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.

CS everytime. The damage I hear people suffer from vaginal birth is awful.

I was you, I had crippling, dreadful anxiety I’d Labour and something would go wrong (previous bad experiences on the NHS too) I blurted all this out to my consultant in tears at 36 weeks and she said ‘my dead, of COURSE you may have a section. Don’t worry)
It was lovely. Planned, calm and controlled. A few things: get the private room if you can, most wards have them although you need to pay. It’s worth it.
And try to keep fit as you can, it helps hugely with recovery and getting your body back.
Best of luck OP 💐

I had loads of miscarriages too and my thoughts on it were that I wanted my baby out as quickly and safely as possible. My consultant agreed that a ELCS was best for baby and that’s what I did. I didn’t have any particular desire to have a vaginal birth anyway.

The section was fantastic, we had such a beautiful day, lots of lovely memories and my recovery was fast and easy. Just keep on top of your pain meds.

Paying for a private room isn’t a thing everywhere. I think it’s gross that it would be in the NHS, actually - offering a better service to those who are more well off. Where I am, single rooms are for mums who are covid positive, or those who’s baby ends up in NICU/SCBU.

Having had two episiotomies, recovering from birthing isn't always easier. Inability to sit most times of the day. Two weeks PP and still in pain with stitches.

Go c section. You'll get over not having a natural birth. My 1st was an emergency c section. Had the option with my 2nd. I chose planned section and I'm glad I did. Surgeon told me afterwards after a e hour op there was no way I would've managed a natural ans it would resulted in an emergency again. I cannot describe the iff between an emergency and elected. Elected was so relaxed ( for me not the surgeon).

After a 2 hour op that should say

My ELCS was lovely. And the recovery was great too - kept on top of paracetamol and ibuprofen for a few days but barely needed it, so don't let people scare you about the recover either! I'd do it again in a heartbeat.

As for private rooms, I was told they don't offer this anymore after birthing due to a mum falling asleep on her baby. They like to keep you where they can see you all. Didn't make sense as my curtain was closed for most of it. This is going back to 2015 so it may be diff now

Planned CS all day long in your position.

In your situation I would go section I think as it is more planned and controlled. I can't speak from experience as I have never had one but I had two vaginal births which both went off plan.

Recovery from planned c-section is usually good - just have someone on hand for the first few weeks to drive and help you. Emergency with GA will take longer. If you have anxiety then prepared c-section may well be best for you. Hope all goes well.

You've got a long time to change your mind.
Personally I'd hope for a vaginal but if the placenta isn't optimum I'd have a C section.

I wouldn't go through induction again so if I didn't go into labour naturally I'd have a c section.

And, as I did with my induction, if things weren't progressing well, rather than risk needing an instrumental birth. C section.

My c section was shitty to recover from.

Hi, I’ve had the same thoughts recently as I also have endometriosis and wanted to understand if a c section would be better, and especially if I was going to need one, I would rather have elective than emergency.

I decided not to pick one or the other straight away, see how the pregnancy progresses, any complications nearer the time and just keeping an open mind.

I went to hypnobirthing classes which have helped massively with the anxiety surrounding giving birth. I did KG hypnobirthing with a hypnobirthing teacher. Even if you decide it’s not for you, Katherine Graves’ Instagram is so helpful with videos talking through topics like induction etc. I found that now I know all the options for induction, pain relief, anything that can happen I feel calmer knowing what we would do in those situations and more prepared. You also go through relaxations/visualisation which is really helpful.

Luckily I haven’t had any complications, so I’m planning a hospital water birth, to reduce the risk of tearing. Obviously anything can change between now and then, I’m 35 weeks, but I feel confident that whatever happens we can make the best decisions for us.

ELCS in your situation. I’ve had both ways - there are pros and cons to both, but I don’t regret going for CS when advised. Birth was straightforward and recovery fine. Yes, it takes longer but I’ve probably been bothered more over the years by the second degree tear after DS1 than DS2 CS.
At the current time I would definitely go for CS - you’ll have a team of staff in the room, not one mw on a short staffed ward. When I had DS1 mw didn’t leave at all in second stage and second mw came in after one hour so I had two of them when he was born. That was over 20 years ago though - I’m not sure all units could guarantee that staffing now.

The only thing that would have put me off a CS was if I’d had a toddler to lift. As DS1 was 7 that wasn’t an issue - nor would it have been for my first.
Whatever you decide, I wish you all the very best.

Problem with questions like this is you're relying on others experiences and inevitably personal experience influences judgement.

I've had two semi elective/ "emergency" sections. First was due to IUGR breech baby and second was failed induction and 'running out of time'. Neither were cat 1 (i.e. under general/ crash scenario) but both were awful for different reasons - the spinal didn't work in first and they didn't believe me until I started trying to roll away and I had complications after second that led to a further surgery. Both of those things could have happened in a planned or emergency section scenario. I still can't bear anything touching my section scar- it's a weird mixture of hyper sensitive and totally numb (almost like the ick feeling you get if you shove a finger into your belly button- unless that's just me? 😂). It also tethered so I have a permanent overhang that I hate. My third was a home birth and was amazing- I wish I'd had the same experience for my first and second!

Wild horses couldn't make me opt for a section unless it was a true medical emergency but that's based on my personal experience- which is what makes it entirely irrelevant to your situation iyswim? Have a read of the rcog guidelines, nice guidelines, Sara wickham's books, aims website and the positive birth book by Milli Hill (covers all birth options). Look at the brain decision making tool and make your decision that way. Good luck! X

I've had one of each and would go for the section in a heartbeat. Vaginal birth does not always equal no complications. I recovered quicker from my section and it was a much calmer and more positive experience for me.

ELCS vote from me. I delivered vaginally for my first and found it to be quite traumatic - though no real damage done, but the shock of the actual delivery stayed with me for a long time.

I chose an elective c-section second time around and it was a wonderful birth experience. Healing was no issue either, neither was breastfeeding.

I had an emergency CS after failed induction/back to back Labour & foetal distress with 1st, DS in SCBU for 7 days & me a mess afterwards. Next 2 were ELCS, totally relaxed births in comparison, not an exhausted wreck of a mum which meant skin to skin & EBF was a breeze right from start.
In terms of recovery 1st time 10days in hospital for both, I was up fairly quickly cos baby in SCBU is a big motivator to get up! At home took a while to get out walking with pram , maybe 2 weeks i think for short walks. ELCS- home after 3 days & getting out for longish walks with pram within 1st week.

I've had 4 vaginally births.
So can't compare with a c section.
Timing of a natural birth is clearly unpredictable, labour is painful but you get get a breather between contractions and pain relief is available. Hospitals are busy places and with DC1 I did feel I was left to my own devices until I was 8cm dilated by which point I was swiftly moved to labour ward where I wasn't left alone.
Second hospital birth was a lot more attentive.
My advice is to try your best not to arrive at changeover of shifts!!
Third and fourth births were home births which were brilliant, undivided attention of 2 midwifes , calm environment. Im a bit of an anxious person too so homebirth might sound counterintuitive but in a home birth you are in control of your environment ( I hate hospitals) and midwives are totally focussed on you.
I did tear very badly for first birth and not so badly for 2nd and third .
First VB left me unable to use tampons and I talking to friends I was surprised about how common this actually is.
Other than tearing recovery time from a VB was very quick.
I was up and about pretty much straight away but would strongly recommend resting as much as possible to allow yourself to recover.
A part of me wanted to experience a natural birth, our bodies are amazing at what they can do! But perhaps c sections are more civilised! Do whatever you feel most comfortable with and take advice from consultant and midwife.
As long as there are no health concerns there's no right or wrong decision.

Ask what your consultant recommends. I started having contractions on the Monday evening, I rang up the hospital numerous times and they said I wasn't in enough pain to come in. Late on a Wednesday night my DH rang up and they still said not to come in as I didn't sound in enough pain. I told them I was coming in anyway. I got in the car walked to labour ward , midwife finally got round to examining me and she was shocked . I was 10cm and my DD was born 30 mins later. I had no pain relief nothing. On the positive side I recovered really quickly midwives also lied on my notes and said active labour of 5 hours 😳.

I've had both - a vaginal birth with DD & a CS with DS.
The vaginal birth was traumatic - no epidural as no anaesthetists available; back-to-back Labour; 3rd degree caused by DD turning on exiting; massive postpartum bleeding & retained placenta which required surgery & GA to remove. DD was born around 9am, I wasn't really conscious & with it till 5pm. I missed almost all of my DDs first day. Consequently my breast milk was delayed by the loss of blood too making establishing breastfeeding harder.
DSs birth - had initially opted for natural birth but was told I needed to be induced at 39 weeks as they were unsure of his size. The induction (pessary) was agonising but worked & went into labour a few hours later. However a few hours further on & nothing had change, no further dilation. Midwives could no longer feel babies head & after a scan we discovered he'd gone back up the birth canal & was lying oblique & it was now to dangerous to progress with natural labour. So CS it was. I was terrified but it was actually incredibly calm & controlled. DS was out within minutes & on my chest whilst they finished up. No PPH, no tears, no retained placenta.
For me, the recovery after the CS was easier & better than the vaginal birth - but I know I had a very traumatic one compared to others. If I was to do it again (I won't be!) i would choose a ELCS.

As another PP says, birth is such a lottery so you will never know which option is best for you. But I think there's definitely less uncertainty with an ELCS, so imagine you will be feeling less anxious with that option which will make things a lot smoother anyway.

Personally speaking, I've had one category 1 crash section after being left for three awful awful days of back-to-back labour where I couldn't sleep, eat or pass urine (when I was finally admitted, they drained 750mls of urine 🤢). (And this was after a very straightforward pregnancy, I was normal weight, walking two miles a day right up to the end etc.)

And one ELCS which was so much calmer and smoother.

Recovery wise, first one took about a week before I could walk to the end of the road, second I was walking around a huge zoo within the same time period. No long-term repercussions; people I know had much worse issues and injuries from third degree tears, forceps, episiotomies etc.

Also I have to say of all the women I know, for first time births, more had problematic births than not, which I think is very common and not very widely publicised.

I've had one vaginal birth, one EMCS, and one ELCS.

Even though I was in a lot of pain afterwards, I'd choose the ELCS every time. My local hospital don't have a fantastic reputation, but the experience was amazing from start to finish.

I opted for it due to shattering my coccyx a few years ago, and I didn't want to risk refracture by having a VBAC. When the lovely anaesthetist asked why I'd chosen an ELCS, I told him about my coccyx and the poor bugger went ghost white 😅😅 He said "Oh darling, say no more! All the pain relief for you!"

The operating theatre was so calm, despite loads of staff milling about. The radio was on, lots of laughing and joking. DP got to watch DS being lifted out, he helped the midwife clean him up and he cut the cord. Absolutely lovely.

Interested to hear so many people voting for ELCS!

I had a smooth vaginal birth and it was (very hard! but) a really good experience, and I recovered very quickly - walking the dog within days and swimming within a month. Small second degree tear which caused me no bother.

Theres no right answer, only the answer that’s right for you and which gives the confidence and peace of mind. I would also recommend The Positive Birth book by Milli Hill - I think it leans towards ‘natural labour’ but the overarching messages are about CHOICE in how your baby is delivered and can put you in a more positive mindset whatever you choose.

congratulations on your pregnancy OP and hope you have a good experience for birth whatever you choose!💐