. As in if it was because something was wrong, or it's just what my body does! My mum also seems to remember going into labour at least 2 weeks before her due date with both me and my sister so maybe it's a genetic thing?

Consultant is happy to book in ELCS at or just before 38 weeks, but obviously there is still a chance I go into labour naturally before that. I'm mentally trying to stay prepped for all scenarios just so I don't get too wedded to any one "birth plan". All I want is a healthy baby and to be as healthy as I can myself at the end of it!

[LittleMissMankyPants]

FWIW I think you're on the right path OP. Plan for every eventuality and expect nothing. Get the c-s booked and see how it goes.

[mimiholls]

So sorry for your loss. I would personally choose a cs in your situation as i would feel it more predictable course of events. The risks for baby are slightly lower with cs, the risks for mother slightly higher but still miniscule. You can look up all the exact stats on the RCOG website of you havent already. I had an elcs and found it a fantastic calm experience and i am quite an anxious person. I was also worried about needing ga and missing the birth- the anesthetist told me the chance is 1 in 200 so it is not hugely likely and I didnt need one. Im not sure what a pp poster is talking about finding the operation painful. The anesthetist spends quite a lot of time checking you are fully numb by dripping water up your abdomen. There is no way you will experience pain during the operation though you can feel the sensation of pulling/movement.

[TestingTestingOneMoreTime]

I have had EMCS and VBAC. I would suggest ELCS and if I had my time again would go that route.
CS should not be painful at all, just like any other operation

[FuzzyOwl]

If a CS is in any way painful, which it absolutely should not be, then say immediately to the anaesthetist.

[cheeriosatdawn]

I did say something to the anaesthesiologist. (Rather loudly as I recall.)

Anyway. From conversations had with friends after the fact, few described the surgery itself as anything other than painful, at best.

Still: no one mentioned that before I went in for mine, and I wish someone had: expectation management (and the opportunity to discus pain management protocol more clearly pre-op) and all that. No sincere suggestion about an actual fatwa on the subject; omission related more to convention rather than something cast in stone--as with many things related to birth.

Three cheers for more information rather than less. Cheering for you, OP.

[LazaUbi]

I'm so sorry for what happened to you OP. I can't imagine how painful your loss has been.

In your circumstances, based on what you've written, personally I would opt for a planned section. It is much calmer and lower risk than an emergency section. There are risks to any kind of birth but, especially if you'll have better resourced private care, a planned section shouldn't pose a great risk and you wouldn't expect to have a general anaesthetic.

I don't know if it helps but I'll share my experience. Our planned section was a lovely birth experience. It can be made personal and wonderful. I was so worried and nervous (for different reasons to you) but we made a birth plan which involved them lowering the screen so we could see our baby being born, immediate skin to skin after birth, an hour of peace straight afterwards so that the three of us could bond together without lots of medical staff around, etc. It was painless and the pain afterwards was not too bad for me, people with tears probably suffered more. I wasn't groggy, I remember it all. We were home within 24 hours.

Ultimately you should do what you're happiest with, but I wanted to reassure you that a c-section won't necessarily make you groggy or have a long recovery, or impact breastfeeding, as that is all really just down to luck and appropriate support from medical staff, as it is with any other birth.

Wishing you all the best for everything going smoothly, whatever you decide.

[LazaUbi]

Oh and having read earlier posts, I felt zero pain during the procedure. With a local anaesthetic there should never be pain at all. If there is the anaesthetist has done something wrong.

[LittleMissMankyPants]

Cheerio perhaps you could tell us all which hospital you and your friends had their painful c-sections so we could all avoid attending their ourselves at all costs!!

I am genuinely baffled as to how anyone could possibly describe a c-section operation as painful. I would class my first as perfectly fine, no different to have a rather pathetic tummy massage and the second as mildly uncomfortable like when the dentist gives you a good scrape. No, actually, not even as bad as that. And I have a very low pain threshold.

[FuzzyOwl]

@cheeriosatdawn if you haven't already, please do write to your hospital's PALS department about your experience because a c section shouldn't be painful and its awful that several of you (presumably at the same hospital?) found it so. I know lots of people who have had sections and honestly don't know anyone who has said they found the proceedure itself painful.