C-Section or Homebirth ?

[BirthChoice]

Hear me out!

Background: Gave birth at stand alone MLU in area ‘A’ (half an hour from home) in summer ‘19 and had a 3a tear, the birth was generally fine but took a long time; I woke up with contractions at 3am on Monday and gave birth at 6am on Tuesday. Had to be transferred to hospital around half an hour away for a repair under local anaesthetic after the birth. Tear repaired by Dr in theatre and subsequently healed very well (I suspect I had a better repair job than lots of people do with bad second degree tears, a bit of gas and air and a midwife). I had a ‘birth reflections’ meeting a few months later and was told that next time I would be advised to give birth at the main hospital, under supervision from a senior midwife to try and prevent another 3rd degree tear or I would be offered a c-section. No real reason found for the tear other than long labour and spent a lot of it in the water.

Fast forward to now and I’m pregnant again. I’ve booked in with ‘MLU A’ again. They have advised me that whilst they are happy to take me on I’m ‘out of area’ which basically means they can’t facilitate a homebirth. I thought this was fine as I had planned to opt for a c-section as I didn’t want to give birth on the labour ward of a busy hospital (I could hear women screaming whilst I was being repaired previously ) and wanted to avoid interventions that could lead to an instrumental birth (tearing risk). My midwife, however, thinks I will be fine to give birth at the MLU again. Which has got me thinking about a homebirth. To my mind it has the same positives and negatives as a stand alone MLU (home comforts, birth pool, less intervention vs not being close to hospital if something goes wrong, no strong pain relief) except with the homebirth I can guarantee a pool will be available, I might not need childcare and I don’t have to worry about when to drive to MLU (half an hour drive in labour).

All that being said, if I want a homebirth I would need to transfer my care to hospital B. I’m reticent to move to a different trust when I’m happy with the care received by area A but I think a homebirth may be a better option than the MLU in area B.

Or I ‘just’ go for the section in area ‘A’. I’m not thinking the c-section will be the easy way out but I was exhausted after my previous birth and couldn’t lift my baby properly for a few days after the birth (after leaning on my arms in the birth pool for 12 hours) which would be nice to avoid. If I have a worse tear which causes long term issues (incontinence) will I kick myself for not having a section? I remember thinking after the baby came out last time that I was an idiot for having an unmedicated birth and should have gone to hospital for an epidural!

[BirthChoice]

Posted too soon!

I need to decide if I want a home birth or a c section because it will affect which trust I have my care under.
Option A) stay where I am and give birth at MLU like last time
Option B) stay where I am and have a csection
Option C) change to different trust and have a homebirth

[Tempusfudgeit]

ELCS. Every time.

[BirthChoice]

@Tempusfudgeit thanks for replying! Why do you say that? Just to avoid the tearing? Does that outweigh the negatives of an elcs?

[Babyboomtastic]

I'd say elcs too personally. Saint that, ice never laboured or given birth naturally so I have no idea what it feels like. But I found my sections very relaxed and pain free, giving me time to concentrate on my babies!

[SweepTheHalls]

Having torn in my first otherwise lovely birth, and in my 2nd really lovely birth..... I went for a C Section for no. 3 to avoid double incontinence, which was a risk of tearing again...... Take the C Section!!!

[BirthChoice]

I REALLY like the idea of not being exhausted after having the baby. I didn’t have PND and I wasn’t expecting a rush of love when she was placed on my chest (I know this isn’t always realistic) but all I could think was THANK FUCK that was over once she was born and wasn’t too interested in her till the day after
We’re mates now though

[LBTM]

I had a small tear with my first, elcs for 2nd (breech baby) and induction with a huge episiotomy for 3rd (DS trying to come out arm first). I would go for a vaginal birth in a flash if I had another. I didn't have any C-section recovery complications but I found the first week so painful and felt my core muscles were pretty messed up and didn't fully recover. The advice is not to lift anything heavy for 6 weeks after a C-section which would be really tough if you have a toddler. I'd be too worried about something going wrong to have a home birth so an MLU sounds ideal.

[BirthChoice]

@LBTM so do you think your core NEVER recovered? One of the positives for me of an elcs is that I would be avoiding the possible long term consequences associated with tearing (incontinence).
I didn’t think there was much risk difference between a homebirth and a stand alone MLU (both would require a 30 minute transfer to hospital)...

[HarleyQuinn21]

I know everyone recovers differently but honestly my recovery from elcs was perfect, the third trimester hurt more than my recovery so id say elcs everytime.

[LBTM]

I got pregnant with DC3 when DC2 was 12 months. I felt my stomach muscles were better healed 3 months after DC3 was born (despite him being almost 10lb) than they were 12 months after my elcs.
I guess I also enjoyed labour except for the last 45 mins and have wonderfully positive memories of both natural births but really didn't enjoy the c-section. I reacted badly to the drugs at the end and was very confused and nauseous for several hours afterwards. But it seems like everyone has different experiences.
I think the stats on safety look good for home births, especially if not your first. It's just a personal feeling so I think I would find it hard to relax at home.

[Onlythelonely1]

Do you have any symptoms of urgency of your bowels (having to rush to the loo) or faecal incontinence? If you do then I would consider the c section.

If not then I would personally go for another vaginal birth. For the majority of women who have had a previous vaginal delivery, the second one is easier and quicker and the chances of tearing are less. A small number of women are unlucky and do tear again. This may be more likely if you have a large baby or rapid delivery. If you were in the pool last time for many hours then that might have increased the risk.

An instrumental delivery is significantly less likely if you had a normal vaginal delivery last time, so I would worry less about forceps etc. The sound of other women screaming is never nice but can happen on an MLU as well if there are others there at the same time as you. Once you are in advanced labour you probably won't care so much, and it's usually so much easier the second time.

I haven't had a C section but had similar surgery for a myomectomy and it was very sore. Your mobility will be significantly restricted. Some women do feel that they get full strength in their abs back but not everyone does (I'm a GP and tend to see those with problems).

Personally I would want to discuss it with an obstetrician, but would probably go for a hospital birth with a senior midwife present - not a trainee as I had for one of mine. You could also go to the MLU or have baby at home, but it just becomes so much more of a hassle if you do need stitches. If you are already in hospital you can ask for a registrar review of any tear. As you said previously, a good repair is usually the key to getting good healing.

Ask for them to ensure a controlled delivery with a warm compress (flannel) on the perineum. I had to shout for my husband to do this for my second delivery as the trainee midwife conrinued to believe I was 4cm despite the head being right there.

If you want to use the pool you might want to get out for the second (pushing) stage to try to ensure a more controlled delivery.

If you Google for Delivery after third degree tear there are some useful leaflets from the Royal Berks hospital trust and the RCOG.

Best of luck!

[BikeRunSki]

ELCS of those two choices. I don’t want to scaremonger, but I’d always choose a hospital birth of any sort over a home birth now.

DC1 was delivered by emcs.I chose hospital (labour ward) VBAC DC2 which resulted in a uterine rupture due to previous emcs, and a crash section under GA. After the foetal heart rate monitor flatlined, DD was born in literally a matter of minutes. In a debrief with the surgeon a couple of days later, I was told that mine and dd’s chances of survival if we had not been in a hospital were slim.


I’d had excellent, gentle and non intrusive care during labour, I wasn’t stressed, my uterine rupture was entirely attributed to how quickly I contracted and how this stressed the internal scar from my first cs. I stopped at 2 dc, but I’d always chose elcs after cs of any sort.

[SylviaPlath1984]

Similar-ish situation here and I'm booked in for a section! Honestly after weighing everything up I can't wait to have one, I've heard such positive stories about electives! I know everyone will be different but given my options I'm more than happy to be booked in for my section.

[BirthChoice]

@Onlythelonely1 no faecal (or bladder) urgency or incontinence. On the one hand as I suffered no long term ill effects the first time I don’t want to risk it a second time, however, the risk of a bad tear seems low and I’m aware a vb is generally better for mum and baby.
I have growth scans with a consultant so I’ll definitely discuss it with a dr at some point ( I adore my named midwife but she is definitely biased towards the MLU). Last time I laboured in the pool but gave birth on land so would be happy to do that again.

@BikeRunSki I didn’t have a c section last time - I definitely wouldn’t have a home vbac.

I really hope I don’t offend anyone here who has had an elcs but I also think I feel a bit guilty for potentially having an elcs as a vb would be better for the baby. Obviously if the baby’s life were in danger it would be different but the elcs would be for my health and I’m worried that it would be more traumatic for the baby. I’m worried that the baby won’t have the benefits of a vb (good squeeze on the way out to clear lungs; vaginal micro biome; being ‘forcibly’ removed in a surgical setting) - I’m aware you can somewhat mitigate these things with a ‘gentle’ c section but overall a successful vb seems better for the baby. Would it be selfish to have a elcs?

I think I’m realising that overall I don’t particularly want to give birth in any fashion whereas first time round I was quite excited!

[ChateauMargaux]

I am a doula and I had a client who had a 3rd degree tear and surgical repair with her first (I was not in attendance) and a vaginal birth minimal tearing no stitches required for her second which was at a birth house so somewhere between a home birth and a MLU. She laboured in the tub and gave birth on all fours. The attending midwife was aware of her previous history. The mother was led by the contractions, no coached pushing, position was optimal to minimise tearing (not squatting) and we had oils and warm compress to press against the perineum but it all went smoothly, there was no need. She was diligent with perineal massage in the last 4 weeks of pregnancy and also did pre natal yoga and spinning babies for optimal baby positioning so she was stacking the odds in her favour.

[Babyboomtastic]

@BirthChoice

I believe that c sections are marginally riskier to mum but are safer than a vaginal birth for the baby btw.

[caringcarer]

I had 2 vaginal births to first 2 babies with small tear for first. I had third DC by c section as very large and baby in distress and my blood pressure through the roof. I was taken in hospital for total bed rest then had section at 36+3. Baby almost 9 lb. I went home 3 days later as baby jaundiced and I breastfed. I was up day after birth walking into shower room. No problems after at all. Only issue you cat drive for 6 weeks after birth. I very clearly remember thinking I wish I could have had c section for first 2 as avoided painful labour and Tear.

My niece had bad tear with first, offered c section with second but refused it. She tore really badly with second birth. 5 years later still has bad problems with soreness and scar tissue. She wishes she had taken section. Her babies were enormous though 10 lb 6 Oz for first and 11 lb 4 Oz for second.

I would take section offered. Don't risk incontinence and bad scar tissue from tearing and episiotomy.

[AHobbyaweek]

Home birth. Better outcomes and less likely to tear.

[AHobbyaweek]

Should say I had an EMCS with my first and hated the hospital and the postnatal care so much going for a home VBAC this time around.

I have read up a lot and there are lots of reasons home births have better outcomes and you can do things to make testing less likely.

[Labyrinth86]

Some conditions can be caused by injuries to baby during vb, just to balance the argument. I mean that fact women tear illustrates just how tight that gap is and I worry about damage to my baby being done as I squeeze or the medics use instruments to yank them out. Personally, I'm hoping I'm approved for a c section. Also, incontinence is one issue, vb also increases a woman's risk of pelvic organ prolapse.

[indub]

[quote Babyboomtastic]@BirthChoice

I believe that c sections are marginally riskier to mum but are safer than a vaginal birth for the baby btw.[/quote]
Straightforward vaginal birth has the lowest total (immediate) complications, then elective, then complicated vaginal, then emergency CS. If only you could plan a straightforward vaginal birth... I've tried finding the paper again but a big review found something like 1/5 35yo+ had an uncomplicated VD.

@Babyboomtastic is right though - elec caesar is safest for baby as it significantly reduces hypoxic brain injury, erb's palsy and the other risks of needing to be yanked out any way possible in desperation.

The biodome, asthma, infection speculation is nowhere near as well evidenced as the severe side effects.

[Gem176]

@Babyboomtastic is right, c sections have a slightly elevated risk to mother. The breathing issues in babies are only if delivered prior to 39 weeks and you will struggle to find a surgeon who will perform an elective before 39 weeks for this reason.
Elective c sections are actually the safest form of delivery followed by straightforward vaginal, instrument vaginal and then emergency c section. They just count all c section statistics together regardless of whether it was an emergency or elective.

I had a c section booked for 39 weeks for medical reasons (type 1 diabetes, suspected fgr, baby was moving freely and flipping from head up to head down as witnessed by the consultant the day before she was born) however I went into labour early so while my c section was considered emergency as I was in labour it wasn't an emergency in the sense of haste. It was a very relaxed experience, music playing, chatting away to my consultant. DD was delivered with no issues and was handed over for a cuddle as soon as she had been checked over (no fgr just sga). Within 12 hours I had my catheter out, was up, showered and walking about. I wasn't exhausted and was interested in DD from the start. Pain was minimal, I don't actually remember being in pain but I took all the painkillers that were offered for the first 36 hours. If DD hadn't had slight jaundice I'd have been offered an accelerated discharge. Did a big Tesco shop on the way home from hospital. At 5 days pp I took DD for a walk, got her registered and went for lunch. I know this isn't everyone's c section experience but I'll be choosing an elective again. I'd also say, your experience of a tear is probably better than a lot of others. You were stitched well and healed well, that isn't always the case as can be seen from numerous threads on here.

Good luck with whatever you decide 😊

[ColdCottage]

A few close friends had elective sections after traumatic first births. All 4 were so pleased with this choice and had so much more positive post birth experiences too.

[Dryshampooandcoffee]

Are you likely to have any more children? One of the greatest risks of C/S is that there will be a scar on your uterus for the next pregnancy, which can lead to problems with the way the placenta attaches to the uterine wall, and increases you risks of the uterus rupturing.

Recovery from a vaginal delivery is generally much more straight forward, and stats for people having a 3rd degree tear with their second baby (when sustaining one with their first) are still incredibly low, I think 5% or something. It might be that the midwives assess the situation and perform an episiotomy if they feel it would prevent a 3rd. So it would also depend how you would feel about that.

And, HUGE congratulations on your baby. I hope everything goes really smoothly