planned cs or natural vb at age 46 years ?

[Gerri40]

hi all, I'm 46 years old and 23 weeks pregnant with my first child. My consultant has recommended I have elective cs at 38 weeks as 'there may be complications with labour due to my age'. I'm a fit healthy person, slim and a non-smoker with no health issues and no issues with my pregnancy. I really don't want a cs as want to be totally hands-on with my baby from the moment they are born, obviously the surgery and recovery would limit what I could do physically and practically and hold me back so to speak in the first 6 weeks or so (assuming it's only a 6 week recovery period and not longer!) I want to breast feed and don't want anything to impact on my ability to do so. Has anyone around my age experienced a normal vb or had difficulties with labour due to their age? Also, what have been your experiences with planned cs ? Obviously I realise that if I do encounter problems with labour I could end up needing an emergency cs which would be far more traumatic than a planned one. I've never had any kind of surgery before and would obviously prefer to keep it that way. My hubby is off work for 4 weeks once baby is born so he'll be there to help with practical/heavy stuff but even so I'd rather not be hindered in what I can do. Would appreciate comments from Mams of my age :-) thank you.

[CottonSock]

I am a bit younger than you, but not much. Second dd was planned c section. First was c section after failed induction. After both I healed quickly. Vb also has recovery . C section does not hinder looking after a new born. It's all feeds, cuddles and nappies. Your dh can look after the house stuff. I am fit and was fine to drive by 3 weeks. First few days are painfull, but really not that bad (compared to 3 day induction).

[ohamIreally]

Hi I was 41 when I had my first child by elective caesarean and it was great. Breastfeeding was fine. Recovered well. I think the risk of an emergency caesarean is quite high when you're older and an elective is a very different kettle of fish. I had mine to reduce the risk of prolapse which has been common in my family.

[Dinosauratemydaffodils]

I'd be going planned section based on the fact that negative outcomes including both lots of incontinence and severe tearing are influenced by age. You might be fine or you might not but you have no way of knowing.

I had my first at 37. Perfectly healthy, non smoker, trouble free pregnancy in every sense. Ds decided to wedge himself into my pelvis at an interesting angle, 75 hours of labour and failed forceps later he was born by emcs. I was up and dressed 5 hours later and apart from a short stay in NICU (due to how long my waters had been broken) I looked after him by myself and we were out and about as soon as we got out of hospital. No physical issues breastfeeding either.

My sister in law had one at 38 vaginally. She's still suffering from incontinence issues 10 years later and spent the first six months of DN's life sat on a rubber ring.

I'm now pregnant again at 40 and have no interest in trying for a vbac although apparently it was entirely Ds's "fault" he got stuck because the risk of an operational delivery/damage is too high for me.

[DeadButDelicious]

Bit younger than you but I had an elective section (traumatic first birth) and it was great! Very calm, delayed cord clamping, skin to skin etc, I didn't end up breastfeeding long term (whole other story) but my milk came in just fine. I could do everything I needed too for DD, as a PP said it's all cuddles and feeds and nappies at that stage, DH dealt with everything else. I felt pretty much back to normal within a fortnight or so (compared to 4 long months with my first, vaginal, birth).

An elective is a whole different story to an emergency section.

[NorthernLurker]

I was quite a few years younger than you when having my kids and all were vaginal deliveries. I haven't really noticed much difference between my post birth experience than my friends who had elective c sections. Emergency c sections are another matter.
I'm sure you're in great shape but fundamentally 46 is at the far end of curve for first time mums and I don't think you can assume that your good health will carry you through. It may but I would personally take a c section at 38 weeks and look forward to planning that. Are you getting extra growth scans? I would be keen for that too.

[DeadButDelicious]

Bloody post button!

If your consultant is recommending it I would listen to him.

[PoshPenny]

I had two emergency c sections in the end due to failure to progress. The only thing that is really a PITA with a c section is not being able to drive for 6 weeks afterwards. I would listen to your consultant on this.

[DuggeeHugs]

I had an EMCS at 37 and ELCS at 39 - both lovely deliveries and smooth recoveries.

One of the stats I found on the RCOG website was that at 38, the risk of anal incontinence following VB and having never delivered before is 18%. The risk goes up with age.

Have a look on their website for other birth risks - it opened my eyes and may give you an insight into why your consultant is advising you towards a CS.

[HangingRoundInABofAlorsStance]

Last child at 43 - completely natural, not even a paracetomol - I tore very badly. Poor pelvic floor/urinary incontinence as a result.
Not sure what to tell you as I have never had a c section. I can tell you Natural Birth™ is overrated and possibly the worst decision I ever made (had ventouse twice before and an episiotomy, blamed myself for not feeling urge to push due to epidurals - turns out this was bollocks). I wanted an elective with my third but then talked myself into the polar opposite. Big mistake. Huge.
If birth goes well for you, you were lucky - and no matter what all the hypnobirthers will tell you it IS luck - but there is a reason so many obgyns decide on electives themselves: they have seen when it goes badly and the consequences of that.

[HangingRoundInABofAlorsStance]

Oh and now I am your age, if I fell pregnant now, it would be a no brainer for me: elective CS or I wouldn't be having it.

[Cousinit]

I had three natural births, the first at 34, the third at 43, so a bit younger than you but not much. No problems at all and I am also fit and healthy. So no reason why an older woman such as yourself can't have a natural birth. Having said that, this is your first child so it's very much unknown how your body will cope in labour. I'm not sure what I would do in your position but I would probably be swaying towards what your consultant advises. I'm generally pro natural birth where possible but in your situation this is probably the safest option.

[Cousinit]

Also, plenty of women I know have successfully breastfed following a CS birth. Good luck with whatever you decide, I do sympathise as it would be a tough decision for me too.

[nogooddeedgoesunpunished]

I was in your situation nearly 2 years ago and am typing this lying next to my gorgeous snoring DS! A very kind consultant advised me to go down the elective C section route due to it being my first pregnancy and my age (46) at due date. They were not keen for me to go past 39 weeks due to stats around placenta degrading ( sorry can't remember the correct technical term) and that induction often doesn't work leading to the need for an emergency section anyway. I wanted a natural birth and was v upset . I ended up with the planned section as baby was breach at 36 weeks and although turned ( wouldn't recommend) turned himself back again . I had some complications with bleeding from fibroids which if not in surgery may have been difficult to control. Recovery from c section is preferable to recovery from some of the horror stories I hear from friends who have had bad tearing leading in some cases to incontinence. In the end , only you can make the decision but getting baby out safely with you both well is the main thing. Good luck and congratulations . You are in for an amazing time !

[Situp]

I am 38. I have had Vbac with foreceps, elcs and emcs with my 3.

Recovery from both csections was better than vbac. First 48 hours were very uncomfortable but because I hadn't gone through the exhausting experience of labour, I was not wiped out in the same way as vbac.

I am now 16 days post emcs and apart from being careful re. Lifting heavy things and taking it easy I have been completely mobile for over a week.

Plan for it and ensure you have help with the other stuff so you can focus on you and baby and you will be fine.

If you don't want elcs based on recovery time, I would definitely say that recovery from elcs was far better for me than vbac with foreceps.

Having DH at home will make all the difference!

[Peach1886]

Another older mum here saying pls listen to your consultant - my best mate had her last at 45 (like you v fit but with three previous speedy vb) and was advised to go for elcs because baby was large and back-to back. She wouldn't hear of it (old hippy - like me - wanted entirely natural "mooing in a field" experience). 10 hour very painful labour followed by major pph that nearly did for her, I was birth partner and watched three midwives working on her frantically - like something out of James Herriot, arms up everywhere - whilst I did skin-to-skin with little one and gave him a bottle because she was too out-of-it...

Not aiming to frighten you, just saying enjoy the gift of your newborn - how s/he gets here is not important at our age, the important thing is that s/he does, and that you are fit enough to enjoy those precious early weeks. Really, please give up on doing it "perfectly" and just get it done safely and without the risk of unnecessary trauma for both of you; no medics recommend surgery if its not needed so your consultant clearly thinks it would be best. I promise that the moment you're holding your baby you won't care if it was delivered by Parcelforce...it really is that irrelevant.

[spiderbabymum]

I ve got two children
Both CS
One when I was 36 years old and one 40
Both were a month early
I would really urge you to take your consultants advice
He is managing risk
And trying to give you the best outcome : a healthy baby
And protect you from obstetric complications

[balljuggla]

I'm 34 and had an elective c-section last week to deliver my daughter. I'd desperately wanted to have a natural birth but the decision was taken out of my hands. 10 days later and recovery has been an absolute breeze. I'm barely taking any painkillers, my wound has sealed and is healing great, and I'm fully capable of moving around/walking around town etc. No problems at all bonding with baby or breastfeeding. I know we're all different but just thought I'd share. I'm not the fittest person and barely exercised during pregnancy due to SPD.
Also, my daughter's actual birth was incredible. Everyone was so professional and kind. They are used to putting you at ease and making the process at comfortable as possible.
The real hardship is the sleep deprivation that comes with a newborn! I can understand why it's used as an interrogation technique...

[spiderbabymum]

My first was delivered early due to severe growth retardation : he was 4 lbs 6 ! And is fine

My consultant advised that my second be delivered at 35 weeks . I was desperate to keep her in another week so we agreed on 36 weeks
I understood at the time that this early delivery was based on reducing the tiny risk of stilbirth .
..... as I was over 40 . No one who has been bereaved in childbirth is going to come on here and talk to you about Stillbirth .
But I know women who have gone through this .

I would not attempt labour at 46
I’m 45 now

I urge you to talk to your consultant again

[Sipperskipper]

I successfully breastfed after a nightmare emergency CS. My recovery from the section was slow and difficult, as I’d been in labour for 28hrs beforehand and was exhausted. I’m having an ELCS next time, without a doubt! Personally I would go for the ELCS, purely to avoid an emergency one after a difficult labour.

[QueenAravisOfArchenland]

Ultimately it's up to you, but even as someone who's very much pro vaginal birth I think it's important to be clear that, as a Pp said, a FTM of 46 is at the far end of the bell curve. Being fit and healthy helps you cope with pregnancy but it won't stop your placenta prematurely crapping out on you. Bluntly put, no level of "fit" can eliminate the risks that go along with your age. As a result, the hospital will almost certainly want to induce you before 40 weeks, and an induction in that situation does have a high risk of ending in EMCS.

I would ask for a second opinion (perhaps talk to the head of midwifery: doctors do sometimes have an unreasonably low threshold for intervention because they literally never see normal vaginal birth) and do your own research. Weigh up the risk factors for yourself.

[Katy75]

I had elective c-section at almost 42 and was home the next day with just paracetamol and ibuprofen for pain relief. It does hurt but I have heard so many stories from friends about complications with natural delivery and I know that is not straightforward either (laboured to the end with my first child who got stuck at pushing stage so had EMCS). No problems breastfeeding either time. I found the natural labour far more distressing.

Lovely that you are becoming a mum. Enjoy your baby

[Snowydaysarehere]

I had ds at 43 by emcs after numerous vb. Was totally fine, actually would have been discharged the next day but ds was under lights for jaundice. No pain really as felt fine. Shame couldn't boil the kettle for the guests though! . Was nice to be spoiled after surgery tbh! Bf unaided and was driving after ten days - just check with insurance but most have no restrictions. And congratulations - I am 46 and very envious!!

[spinn]

Most people have to fight for an elective section for first child so the fact that the consultant is recommending you have one is a major flag for me and I would be listening to them.

[Batterseapark]

Hi OP,
Risks of instrumental delivery and EMCS increase from the age of 35.

Friend of mine had EMCS for first and said she had to be on morphine (in hospital) for a couple of days. She opted for elective second time and said although in pain, paracetamol and Ibuprofen were enough and she could go home much faster.

Personally I'd go for ELCS. All the best

[GandalfsWrinklyHat]

Section!