Why vaginal birth?

[SantaSusan]

Inspired by another thread. I'm really interested to understand the reasons for most women opting for a vaginal birth.

Disclaimer: I really, really want this thread to be a nice discussion to share views. I'd hate for this to descend into a judgy or unkind thread! Obviously, however anyone chooses to give birth is their choice alone. And as long as your precious little bundle arrives safely at the end, then who cares how they got there!?

I ended up with an elective. I never in my wildest dreams thought I'd have anything but a vaginal birth. However, for reasons I won't go into, it was decided during my pregnancy that a c section would probably be the best option for me. Everyone I spoke to absolutely loved their c section experience, and 99% of the comments online were so positive, so I wasn't worried about it at all once it was decided upon.

I had absolutely no pain during my c section or during recovery. I breastfed right away. I was up and about pretty much immediately. This seems to be the experience of most women who've had elcs. I would have an elective section again and again. If I'm lucky enough to have another baby, it'll be another section.

As such, I often wonder why more women don't choose to have their babies this way. It's so common in other countries. I think there's a lot of misinformation around c sections. The risks are also lumped in with those of emergency c sections, so electives are often painted to be riskler than they actually are.

You often hear people saying it's major abdominal surgery' in quite a judgemental way, which of course it is. But as far as surgical procedures go, it's generally very straightforward and in most cases, is easy to recover from.

I also repeatedly hear that vaginal is best as it's the most natural. But just because something is the 'natural' way to do something, doesn't necessarily mean it's the best. There's lots of things we do now with technology and with medicine that isn't the 'natural' way, and nobody bats an eyelid.

I can't quite put my finger on why I was so opposed to c sections previously. It's like it was subconsciously ingrained in me for no reason other than popular rhetoric. Which is why I'd be interested to hear why others decided a vaginal birth was best for them? Or why others knew they wanted an elcs? Has your subsequent birthing experience changed your minds at all?

A significant number of female obstetricians choose an elective cesarean, often as they've seen some awful birth injuries.

My reasons for wanting a vaginal delivery were wanting to avoid the inevitable cascade of inflammatory processes which occur when you cut through that many layers of skin and muscle. Adhesions are common - about 35% of women after a first section and they increase the risk of a lot of things like ectopic pregnancies, pain, risk of bladder and bowel obstructions.

I also didn't want a scar or that weird overhang that a lot of people get.

Basically I wanted to avoid someone unnecessarily cutting into me!

Almost complete, but you missed out brain damage to the baby, which is the motivation behind many CSs, and the major risk of CS levels which are too low. It's a balancing act and the precipice on both sides is very steep.

Oh okay that’s good if they separated elective from emergency.

Some hospital trusts still give out patronising, highly biased ‘information’ booklets/sheets to women wanting to opt for c-section, that basically conflate the statistics of both planned and emergency cesarean against a successful vaginal delivery. I don’t know how they get away with it, completely goes against informed choice.

Brain damage to the baby is not a specific risk factor of vaginal birth. If something goes terribly wrong in labour and the baby gets distressed, then a timely cesarean section can prevent or reduce asphyxia which leads to brain damage, same with any other complication in pregnancy or labour. But brain damage in itself is not something specifically attributable to vaginal birth. Brain damage can happen during pregnancy, and can also happen during complications of a cesarean section (for example, difficult extraction, of which I've witnessed and assisted in a few).

One of the biggest things about this whole discussion is the appalling methodology.

A VB includes the risks of assisted delivery and emergency CS. An unaided VB is the lowest risk but the highest risk is all stacked up in an EMCS.

An EMCS is a totally different experience to a managed ELCS, not least because a woman's body isn't contracting, she's not in pain and she's not exhausted from hours of labour.

Women have ELCS precisely to avoid the heightened risks of an EMCS. It's not rocket science to grasp this concept. Women at high risk of an EMCS are certainly not crazy for wanting to manage this risk with an ELCS especially if they want fewer children.

The number of academic studies that fail on this is appalling. It basically makes them completely worthless and indeed potentially harmful.

This thread has numerous examples of women conflating EMCS and ELCS too with posters saying they wanted to have a VB to avoid an ELCS. Which they can't rule out because by definition a EMCS is a consequence of an attempted VB. Or saying that an ELCS must be terrible because they had an EMCS etc etc.

Studies that uses the correct methodology is actually vastly limited - to a degree that's shocking. About ten years ago I spent many many hours looking at this.

In part it is because of an ideological desire to push VBs and partly because of poor understanding by researchers of how the birth process isn't a series of unconnected outcomes.

This is why women need an individualised approach to childbirth which takes into account their individual risks - if your risk of an EMCS is substantially higher, why shouldn't women be given a choice to manage that risk as they see fit?

Quite. It's utterly utterly appalling and it's about preserving their stats not about the wellbeing of women.

I had planned C-section, I chose this way as I was terrified for the tough, the pain, something goes wrong while I need to push the baby out. I remember I said from the very young age that if I have had a baby the only way I would give birth to them is C-section!
I told my midwife on my booking appointment thats the only way how I would give birth! (Bear in mind it took us 3 rounds of IVF to got to that point so you would think I would do anyhow).
I was judged by friends, colleagues, family.
I've got my date on the 28th weeks, I knew in advance.
On the day, the feeling that I will have the little joy with me soon, I felt incredible! It's like present which you crave so long and you don't even need to have the pain for it!
My section was at 10:30am, could breastfeed straight, I was discharge next day at 11am, shopping in Tesco within an hour, I was driving after 10 days, my scar is beautiful and reminds me every day that our family is complete.
I was high for weeks with love and with the superwoman feeling!
I'm glad I had the choice!

I wonder how many elective caesareans there’d be if people had to pay for them

I suspect quite a lot. Lots of women would think it was a price worth paying to avoid damaging their undercarriage. I was lucky (and only had one child). Lots of women are not, and end up having to have pelvic floor repair surgery which isn't what you want when you've got a young baby to look after.

Well, quite. Why on earth can't mothers do what's best for them and stop judging other people. It doesn't affect you, so keep your nose out.

See also smear tests. The ridiculous judging of women who don't want to have them. It doesn't affect anyone else, get your own and leave other women alone.

And it's not a question of NHS resources either. The NHS has to treat lots of people for things that other people might not feel are "fitting".

I mentioned my lovely home birth with DS2 above. DS1 was born at The Garden Hospital in Hendon, which promoted natural birth. DS 1 was born there very naturally after a very long labour. The key factor in getting him out without drugs and interventions was the constant encouragement and support of the midwife and the obstetrician (Faith Haddad) It almost felt like counselling/therapy as they talked and coached me through a birth that in other circumstances would have involved intervention. If women had better support in labour I feel there would be more vaginal births through choice. I was advised there was no reason not to have DS2 at home, which was a magical experience.

I didn't want my deliveries to be medicalised - having to stay in hospital, being on a drip, catheter etc. I didn't want my stomach sliced open and then having to recover from major surgery while also having a newborn. Everyone I know who's had a cesarean has had a much slower recovery and more pain than I had with my vaginal births.

I'd also say that if we are taking away a woman's choice because elective c-sections are expensive and take up resources by making it a luxury not everyone can afford then surely we'd have to do it with birthing choices too?

Want a homebirth? That takes up 2 midwives for one woman, pay for it.
Want an epidural? That makes a vaginal birth more expensive, pay for it.
Gas and air? Still too expensive, pay for it.

Or we can allow all women access to options on the NHS and they can simply do what they feel is best for them. From homebirth to elective c-section.

I've had 2 c sections, one emergency the other elective due to complications of the first. I would want a vaginal every time. I had awful recovery both times. Took ages to get back to normal and standing and walking was awful for a while. Having to inject blood thinners daily having a drain in my wound. C sections are major major surgery and imo not the easy way out. I wish I could have a vaginal birth. Studies also show that the anti bodies baby gets from coming out thr vagina is much better for them.

I had a c section for medical reasons, but I have several friends who had uncomplicated vaginal deliveries, and they had a much easier time of it than I did! One friend had 2 hrs from first contraction to baby in arms. No tearing, up and about immediately afterwards, home same day.

I was in bed until the next morning, in hospital for 5 days, and in quite a lot of pain sitting up and turning over in bed for about a week post-partum. Couldn’t run, swim or do postnatal yoga etc until 12 weeks, whereas my friends could do those things from about 4-6 weeks.

Obviously if you have a complicated vaginal delivery it will be much worse than an uncomplicated c section, but an uncomplicated vaginal delivery looks like the best option to me. The issue is you can’t guarantee what you’ll get.

Totally agree, and I would just add that “elective c-sections” are still mostly done for a reason - it just means “not done as an emergency in the middle of labour”. Not vanity surgery.

You might have a planned elective section at 36 weeks if you have placenta praevia or vasa praevia. You might need a section earlier if you have eg severe pre-eclampsia, or another medical condition. These are all elective sections, but you haven’t “chosen” a c-section as such, medically you have been told you need to have one.

I am completely fine with people choosing to have a section as well! Just pointing out that it is annoying when people assume all elective sections muse have been done for silly or frivolous reasons - DS would have died if I hadn’t had my planned section at 36 weeks. An attempt at vaginal delivery would have killed him as soon as my waters broke. And yet people on here still make shitty comments about people who have had elective sections.

Very true.

I've requested an elective c-section because I'm having twins. I obviously could attempt to deliver twins vaginally if in the correct position but it does make the chance of an emergency c-section higher, not to mention the risk of having one vaginally and then needing an emergency c-section for the second twin.

It isn't something I'm prepared to risk so I'd just rather go straight to an elective c-section.

We've read negative and positive experiences for the mother of both elective and vaginal births. I've not read the whole thread but have there been any posts on the effects of elective (rather than emergency c sections) on the baby versus vaginal delivery?

I had 4 vaginal births. I wanted to have my babies as naturally as possible. I wanted to avoid medication and surgery, as for me, i see surgery as a last resort - i know if anything went wrong a section would happen, but it wasn't what i wanted.

I would have loved to have had a VB. unfortunately, I had a 9lb7 back to back baby and I have a narrow pelvis. I was induced at 42 weeks, which meant the odds were stacked against me. I ended up with an EMCS. I felt such a failure and reading this thread hasn't been great for my mental health, but my DH regularly reminds me that the chances of one of us dying or my child having cerebral palsy were far greater due to size and position of child and a consultant friend said that actually the only thing that might have held it off was better care in terms of trying to turn my baby before or around the time of the induction so that she was not so wedged in (labour never started naturally for me, I think because she was), but midwives didn't really bother with any of that - I had sweeps and they basically just took my blood pressure and told me to have a VB and breastfeed. When induced, I was left to my own devices and checked on every 3 hours. No one even remarked on my baby being back to back or looked at me as an individual person. It was lonely and I was very much a piece of meat. When I eventually had a c section after 48 hours, I had a big PPH, then I fell asleep and midwifes berated me for doing so and not putting enough effort into feeding.

I had another baby in the pandemic and chose to have a section because I had a child to care for and couldn't stand the idea of being in hospital for multiple days without being able to see my first if I ended up with an EMCS. He was a poorly baby and I still feel lots of guilt about it. He was 8lb13 at 39 weeks, so would also have been big if I had waited to 42 like my daughter.

I wish I had had two VBs and my recovery hasn't been easy in terms of my core and I feel a lot of guilt, but I think I would have been taking a lot of risk with a VB. unfortunately, no one in the NhS discusses these risks with you in an impartial way, so the "failure" is all yours.

When I asked for an ELCS, they were very quick to point out the risks of me dying on the table, but they never mention the risks of having CP or death of baby from a VB. statistically, an ELCS is safer for baby, especially for a big baby, but there is a lot of manipulation at a time at which you are quite vulnerable. Of course, a VB is better for seeding and BF. Individual triaging with medical professionals who understand statistics would be brilliant, but I think this would need a lot of investment as unfortunately a lot of medical professionals don't use data well (I was told that after one section, those who choose VB have a 2/3 chance of having VB, but when I asked whether I'd be more likely to be in the 1/3 or the 2/3c the junior doctor said she just couldn't say as she hadn't read my notes - she just expected me to assume that a 2/3 chance was so likely I didn't need to think about other options).

The appropriate comparison isn't ELCS vs VB, it's ELCS vs attempted VB including EMCS.

Absolutely, and why even stop at epidurals and gas and air? If you want to try for a vaginal birth but you have factors meaning you're less likely than average to get a straightforward, cheaper one, no free NHS care for you. You can have a free ELCS or pay, you irresponsible woman. Because as soon as you bring in that principle for one type of birth choice, it's sitting there ready to be introduced for others.

Or yes, we could just not be stupid arseholes.

Seems so many people factored in a slower recovery with a c section and that’s why they went for a vaginal. Not wanting to be recovering from surgery whilst having a new born baby to look after

I just don’t get that! I would rather have a longer recovery and reduce risk in the long term of pelvic floor damage, tears , prolapses etc. baby’s dad and other family can help during the recovery!

And what about those women without a partner/family? Not everyone has help.

My DH was off for over a month but not everyone can do that. I have no family help.

My friend had her children when her DH was on deployment (army), she was over 200 miles from any family or friends.

Not everyone has the same life.

@SouthLondonMum22 they are available. You can have a c section for no other reason than maternal choice, on the NHS.

I would rather have a longer recovery and reduce risk in the long term of pelvic floor damage, tears , prolapses etc.
You can get those complications after a c- section as well. And others too