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?

I had an unrushed EMCS after failed induction - some of the staff called it a semi-elective CS. I would never choose a CS if I had the choice TBH. I found the feeling of being cut open afterwards incredibly traumatic and painful and DD had to go to SCBU because of fluid on her lungs and stomach from being forceped out of the incision. Although recovery was better than I expected, it was still really difficult: my wound got slightly infected, the ABs gave me breast thrush, I couldn't drive for 6 weeks (wasn't ready physically) and I needed loads of help as I couldn't lift DD's car seat into the car or pick up the pushchair.

I had a natural first. ELCS 2nd due to breech

No difference with either regarding breast milk. Same time for both.
Got infection with Cs. Wasn't so bad really. I was pretty ill had 5 days in hosp. But I wasn't tired as I hadn't laboured for days.
It was 38+4
I healed well but I do anyway. Drove after 4 weeks. Had 3 yr old so explained she had to climb up for cuddles.
No problems at all.
I'm not having anymore but would ELCS if I was

You will find good and bad experiences of all kind of birth on this board. Japhrimel often posts to say she would never have another (I don't think she's had a VB at all, though, and the OP here is talking about a CS after a TRAUMATIC VB - posters often overlook this) - I often post to say my ELCS was wonderful. Which it was, and I recovered more quickly than friends who had relatively uncomplicated VBs, who were left surprised and shocked by the level of injury that was considered 'normal'.

The point is, there are pros and cons to every situation, and you can't predict what your birth will be like, ultimately.

All you can do is take as sensible and informed a view as possible, and then try and make those choices work for you.

If you want an ELCS, getdown, then get another consultant's appointment and be prepared to argue your case well. Consider getting other HCPs onside, like a GP, or ask to talk to a member of the perinatal psychiatric team, to discuss how traumatised you felt after last time, and your concern you will have a similar experience this time round.

If you have spent time in a mother and baby unit, they should be taking you very seriously.

I felt like his attitude was that 3 months in a mother and baby unit, and "severe mental trauma" did not count as "medically indicated" WRT having an ELCS. i.e. PND is not a "medical" reason. Which is quite insulting to people with mental illness I think.

I know my perinatal psychiatrist has offered to write to him and support me in an ELCS. The thing is I am just not SURE if that is really what I want.

If he is to be believed, then second time will be much quicker, easier and less traumatic. And I know japhrimel and others' stories scare me enough to realise that CS is not the easy option either.

It's just I think for me, a major factor was the sheer exhaustion which came from labouring in agony for so long. And that would not be the case with an ELCS.

I have booked an appt. with the consultant midwife to discuss "strategies" for a better normal delivery.

I don't think I would be able to see a different cons ob unless I changed hospitals TBH.

GetDown, if you yourself are in two minds about it, that's a different issue (although you are entitled to a second opinion, and they should advise you about which consultant is available for this).

It depends I think very much on what is important for you, individually. If you have any underlying physical health issues/allergies, that's something to take into consideration for a CS, as it might affect recovery. I recovered very fast after my ELCS, felt fine afer 4/5 days, physically back to normal within a fortnight, really. No pain, as I was given painkillers! No post birth exhaustion, still exclusively BF-ing my 9 month old DS now....Who was born with Apgar score of 9, perfectly healthy...

But then I was fit and healthy, so didn't anticipate any problems. I even had a substantial blood loss during the op (>1200 mls), but felt fine, and never even got anaemic (iron levels during pregnancy were excellent).

So I read stories like yours and can't believe what some women go through in terms of injury and trauma in VB, compared to my ELCS experience.

But then that doesn't tell you what kind of experience you would have, of course. Your consultant can't promise you will have a particular kind of birth, although a lot of women do say second births are easier.

He does seem to be remarkably dismissive of your mental health. I have to say, if a perinatal psychiatrist would support a C section, then he should have been MUCH less dismissive.

I hope you have a good appt with the consultant MW. I found my consultant MW was hugely helpful antenatally, in discussing birth plans.

It may be that if you fear another long and difficult labour, you can ask for a birth plan which implements a move to C section as soon as labour is stalled. If you get a quick and easy 2nd VB, then great, but you can ask for a 'Plan B' if things aren't going as you'd like.

I was going to request one so I suppose the answer to your question in my case is yes. But after discussing it with the Consultant it is unlikely I will make it to the 39 week date and unlikely if all goes well (i.e. isn't stuck due to being brow) that I will arrive to hospital in time for them to do a CS. So I have had to rethink my options and in my circumstances have decided to go for a VBAC.
My first was born by VB with a failed 3rd stage and my 2nd was born EMCS for brow presentation.

Thanks fruitybread that is really helpful advice. I wasn't aware I could opt for moving to c-section if natural labour stalls. First time round my labour did stall (I think partly because of the terror I experienced and associated adrenalin) and so they topped me up with syntocinon which of course, added to the stress and agony. I'm not sure the consultant would accept that though, but I suppose there's nothing to stop me putting it on a birth plan.

Physically I am very healthy - not overweight, no allergies, no long standing health problems. So I think I have a good chance of, like you, recovering well from a c-section. Incidentally I had no history of mental illness prior to this PND "episode", which makes me think it was connected directly to the shocking birth, rather than an underlying susceptability to depression.

That's amazing you lost more than 1200mls during your birth but didn't get anaemia! I lost less than that and required a blood transfusion of 2 units!

I'm looking forward to the appt with the consultant midwife - good to hear that yours was really helpful. I'm hoping she can reassure me a bit and stop me being so afraid...

... on a related note, can anyone recommend any good books on staying calm during labour / hypnobirthing that kind of thing, or any CD that is really good to listen to before or during the labour?? I've looked on Amazon and there are just SO many I don't even know where to start....

Hi, I haven't read the whole thread, but just wanted to give you my experience as I was in your position not that long ago. I had an extremely traumatic birth with DC1. I don't want to go into massive detail, but it included back to back baby, continuous contractions (no break in between), prolonged 2nd stage (4 hours), stuck baby eventually delivered with ventouse, episiotomy, pph, retained placenta, 2 blood transfusions (4 units) and a very ill baby and prolonged hospital stay. I had PTSD diagnosed during my second pregnancy.

I was given the option of an ELCS or a natural or induced VB. I eventually decided to go for an induced and heavily monitored labour so that I could be sure that they would act on anything that was going wrong immediately and also in the hope that everything would go fine and it would be a 'healing' experience.

I had DC2 about 6 months ago. Everything did go fine (more or less), both me and DC2 were fine, but this has not been a 'healing' experience at all. What seems to have happened is that it has brought my experience of DC1's birth right to the forefront of my mind. I can't stop thinking about it (even though it happened over 2 years ago) and I feel like it is just getting worse :( I am not saying this will happen to you, but if I could go back in time I would change my decision and have an ELCS. It is a huge regret for me and I wish I could get all these memories from DC1s birth out of my head. :(

Just read that you have been refused a ELCS. If you want one, please please ask to see another consultant for a second opinion. I would hate anyone else to feel as I do now if there is an alternative. If you want an ELCS, then really push for one. Best of luck. I hope you get the birth that you want.