ELCS or natural?! Which is safest?

[April2013]

I have the fear about my baby dieing during or soon after the birth. With my first birth his heart rate was dropping and they tested his oxygen levels and put the monitor on his head to keep a close eye on him, all fine. I'm so worried about this scenario happening again but not playing out well, or problems caused by forceps or some other problem. Statistically what is safer for the baby?

[BadgerFace]

It depends on a lot of different factors and what is statistically safer in your particular situation and set of circumstances will differ from another mother's.

It's not quite your situation but there are some stats in the ROCG paper on having an ELCS vs a VBAC. As a very general rule of thumb a VBAC is marginally safer for the mother and an ELCS is marginally safer for the baby, but as I say your own particular circumstances and first birth are important.

Did you have a debrief after your DS's birth? If not then I would ask for one to get more information on why his heart rate was dropping, the likelihood of any issue happening again in a subsequent birth etc so you have as many facts as possible.

[Junosmum]

Depends on circumstances but for most babies vaginal birth is safer due to it stimulating breathing mechanisms, but it depends on a number of factors, including your birthing history.

[QueenMolotov]

I believe the generalised order of safety for baby is:

1. Straightforward VB
2. ELCS
3. Assisted VB
4. EMCS

There is credible evidence to back that order up, but I don't have it to hand right now, sorry,

[QueenMolotov]

Oops
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[KatyN]

Have you spoken to your mw or consultant (if you have one) about our first birth and your impending second one? My son was internally monitored throughout my labour and then delivered in an emergency when his oxygen levels dropped. He inhaled his meuconium and spent 2 weeks in nicu.
When I was about half way through this pregnancy I had a really supportive mw (earlier ones had just brushed off my past experience) who referred me to the matron of the delivery suite and we talked very openly about what had happened with my son and what would happen this time. We agreed what I would like in place this time to ensure I doesn't happen again. I know in my heart of hearts it won't happen again but of course I am crapping myself. I am going to be monitored as soon as I get to the hospital (not just every 15 minutes), I can go to hospital as soon as I think I'm in labour and no one has even suggested the mw birthing centre as I want to be 5 seconds away from a doctor!

Just some others things to think about other than a cs.
Kx

[April2013]

Thanks so much for your replies.

It was in a different hospital so I'm not sure how to go about getting my notes so I can discuss them with my obstetrician, but will try tomorrow.

The constant monitoring sounds like a plan, thanks.

I reacted badly to the epidural, blood pressure dropped more than normal every time it was topped up and at the time the midwife said the baby's heart rate was dropping because mine was.

I've talked to a midwife and obstetrician about my first birth and they both said it was normal and just them being extra careful with the monitoring but they havent seen my notes and I feel like there is something wrong with me when it comes to epidurals - also, my legs took a lot longer than normal to come back and the anaesthetist seemed surprised and concerned about it and I was beginning to freak out about it. My obstetrician said she had never heard of this before so it seems very unusual (thankfully!).

Have been referred to an anaesthetist to discuss it all so perhaps my notes from first birth will be needed for that when that appointment comes through.

So I don't want an epidural or spinal block incase causes further problems with my\baby's blood pressure \heart rate and my legs but I'm not sure if having a general has other implications for safety if need an assisted vb or emcs? I have asthma and apparently epidural is preferred with asthmatics but it is well managed so I'm assuming if that is still the case I could still have a general.

I'd like a natural birth but don't want the epidural\spinal issue to cause problems incase I need any intervention fast or need to be awake and feel a bit for the intervention to work. Wondering if best to bypass that and go straight to ELCS. I have previous anxiety and OCD all over my notes, though that side of things are pretty good now, so could use that to argue my case. But clearly though I am doing OK with anxiety now, the birth is a major thing playing on my mind and I think I might become V anxious later on in pregnancy. I don't know what I would do if the anaesthetist says don't worry you can still have an epidural if needed.

[BadgerFace]

I am sure you will be able to have your current team request your old notes so they can go through them with you. Hopefully the anaesthetist can give you more information as to whether you are likely to have issues a second time with an epidural. It might be that you would be fine with a spinal if epidurals don't agree with you as they are slightly different things. Funnily enough one of my questions for my ELCS consultant next week is whether I had an epidural last time or a spinal and what is planned for this time.

I think a general anaesthetic is fairly rare and comes with its own risks and recovery from it is obviously likely to be longer.

I have just read Caesarean Birth by Leigh East which I would highly recommend. It has lots of information which might help with your decision making.