To ask for help deciding between ELCS and vaginal birth

[elm26]

Hello everyone

I am 24 weeks pregnant with my first baby and I'm 29 years old.

I've had multiple miscarriages (double digits) and this is the first time I've made it past the first trimester.

Due to my history of unknown cause of miscarriages, endometriosis and my history of anxiety and depression, my consultant has asked me to think about my birth and whether I'd like a planned, controlled ELCS or to allow myself to go naturally.

My placenta is currently low and nearly covering my cervix so of course this could take the decision out of my hands and I have scans at 30 and 34 weeks to see if this has moved up.

I love the idea of natural birth BUT I'm terrified of the thought of needing an emergency c-sec or an emergency in general. I'm naturally nervous of the pain, the length of time it can take etc. I'm equally as nervous for a c-sec as it's surgery and there are risks and the physical recovery is longer, pain etc.

However, if a planned c-sec I imagine it would be calm and controlled (unless something unexpected happened I guess), I'd know the date, I'd be able to prepare myself.

Please help! I'm giving myself anxiety thinking about the anxiety of either! 🤦🏻‍♀️ I really have struggled with this pregnancy, convinced I will lose her at any given moment because of our losses and it's really taken it's toll on me.

I have never had an ELCS as both my births were vaginal. That said, both of mine needed intervention from a doctor and there was a lot of pain and an episiotomy in both cases. With my first, there was a lot of blood loss.

If I had to do it again, I would opt for an ELCS, especially if you have a good support system at home for after the birth.

In your shows I'd consider a couple of things. Firstly, did I want more children (every section increases the odds of certain complications). Secondly, where is the placenta going to end up? The decision might be taken out of your hands.

Whatever you decide, I hope it goes well for you.

I had two vaginal births and they were honestly one of the best most empowering moments of my life. Yes there’s pain and it’s hard but it was also a fantastic experience. I’m glad I was lucky enough to experience that and I’d have missed it with an ELCS!

Thank you, there's so much to think about.

10 years ago, I'd of told you all I want 3 or 4 children. I come from a big family and always wanted the same but after all of our problems with getting this far with this little miracle I won't ever be having another one.

The mental toll the past 9 years have had on me has been incredibly difficult and I even voluntarily spent 4 weeks in a psychiatric hospital a couple of years ago to get help for severe depression, anxiety and PTSD. This baby was a surprise and I thank my lucky stars every single day she's still okay in there at 24 weeks.

I do have a very good support system, I'm very lucky and have a lovely DH who has worked weekends and evenings to be able to save enough money to cover 8 weeks wages if it was needed due to high risk of post partum depression/difficult birth etc.

As an older mum with gestational diabetes I was offered induction at 37 weeks or a c- sec at 38.
The recovery from a c-sec terrified me more than a vaginal birth. Dd was going to be big I was told and was back to back and if she'd ever been at risk I'd have gone for a section.
I was only going to do it once and to me a vaginal birth seemed like the easier option.
As it was I did 13 hrs in labour, the drugs had worn off before it was time to push and 8lb 6oz dd was hauled out with forceps 3 weeks early.
Still believe I made the right choice.

Everyone is different and everyone’s experience is different so there’s no cookie cutter answer unfortunately. I have 3 vaginally without drugs and 2 were home births (one without a midwife as she didn’t arrive in time). I was able to pop to the shop for cake a couple of hours later, whereas with a c section you would need at least a few days

Whatever you decide I would highly recommend hypnobirthing, don’t just buy a CD to do it yourself actually find someone who teaches it and go to their sessions. You can use it in either birth scenario as it teaches calming techniques. It’s amazing

Are you me?! People always well meaningly suggested home birth to me to help me feel less anxious. The thought of it makes my blood run cold. The more doctors in the room the better as far as I'm concerned!

I've had an emergency CS and a planned one. Whatever you decide, both mine were absolutely fine. The emergency one felt nothing like an emergency, it was just as calm and controlled as the planned one as they are such professionals in looking after you. Good luck whichever you decide x

I think the issue is that you're carrying all the weight of your horrible experiences with you op, you're approaching birth thinking 'oh no, what awful thing is going to wrong that I need to worry about.'

You need to start to trust your body to bring this baby into the world, whatever mode of birth you go for there will be people on hand to help. It's so easy to fixate on birth but it's really only a matter of hours.

Do some yoga, swimming, walking etc and visualize your baby in your arms. Focus on that, not the details of the birth.

Personally I preferred vbac to emcs, but you need to decide based on your own circumstances, not a straw poll on here. If it was that cut and dried then everyone would give birth the same way.

I had a relatively pleasant vaginal birth with just gas and air and in your shoes I'd have the C-section. Even thought it was straightfoward, there was a lot of monitoring due to infection risk and I got very fixated on the readouts, beeping noises and movements.

Having read your posts I’d go of a CS.

I had 2 vaginal births, and would do so again for me, but in your situation I’d want as much control as possible.

knowing the date, it being sooner, as I think they do sections before 40weeks.
Get baby to term and get it out in the most controllable way possible.
i hope whichever way you choose it all goes really smoothly

What is the right decision for someone else isn't necessarily the right one for you.

No need to make a decision now. Wait, read up on both options, get some second opinions.

In your situation I would lean towards a c section OP, I think it will help your anxiety to have a set plan and just knowing that will give you a much calmer pregnancy as well. It is obviously possible to change your mind closer to the time if you’ve had a change of heart, but in your situation I would try to make a decision now so you can let the worry go. I’m not sure hearing everyone’s experiences of both will necessarily help you, though you did ask for it. People are much more likely to share if they have a strong reason for not wanting you to do something in my opinion. It’s like with anything else, if you’ve gone out for a meal and had a horrible experience, you’re much more likely to share in order to warn others. It’s very possible you could have “good” experiences with either and I hope you will. Either way the final outcome will be 100% worth it. Good luck and I wish you and your little girl the best.

It's so hard. I've had 2 vaginal births, and the first I found quite traumatic. I planned a water birth in the midwife center. She was back to back and labour started with my waters breaking, so from the start it was very painful and my contractions were erratic. I reacted badly to gas and air, throwing up a lot, and ended up on an epidural. It was long and slow (but the epidural was fantastic!) and I had the world's most disengaged midwife when it came to delivery. I ended up exhausted and needing forceps, which are brutal and my recovery from that was hard. I ended up needing counselling after because I found the birth so difficult to deal with, emotionally.

Second, I was better prepared and supported, planned an early epidural, and was a lot calmer. I had some issues with the epidural and blood pressure dropping, and felt sick a lot during labour. He ended up coming out fist first, which meant he got a little stuck and I needed ventouse. But it was a much, much easier recovery. And because I was better able to articulate what I needed during labour in my birth plan, I was much better supported, so even though things went a bit wrong, it was a super positive experience overall.

Point being, vaginal birth has a lot of uncertainty. You don't know how it will go and there are lots of things that can go awry. There's more certainty with the elcs, but that brings the certainty of surgery and the longer recovery time that naturally brings. For me, the most important things were feeling in control (as far as you can when giving birth!) and feeling supported - that was the difference between a really difficult first experience and a super positive second experience (though on paper my second labour was more difficult!)

Failed induction with my first that ended up in an emergency c-section. Was a very scary experience baby needed resuscitating didn't want to go through that again! Dc2 and 3 were planned c-section much more calmer and relaxing and recovery with planned was much easier

I had an emergency c section for twins due to low lying placenta bleeding - it was very calm. But it’s not with it it’s downsides - no labour meant my body did not trigger the hormones to make breast milk. Not so good for tummy muscles which are torn. It is better for the baby to go down the birth canal as they are exposed to friendly bacteria they need for their gut and it also triggers infant reflexes to go dormant. But I must admit I don’t have leaky bladder like some other mums

(Anaesthetist). Nearly all emergency sections are also lovely chilled happy times so I wouldn't let that put you off. Only a v tiny proportion are rushes and even then everything is explained and you're v safe. The vast majority involve music on the speakers of your choice or cheesy csection play list if no preference, delayed cord clamping, dad cuts cord, then skin on skin till finished and an anaesthetist taking you a ton of cute photos of the 3 of you

Not going to sway either way (I'd prob go normal and see what happened) but emergency interventions are still happy birth experiences (I rarely see normal deliveries now in my job but I love it and think its v pleasant if a little unexpected for the parents). Elective sections can relatively commonly become emergencies too if labour before your date. Most important thing is to not have a rigid birth plan as they're the ones that often don't happen as wanted and the parents are disappointed

Just remember the birth plan should just involve a healthy happy mum and baby and the teams support u to achieve that

I've had two calm vaginal births that went well but in your situation, I'd think about the elective section. Especially if anxiety is high at the moment.

OP have you thought about talking all this through with a doula?

One that knows the culture of the local hospital and also your preferences/what's important to you etc and knows how to navigate the system to get what you want.

They can also support you in the post natal period x

I have had 3 vaginal births and one LSCS. The section was the 3rd, I could’ve had another but opted for another vaginal birth.

Nothing wrong with my LSCS but, for me, the recovery after a vaginal birth was so much faster

I've had 3 natural births, one on time, one late induction, one early induction with a drip.

In your circumstances I'd go cs. Recovery is worse but you have time to prepare. You've been through enough love.

I was expecting to say give VB a try but then read your post and honestly, I'd do CS.
More for the placement of the placenta than anything else but given everything, it sounds like the best option for you and your baby.

3 vaginal births, all difficult, the last can only be described as barbaric.

Baby 4 was a C. section with GA due to placenta praevia - total relief. Recovery was much quicker tbh except not allowed to drive for several weeks but we managed.

Elcs would be my first choice every time.

That would be a usual protocol for known grp B strep carriage. It might be different in the UK but the Australasian protocol is for antibiotics in ideally 2 doses, 4 hours apart. Maternal antibiotics in Labour is the most effective way of reducing carriage to the baby.

Your baby would need antibiotics if there were concerns they were sick (very low threshold) but this would occur even if the group b strep status of the mother wasn’t know.

I don't have any personal experience of a caesarean section but it's something I was glad to avoid.

One of my nephews was born by caesarean section (on medical advice, because the baby was breech) and according to my sister the recovery from that was far worse than after her previous natural births.

I also have a friend who has had recurring back problems which she thinks are due to her caesareans.

There are risks either way, of course, and I think you can only weigh those up nearer the time based on medical advice.

Good luck either way.