If you had the choice, would you go for an ELCS?

[GetDownYouWillFall]

I am only 14 weeks so have quite a lot of time to go, but the question has been posed because I had a very traumatic birth (vaginally) last time and my MW said I could have the option of an ELCS this time if I wanted, but I really don't know if it's what I want....

Basically my problems last time were long labour, bad tear, repair in surgery, haemorrage, blood transfusion and, to top it off, the lovely urinary incontinence. Was in hospital 9 days.

The trauma affected me badly for quite a while and ended up in a mother and baby unit for nearly 3 months because I became so depressed.

The advantages of an ELCS as I see it are:

• being able to plan childcare
• feeling more in control
• not starting off physically exhausted and depleted
• knowing the date you will have the baby
• lack of long labour and all the related agony and stress (I know CS are painful afterwards though)

But I am really aware of the disadvantes too:

• major surgery
• scar
• possibility of milk not coming in straight away
• risk of infection?
• pain and debilitation afterwards (we have a lot of stairs in our house and am worried about getting around)

So, I am left feeling totally at a loss about what would be best. DH definitely wants to go the ELCS route - but as I've pointed out - it's not HIS body being cut open! Am also aware that a second vaginal birth is likely to be a lot quicker and easier than first time round (is it?), and could actually be a very "healing" experience if all goes well.

Has anyone been in this position, and what did you decide?

Having ELCS for my second was fab fab decision. Had EMCS for first and ELCS was totally different and much much better

My first was only 16 months at time but I had no real problems.

I would heartily recommend ELCS but of course the choice is entirely yours.

Ps my scars are virtually invisible, so don't worry about that.

Congratulations on your pregnancy!
Please don't feel like you have to make any decisions quickly, you have plenty of time to think about it so take your time. When you do make a decision you can still change your mind at any time.
Other people's experiences are interesting, but not necessarily that helpful because you really don't know how you'll feel. Of the 2 people I know who've have elcs, 1 thought it was the best thing she ever did, the other felt like she'd been a quitter and had very bad PND as a result.
Do lots of research, ask your midwife lots of questions and speak to a consultant if you think it would help.
Best of luck!

Just thought I would add in my tuppence worth......

Labour with DD1 was long and slow, ended up in theatre with an epidural.....DD was born with forceps. I had third degree tear (even with episiotomy) into the anus (sorry if TMI ha ha). Had a wonderful consultant who took ages stitching me, with the result that I had no problems whatsoever.

Second pregnancy with DD2, I was offered an ELCS. Spoke to consultant at length who said I was no more or less likely than any other pregnant woman to tear, even though I had torn badly before (and had a 'fault-line' as I thought of it).

Decided on VB, which was natural and lovely and quick, but DD2 came out with her hand up at her face and so I basically tore right along the same line as before, third degree again, cue trip to theatre, spinal and more stitches. Thankfully, I again had NO problems and I count myself VERY lucky.

So, although the consultant said I wasn't more likely to tear, I did, right along the same line. How much of this was actually caused by DD2 'waving' as she emerged, I'm not sure, I kinda feel I would have torn anyway.

SO, sorry this is a bit long, but hope this gives you something else to mull over.....as if you need it right now!

Needless to say, when we plan our third child, I will be going for the ELCS......think I have used up ALL my luck!

rollittherecollette you're right, the incontinence was miserable. It was horrible, debhilitating, embarrassing and depressing. Do you know what the GP said? "don't worry about it, it will probably get better" - errr. It didn't. I mentioned it again on at least 3 separate occasions and was never taken seriously. Then when I got depressed, it was honestly not a high priority to do the exercises as I had no motivation whatsoever.

It's only now I'm pregnant again and at my booking in appt with the MW I mentioned it and she said she would do a referral to physio. Haven't heard anything yet though.

I know that another VB is not going to help in this regard, and may well make things worse.

mohara thanks for sharing your experience - sorry you tore so badly twice. Glad that you seem so positive though. Interesting that you think you will have an ELCS if you have a third.

feb you're absolutely right, I still have a lot of time to think about it I wonder - your friend that had PND and felt she was a "quitter" because of the c-section... was this her first baby? I wonder if people aspire to a VB if they've never actually had one. But when you HAVE had one and you know that there are no medals either way, and actually it doesn't make you a better mother, or even a more worthwhile woman, I think perhaps the sense of being a "quitter" would not be there anymore.

Thanks everyone else for your comments. It seems that there are more positives than negatives for the ELCS at the moment.

getdownyouwillfall, no they both had elcs after miserable VBs first time. She had forceps with her first and couldn't shake the feeling after dd2 that she had failed because she couldn't have babies without medical intervention. very sad that anyone should feel that way. I guess what i was saying is that elcs isn't a get out of jail free card when it comes to PND.
x

I could have written Happygomummy's post. My elcs was fantastic and a wonderful experience all round, with not a single minute of pain (you said in your OP you knew cs were painful afterwards - not necessarily true). To put it in context, having a filling at the dentist would be much worse.

I'd also second what she says about the scar. Please don't let this be a reason not to have a cs! My scar is inside my pubic hair (sorry if TMI) so was never very visible anyway, but 4 years on is virtually invisible. It's a thin silvery line which I have difficulty spotting even if I look for it.

You also said you were worried about difficulties in breastfeeding. There is no medical evidence that cs has any impact on breastfeeding at all. I breastfed both my babies in the recovery room and had no problems. After my emergency cs, the milk took a bit longer to come in, but that was because of the long labour beforehand and PPH, not the cs itself.

Good luck in whatever you decide.

TuttiFrutti - "having a filling at the dentist would be much worse" Seriously??? Wow, I have had fillings and they've not been that bad! Am amazed that you say a CS can be pain-free, not only during but after as well. That is fantastic!

Also it's good that your scar is so insignificant. Did you have to shave your pubic hair beforehand? Based on how massive I was with DD last time, I doubt I would be safe with a razor in that area as I wouldn't be able to see a flipping thing (couldn't even tell what colour pants I had on if I looked down!)

I would absolutely love to b/feed in the recovery room! The sooner the better as far as I am concerned. I was devastated when it didn't work out with DD. If I could get off to a flying start this time without being so totally drained, stressed and exhausted that that would be fab.

Funnily enough tuttiFrutti, I remember thinking about my (wonderful) ELCS that I'd rather have an epidural sited anyday than one of those deep injections into the nerve they do at the dentist. I'm not dentist phobic, I just find them painful. My recovery after ELCS wasn't painful as long as I kept on top of the painkillers - which is what they are there for, after all - and after a few days I was just on paracetamol anyway.

FWIW, I too BF-ed very successfully after mine - there are things you can do to help, like skin to skin in recovery asap after delivery -

I felt I had a much better start to BF-ing than friends who had had long labours, tricky deliveries and were exhausted to start with. It wasn't something I'd considered before at all.

My scar 8 months on is a thin red line, barely visible underneath my pubic hair. I wouldn't have been bothered at all by a big scar myself, I see it as the record of a happy event!, but I can see why it's an issue for others.

Getdown, I got a small area waxed before my ELCS as I was worried about shaving regrowth in the wound area (waxing takes a lot longer to grow back). It was heinously painful and ever since I have wondered how anyone ever gets a brazilian, I only had about 1.5cms off!

(The waxing was a LOT more painful than the ELCS!)

The midwife shaved me before my 2 CS's. My 2 lines are about a mm apart and are very silvery grey

I'm with happygomummy and TuttiFrutti on this one. Just had elcs with DS 5 weeks ago following emcs with DD 2.3 years ago. Elective could not have been more different, it was just a really lovely experience and there isn't even a tiny part of me that thinks 'what if I had tried for a vbac'. I also had no problems with breastfeeding after either. With DD my milk did take a few days to come in but this caused no problems and with DS he latched on as soon as he was put on my chest and my milk came in on day 3. I do think alot of it depends on your mindset though. It never occurred to me after DD's birth that I had failed or that I was a quitter in some way because I had had a CS. I was just relieved that she was alive and with no disability as at one point during labour we thought we had lost her. Therefore when I had the option of a elcs with DS I was pretty certain early on in the pregnancy that this was the right thing to do. Now I would say I was certain that for me it was the right thing. To top it all he appears to be a really relaxed and laid back bub who has pretty much slept his way through the last 5 weeks - the total opposite of DD whose birth experience was anything but relaxed. With both sections I was up and about really quickly although it was harder to rest this time round once I was at home as have DD to look after but 5 weeks on and things are almost back to normal. Obviously though it is major surgery and with anything there will be good and bad experiences but as other posters have said you do have time to think about it all and make a really informed decision - good luck!

I'm 21 weeks pregnant and have just fought quite hard to get the hospital to agree that I can have ELCS. I had an EMCS with DD (now 3) after a very long labour. The whole thing was incredibly traumatic and still 3 years later I hate looking at the photos of DD immediately after she was born because it reminds me of the experience. The psychologist I saw afterwards for PND thought the birth was a significant factor in causing my PND. I have to say I haven't even really considered VBAC because the thought of being in labour again terrifies me. I'm actually quite anxious because they won't do my ELCS until 39 weeks and I'm worried about going into spontaneous labour.

For me, the decision has been the physical risks of ELCS (and I recovered ok from EMCS after 40 hr labour) versus the psychological risks of another traumatic labour possibly ending in EMCS which had a huge impact not just on me but on my ability to mother my daughter, my husband and our marriage.

No, Getdown, I didn't have to shave my pubic hair and like you I was so enormous I wouldn't have been able to see it either! I can't remember if the doctors did it - it's all a bit of a blur now - but if so it wasn't a big event.

In your position I'd go for ELCS. I've had 2 ELCS, both very calm, positive and pain free experiences. The recovery was fine too - this time I'd just carried twins (14lb worth of baby!) and came home to my hefty toddler and so long as I took it easy I was fine. I could lift normally -lugging prams and shopping etc) at about 3 weeks. No problem with milk coming in, and my twins were prem too.

And I only have one, v neat scar - I had the same surgeon both times and he cut out the old scar and pulled it all tightly together, so no overhang! Marvellous man!
And of course with CS, your fangita is fine! Huzzah! Very best of luck x x

really grumpy although I didn't have to fight to get the ELCS after emcs I did feel pressurised by one particular doctor to try for vbac and it was horrible, and made me even more determined to have an elcs. Just wanted to say though that my waters broke four days before I was booked into have the elcs and I still ended up having a c section. I had already checked what would happen as it had been worrying me too. However I had been told that I would not have to labour unless I wanted to. Ultimately we did have to wait some time to go to theatre but I was only having very mild contractions so it wasn't problematic. They also classed the section as an emcs but it really was so different from the first which had truly been an emergency. Anyway, hopefully this should be the case for you too, that if you do go into spontaneous labour before your section date you should still have a section. Maybe you could have it written into a birth plan and put in your notes so at least you can stop worrying about it, I know how stressful the thoughts can be! Good luck.

If I could get off to a flying start this time without being so totally drained, stressed and exhausted that that would be fab.

That was my major worry too, having had such a git of a time establishing bf with ds1. With ds2 he was given to me as soon as he'd been weighed/cleaned up, and the first time he left my side was the following day when I went to the loo! Ds1 had been whisked off to SCBU pretty much as soon as he was delivered. I think it also helps that you've had experience of bf before. The care and support from the midwives/everybody the 2nd time was brilliant, so much better than first time (different hospital). You're not having baby in Salisbury are you? They are FAB!

Best of luck for a happy healthy pregnancy.

Haven't read everyone else's posts but here's my experience for what it's worth.

I chose ELCS for DD because I am seriously pain phobic and have very low pain threshold. It was ace. No pain. None. Neither during nor after. I popped a few painkillers in hospital but nothing afterwards.

Skin to skin in operating theatre and bf'd in recovery room. Bf'd for six months exclusively.

We have a 5 storey house (lots of half landing) with loads of stairs and they were no problem. I was pushing the pram up a steep hill within the week.

Scar is tiny.

Am having next DC in July and will have another ELCS.

Good luck with whatever you decide.

Had a traumatic and very long VB, forceps, episiotomy, tear, the works with my DS. Second time round went for ELCS after much thinking.....I was worried about recovery, cuddles with DS etc, but it was fantastic. It was just amazing, not to be exhausted and be able to enjoy and appreciate the birth. Breast fed with ease, was back driving after 8 days, and the scar is barely there (looks like a tiny scratch!). It was such a positive experience for me and for DH after my first delivery which was long and horrible and I still shudder to think about. The recovery was more straight forward after ELCS than after episiotomy and tear.

Not Salisbury, no, COCKadoodledooo I'm afraid! Going to Lister in Stevenage.

Thanks all for your comments, it seems the ELCS overall sounds like a good option!

Just an update. Had my consultant appointment last week, and it was a definite "no" to the ELCS. Feel a bit scared at the thought of going through VB again I have quite a few weeks to get used to the idea though.

Just wanted to say quickly, you can ask to see another consultant. If you feel you really want an ELCS.

I find it astonishing reading your original post that you have been refused by consultant #1. Did you share all the info with them that you shared here? (sorry, I don't want to be intrusive, I just wondered),

The way women are treated in cases like yours is so inconsistent across the NHS, it's just utterly ridiculous, callous and shortsighted.

I would be requesting to see another consultant. Given that you had a bad tear I think you have every reason to ask (I wont say demand) a cs. Add to that your spell in a Mother and Baby unit I am amazed you have been refused. Perhaps you should take an advocate to the next appt?