Confused about birthing options..! Positive advice needed.

[justmilkpleasenosugar]

As the subject thread suggests....

I'm finding it increasingly difficult to decide how I wish to give birth to my first child: I have the option of having an elective caesarian section however I'm also looking at the possible option of giving birth vaginal.

Please don't comment is you are going to judge or make rude unhelpful comments..! DH is fully supportive of whatever I go with. I just want to make the right choice and only have a few weeks left.

Should add I am NOT to posh to push...pelvis small hence the opinion of elective c-section if I want it. Just wonder if it's better to go for an elective section rather than hours of labour only to have an emergency one?

I am aware of both the pros and cons to each delivery, my concerns are these:

vaginal birth going over my due date (i'm not a patient person), the length of the labour for example 24+ hours, tearing, pain and possible medical intervention etc which could lead to a emergency c-section.
I consider these negative aspects of the labour, but understand that recovery time from a vaginal birth would of course be much quicker that a c-section. Unless I tear badly, I've heard that this can also take a while to heal fully. Baby arrives when ready.

Elective caesarian section Birth itself being pain-free, quick and in a calm environment. Know when it's 'going to happen'. Not having to go through the stress of not being able to have a vaginal birth due to pelvis. The cons of course are recovery period from major abdominal operation..and staying in hospital for up to 5 days.

If there are any mums out there who have had both a VB and c-section births, I would love to hear your comments..??

Name has been changed.

Many thanks, justmilkpleasenosugar

Are you in the UK?

I've had both though my section was emergency, not elective. I'd still go for the assumption that I was going to give birth vaginally unless there were very strong counterindications, and then see how it went.

An emergency section doesn't have to be a full panic crash thing under a general anaesthetic: mine was a fairly relaxed affair and I was able to enjoy skin to skin and breastfeed afterwards.

Yes I am in the UK

Are you under consultant care? If they think your pelvis is a real issue then I'd probably follow their advice.

There are quite a variety of Vaginal Birth options and a few C/S options so I don't think it is a straight one of the other.

I think you need to research the pros and cons of each delivery for the baby too!

Well the concern is my pelvis could be okay..on the flip side it might not! But won't be able to fully know until we 'get to that stage' consultants words not mine!

I've seen 2 consultants, 1 who's offered to do a c-section and the other said no.

It's very unusual for a consultant in the UK to offer to do a section on a first time mum for pelvis issues. X ray pelvimetry has been discredited in this country and the vast majority of consultants are of the opinion that the pelvis may or may not be a problem for any woman - there isn't a way to tell in advance and so possible small pelvis is not an indication for a primary cesaerean. Are you going privately? I'm struggling to see this scenario on the NHS to be honest - of course your pelvis may be too small to birth your baby, so may anyone's! I have yet to meet a consultant who would consider a small pelvis and indication for primary elective, although I'm not giving you medical advice per se, I don't know your individual situation.

So with that in mind, you need to weigh up the pros and cons of section vs vaginal birth and then go with your gut. As your consultant is giving you the choice maybe they don't think a section is absolutely necessary and in fact you are in the position of every other birthing woman - you may have a successful vaginal birth and you may not.

Hi!

Tricky one! I am a Midwife and a mum ( x2 vaginal deliveries) You are obviously very well informed re pros and cons if each so wanted to answer you directly and make one possible suggestion ( if I may) My best friend had both a cs and normal delivery. She said that at the time of the labour, a cs would have been much better but she says it was the difference between the recoveries that made the difference - not being able to lift, drive etc after the cs was a real issue for her.

Trying to be pragmatic and helpful now, all first time mums are an unknown quantity in an obstetric capacity! There are 4 pelvis types - not all of which are conducive to a normal delivery depending on the size and position of the babe. A small baby can get through a small pelvic outlet! I think the size of your baby is an important consideration. If s/he is small ish approaching term, a vaginal birth may be viable. If your partner is 10 foot tall and the baby is estimated to be big, perhaps a cs would be better. Or what about a trial of labour? (hate this phrase but it does describes what I mean). Agree beforehand acceptable progress and analgesia and see what happens! would it reassure you if you knew that you that you wouldn't be left to labour indefinitely? Sorry got to go - the kids seriously need bed. Please ask if you need any clarification or if you think I am a madwife feel free to ignore! Best of ly k anyway.

I've had both. Three vaginal, including a wonderful planned homebirth in water, and then a elcs. I got the elcs abroad under private care. Was overdue and am anti induction for reasons irrelevant here. Anyway, made a very hard a tearful decision on elcs as my gut was it was best for dd even though I am very pro vaginal delivery. Turns out there was a lot of meconium and placenta was starting to deteriorate so the best decision for us.

BUT, the recovery for me was a shock as I felt helpless and the pain over a few days was at least as bad as the pain over a few hours with the other deliveries. Unless there are issues with the baby and your consultant feels a cs is necessary, I would recommend what laluna said. Another consideration is subsequent births - you may not be able to vbac.

Good luck with whatever you decide. Most important thing is baby arrives safely.

Personally I would avoid surgery if at all possible, but that's personal. I found the recovery interfered with mothering my baby in the early days (especially not being able to pick him up myself, and the MW who kept telling me off for holding him or letting him sleep in my bed rather than go back to his crib where I couldn't touch him and could barely see him) and I'm not comfortable with the drug burden and its impact on feeding etc, I had a very sleepy newborn. Others wouldn't be so concerned.

If you did go for VB, do some homework on Active Birth, read Janet Balaska's book, chat to an ante natal teacher, doula or prenatal yoga teacher about optimal foetal positioning and good birth positions to open up your pelvis. Water births are good for positioning and reduces risk of tearing, so worth asking if your hospital has a pool.

Hello justmilk. Like Cory, I ended up with an emergency section and mine wasn't a big panic either.I had dd on the Saturday and was home on the Monday. I was surprised at how soon they let me go. Unlike Porcelain, I was allowed to lift dd(must have been horrible for you), I was just told to take extra care and not to lift her off a changing mat on the floor and that kind of thing. After dh went back to work, I had to lift her as there was no one else to do it! Overall my experience of an emergency section was positive.
It's a tough decision but I wouldn't let the possibility of emer-section put you totally off the "try it and see" vaginal birth.

Hi justmilk, you have to go with your gut, some people feel that giving birth is there right of passage, and some without any pain relief!! Remember you won't get a medal for doing it vaginally and it certainly doesn't make you a better mother, no matter how long your in labour or how painful it is no matter what some women believe. What does make you a good mum is getting the baby delivered as safely as possible, and that for you might be via c-sec, you could spend hours in labour and still have to have a c-sec, but if you want to give it a try then just go for it!

My step-mum and sister in law both had to have c-sec's and both couldn't believe they worried about it, as it was the best thing they ever did, both recovered really quickly and with no problems!

I'm 16+2 with my first, looking into Hypnobirth, will definitely be having pain relief if I feel like at the time, and have no problems with having a section if its recommended!

Also, a bit personal but can I ask you how narrow your hips are? As I was a size 4 before becoming pregnant, and although i'm expanding it's only outwards??

Hope this helps, and don't worry about it, it can still be enjoyable either way!

Just to reassure anyone who is very slim and worrying about giving birth vaginally, your outside measurements do not necessarily indicate that your internal pelvic dimensions are not suitable for delivering a baby. I'm extremely skinny naturally and had the easiest and least intervention-ridden birth of anyone I know.

OK, without going into the whys and wherefores, I have had both an elective section and a vaginal birth and if there's a next time I will definitely be hoping for another vaginal delivery. Physically easier, emotionally easier, and for me the main difference was that I felt so very positive and euphoric after the vaginal delivery, whereas after the section I felt shell shocked and like I'd been hit by a bus.

But ask the next person and they'll have had a different experience and say the opposite - it is a decision only you can make.

Hi, you talk about what's best for you; which is understandable. But you might want to look in to the research for what's best for your baby too. There's a lot to weigh up there. I guess the baby getting stuck could make it distressed, on the other hand I've read that missing out on the natural hormone changes before birth and the bacteria in the birth canal can both lead to long term effects on the baby. I was a c-section birth and have allergies and immune problems and apparently there is a correlation there.

Anyway, don't want to ramble just make sure that you think and talk through all the options.

Have you had a look at this thred about section experiences - might help with your decision making?

www.mumsnet.com/Talk/childbirth/1053355-C-Section-Information-Real-Life-xperiences

FWIW I had an emcs 4.5yrs ago (poor position lead to failure to progress and foetal bradycardia) and a successful vbac 25 days ago. I'd take the vbac over the section any day IME. Totally agree with doric about the feelings after both deliveries.

Just to pick up on a couple of points that you may well already know:

• as has been said, external pelvis size does not indicate internal pelvis opening. Plus, towards the end of labour the pelvis should loosen (taken to extreme this gives you SPD) allowing more room as the two halves can ease apart R/L - and if you don't labour on your back your coccyx lifts to allow an even larger exit for your baby.

• every labour for every woman is different. I've been through 2 labours with no chemical pain relief. I don't expect a medal and I wasn't doing it as a right of passage and I certainly don't look down any anyone who used every drug available to get through their labour. All I know is that for me, in those 2 labours, I did not feel the need for drugs to get me through it. The only time I'd describe it as "painful" was in the 10 minutes just before transition - when it came to the 3rd stage I quite enjoyed it :o

• have you considered the impact on future pregnancies? If you want more children at some point then the risks in those pregnancies will be increased by having had a CS - not necessarily by much (depending on whether there are complications and how the scar heals on the uterus) but the risk profile will have changed.

I think if it were me I'd go for the pragmatic approach - go with a planned vaginal birth but with clear break points where you'll go to a CS with no arguing (no induction, no augmentation, going with your gut feel if things feel wrong). Get it agreed and signed off by the most senior consultant you can prior to the birth.

But that's me and what I'd do.

I'm also a great believer in the psychological aspects of vaginal birth - so I'd also be tempted to follow your gut instincts, whatever they may be.

Fingers crossed you have a calm birth, however it happens :)

Thank you all so much for your advice...

I'm seeing the consultant tomorrow so will have a much better idea then, baby's breech at the moment so you never know, might be taken out of my hands. I've finished my antenatal classes so know feel I have a much better understand of everything!!

I'll let you know how I get on!

laluna Thank you so much, best advice anyone has given me over the past several months,...inc my own MW's and Docs. Maybe it helped to see it written down in type and not messy handwriting....

My mum told be all women in our family have small pelvises and need sections (all women just being her and her sis- she forgets she was vaginal birth herself). I mentioned it to consultant and he offered me section as I'm little and my hospital very Pro section (1 in 4). So sure enough I ended up, after trying normally, with emcs. Theory proved in my mind until I saw consultant with ds2 who pointed out ds1 was back to back which was probably the issue as opposed to pelvis. He was right as ds2 and ds3 both successful vbacs. Despite this my mum frequently still proclaims none of us have the frame to give birth naturally! Vbac all the way for me as recovery after my emcs not good ( elcs could be better though)

Second Doric too about the emotional side. Had feeding and bonding issues with ds1- generally not a positive experience. Felt like I'd climbed everest (in a good way) after ds2 and ds3.

Got to feed DD in a moment, so will be brief. I had a HORRID VB with my DD (who is DC1). I have a narrow pelvic opening, although this was not flagged beforehand. DD was 3.4 kilos, so not overly big. Anyway, both my coccyx and pubic bone shifted out of alignment during labour. I could feel this happening and it was excruciating. Post birth, walking, sitting and lying down have all been painful. And lifting was very difficult at the beginning. I have had physio to try and get things back and strengthening my pelvic floor and other core muscles should help to get things back into place and keep them there. I didn't have any interventions. Obviously there are other issues to consider with a VB - in my case I had tears that became infected, opened up and healed with adhesions. But all that can happen no matter what the size of your pelvis. In the first week or so after the birth, was extremely shocked after the birth and found it hard to look at DD, even though I loved her so much. If there is a DC2, I will be having a section - GP and gynae agree it is the better option for me. Good luck!

My consultant advised a c-section for my first birth-my pelvis was shattered in a childhood accident and they didn't know if I'd be able to deliver vaginally. I ended up going for a trial of labour with epidural; so I could remain conscious if things ended up as an EMCS.

End result, I had a successful VB, with no need for forceps,ventouse etc.

Whatever you decide,Good Luck!