Dilemma- ELCS for psychological reasons or a VB? Anyone help me decide?

[Thandeka]

Hospital have promised me an ELCS for psychological reasons after an extremely traumatic first birth. No medical/physical reason for me to have ELCS.

Last time I experienced:
Being left on own screaming in agony- completely crap unsympathethic midwives.
Failed epidural and canulas (finally managed to get 4th canula and 2nd epidural to work!)
failed ventouse.
Forceps, Episostomy.
Oxygen starved Big baby (9.5lbs) with Pneumonia and possible brain damage very ill on NICU for 5days.
Lots more but those are the main issues.

Had always been completely adamant it was ELCS next time or no more kids (I even said I wanted a termination in early stages of this pregnancy if I couldn't get an ELCS). Now they have said I can have one weirdly I have had a huge change of heart and am now about 50:50 on either option.

I am starting CBT next week to help with my PTSD that I still have and I will be having a growth scan at 34weeks to help decide too (if it follows the trend of second babies are bigger then NO WAY am I doing it vaginally again).

At the minute (17weeks). My thinking is getting a good VB experience would be more mentally healing than an ELCS. However- if I have another bad experience then I am going to be completely fucked up forever- we are talking possible nervous breakdown if it goes wrong again. Not sure I can take the risk.

I have arranged a Doula and written a birth plan for a possible vaginal birth- I would still want/need an epidural but then what if I can't get another baby out and the same thing happens again?

In terms of an ELCS the advantages are- it is unlikely to go wrong and if it does it won't be "my fault" for not being able to get baby out- which I know I shouldn't think like that but still do. Also another advantage- none of that horrific pain, panic and chaos- a lovely calm experience- granted recovery will be harder and more painful but I can cope with the idea more than the idea of another labour.

In a way I sort of either want a breech baby so has to be ELCS or to go into extremely fast (and painfree!) labour before my ELCS date so I don't have to make this decision! (Hospital have said if I do go into labour before my due date it is my decision whether to carry on or have the section- hence the "fast" labour so decision is out of my hands IYSWIM!

I am in a real dilemma about it all and can't decide which way so thought starting a thread on it and getting advice from you lovely mnetters may help me. Oh and another thing factoring my decision is DH is fairly adament he can't be my birth partner at a section but will at another VB- which is a weird one as I would prefer him not to be my birth partner at another VB as it was pretty traumatic for him too- but really want/need him with me for a section. Sigh. I know he would probably prefer me to VB again but he is supportive of whatever I eventually choose.

First of all , and well done for deciding to go through with another pregnancy after that awful experience!

I wonder what has prompted your change of heart to swing 50/50 towards VB? Or what feels like it would be mentally healing to deliver successfully by VB this time? Not trying to be critical or argue in favour of CS over VB, just wondering if it's something to do with the horrible sense of failure that some ladies get left with along with the other aspects of birth trauma? A successful vaginal delivery may well help that - I dunno as I'm definitely not an expert on birth trauma or recovery - but you didn't 'fail' at giving birth last time, you and little one are here and another one on the way!

I think it would be important to find out why DP is balking at the CS birth partner too - is he squeamish about the surgery? WOuld more info about what being with you in theatre help him? And if he were to change his mind would this make your decision easier?

Sorry more questions than answers, I'm afraid! I hope the CBT helps, you said it is for the PTSD but this might be another space to look at this issue too?

You have plenty of time to make the decision, so good luck x

Awww thanks for reply. Questions are good- they help with my thinking!

The mahoosive change of heart has been because before all my energy was focused on getting an ELCS agreed as until it was a definite option I couldn't think about anything else. Now it has been agreed I feel like I have the relaxed space (well 22more weeksish!) to decide. It is really unexpected that I have had such a change of heart. (I also had an ectopic pregnancy in jan and lost a tube and I was weirdly calm and ok about that mainly because my overwhelming sense was "thank fuck I don't have to go through labour again"- after that I did a lot more work on the PTSD and had more counselling (which was ok but not great) and then by some miracle got pregnant first month of trying. This is my 4th pregnancy.

During my last birth I gave up- I wanted to die/ or I really didn't care if the baby died and I distinctly remember thinking "it's okay I've had a miscarriage before, I can cope with losing this baby". Which seems obscene when you look back at it but I hadn't met my awesome baby girl then. So I guess there are a lot of feelings around guilt and failure for that that I want to process. But also I am not a complete martyr- natural birth maybe best for baby - but that just aint never ever gonna be a plan for me!

DH is incredibly squeamish (especially blood and needles)- he was amazing considering during the last birth considering I was so out of it with agony I don't remember alot but he witnessed it all sober. I really don't get then why he finds idea of being present at ELCS so much worse than VB as he wouldn't see anything but he says its a sterile operation and he can't be part of it but he is okay with the "natural" ha! process of childbirth. Its a bit odd- he hasn't completely ruled it out entirely but he is pretty fixed on it and I think I will struggle to get him to change his mind.

I think if he changed his mind it would help because currently it is swaying my decision more to VB which I am not entirely sure I want/am happy with. In fact the impression I get is that many people think I should VB again so there is almost an element of peer pressure! My lovely MiL is only one who definitely told me ELCS was good option for me (and she has had 4 births I think mostly without pain relief!).

I guess partly I am a control freak- ELCS presents opportunity to stay in control and what happened last time can't be repeated. VB is the unknown- potential for greater benefit but also greater risks. Hmmm am I a gambler?

Can you negotiate with your consultant to try VB but have a very low threshold for intervention? So basically, you either labour really really well or get a CS.

No induction - if you overdue you get a CS
No hormones to speed up labour - if labour shows down you get a CS
No delay in the second stage - if pushing is going slowly you get a CS
No mucking around with the baby - if any concerns on the trace at all, you get a CS
Change my mind/feel uncomfy at any time - get a CS

I'm not trying to belittle your experience at all, but I have delivered many hundreds of babies and unfortunately a pretty crap first time experience (in terms of having lots of intervention) is not uncommon. It just doesn't seem to happen second time round - not saying it never does, but almost overwhelmingly second time mums just come in and pop them out, even if they had the full shebang the first time. One of our consultants says that your first birth is an investment - you have a long, crap, painful, horrible labour but then once you've done it once, the rest of the times you do it is normally really easy - that's your payback for your investment in your first labour. She really laments second time mums having CSs for crap first labours - "they've invested all that and not getting any benefit (i.e. not getting the lovely quick second labour they earned the first time!)"

Could you investigate whether there are any caseloading midwives at your hospital so you could get to know who will attend you in labour? Maybe speak to the SoM of Head of Midwifery and see if they can organise anyone who would be willing to caseload you through you pregnancy and labour?

I had a pretty rubbish birth with dc1 (though not as bad as yours) and was adamant I wanted an ELCS for dc2. Like you I was offered one, though advised that a good VB would be possible. In the end, we agreed to go for a VB but move swiftly to CS if I felt like I was not happy with things.

In the end, dc2 arrived a week early, 5 hours from first twinge to born, completely naturally. And it was a very healing and positive experience. I was lucky though. But knowing that I could move to CS at (almost) any time was very helpful.

Hardertokidnap- that is a brilliant list and shall add that to my VB birth plan.

Really helpful post too. I know in all liklihood I would be okay next labour (i had no postnatal complications apart from an infected stitch which at times was as bad as contractions!) but it's just the "what if...." to be honest I think I would be okay mentally with another forceps/episostomy but what would definitely cause the breakdown would be another very ill baby. In fact my PTSD definitely wouldn't be as bad if it wasn't for DD being so ill and even now I worry about her (she has been a bit late to walk for example- although she is fine and meeting milestones).

Another ponderance I have is I work in sexual health and some of my work involves teaching pregnancy chilbirth etc. Some of my experience is already colouring what I talk about and I want a positive experience for work?! haha! and also for DD and baby- do I want to say baby2 came out of sunroof coz mummy had a rubbish time with DD- how will that bode for DD having a positive birth experience?

OK, so loads to think about. I really wouldn't worry about DH - if push comes to shove, is he going to miss the birth of his child, really? What if you have to have a CS during labour, would he say "OK, I'm off then, see you at home"? No. Probably his own natural preference is colouring his reaction (which sounds kneejerk) and if you had the CS date booked he would begin to get excited with you.

Have you had a thorough birth debrief including looking at DD's fetal heart traces in labour? It's just that continuous fetal monitoring is incredibly sensitive at picking up fetal distress (the oxygen starvation DD had) and that is very unlikely to be missed. Unless someone didn't interpret the trace properly, it's likely the starvation happened at the last knockings - and if you manage to avoid another prolonged second stage by switching to CS at any sign of a delay in second stage, then that situation shouldn't arise again. There is also something the doctors can do called fetal blood sampling - it's pretty invasive and unpleasant, although painfree if you have an epidural, but it will tell you for definite whether a baby is suffering during labour. Perhaps you could chat to the consultant about having that during your labour if you start to feel wobbly/anxious.

Best of luck xxx

Have gone through debrief- they were picking up decelerations for about 20minutes prior to her being born but they were sporadic. Consultant said they never should have tried the ventouse but that would have only saved us 4mins or so.

DD had MRI at 8days old this showed evidence of Hypoxic event but not brain damage as such (I think they used neurocortical fuzziness which made me laugh!). They suggested a repeat MRI but in the end we decided not to as it was quite a palaver with the sedation etc and she was meeting all her milestones.

My second stage was 1hr 20mins. They let me push for an hour but was getting nowhere then DD was distressed and I was exhausted and unable to carry on so they went in for her.

Helpful point re. DH too he wont miss it- he is in my bad books this evening as I just went to him "have been thinking about my birth options" and wanting to tell him about this thread and he laughed at me in a "oh not again kinda way" so I got really pissed off so skulked upstairs to mumsnet. Humph men!

Am defo going to get in touch with chief honcho midwife lady to see about a caseload midwife. I did mention it at consultant appt (which chief midwife was at too) but they sort of blathered about shifts and said it wasn't really possible. However my normal midwife said they are shifting to that kind of system in sept anyway- so will contact them and see. I like my regular midwife- she is a bit bats but I reckon she'd be a good person in labour.

Eeep I think I maybe leaning even more towards a VB (with ELCS option at slightest thing going awry)- hearing stories like Reelaroundthefountains really helps too- thanks! but only thing that worries me about swapping to CS in labour is it then is classed as emCS and recovery from a contracting uterus cut open is harder than a non-contracting one I believe? Plus knowing me I'd probably scream for a CS at first twinge and whether they would take me seriously and also whether I would genuinely mean it. Maybe I need a really random safeword which means "no I am not just saying this I really mean it" haha!

hiya, sorry to hear of your first experience. i had similar but with added complications of very bad 3rd degree tear. i then had elcs for 2nd baby and it was the best decision i ever made! i realised that i missed out so much on bonding with ds and enjoying newborn stage as i was so traumatised both physically and mentally from an horrific birth. this time it was so much better and have enjoyed so much more. dd also much calmer baby and i think thats why.

the recovery from cs was also so much better and quicker. in no way harder or more painful at all. i dont know why anyone ever has a vb just cant quite believe people or trust them when i hear stories of straightforward deliveries.

so from my experience i would say go for cs. also your dh can just stay by your head and not look over sheet at all. also may be easier for him as you wont be in pain or distress so i think that makes it easier on them?

anyway best of luck whatever you decide!

Also very helpful to hear yummytummy thanks. I think if I had had a 3rd degree tear there would be no doubt I would ELCS as it was I was very lucky to heal fairly quickly with no last damage.

I heal quickly from op's so am working on assumption recovery from either an ELCS or a VB would be similar (maybe not an EMCS though.).

Also another plus for ELCS - no further damage to fanjo. Its already a bit baggier down there (although H assures me he can't tell!- ) but the thought of urinary incontinence or even prolapse is a bit scary especially as I have big babies!

hi, glad to help. ur def right about avoiding further fanjo damage! so many risks with vb just not worth it!

Hmm now I think I need to right a big list in four squares- advantages and disadvantage to VB and advantages and disadvantages to ELCS and then score each one with a value out of 5 and then work out the winner.

Anal much?

I'm sorry to read you've had such a hard time. Something to remember is that even ELCS might not go well. I don't say that to scare you, just pointing out that even if it all seems planned & coordinated & predictable, unpleasant and/or even unpredicted things may happen (or unpleasant health professionals may be the ones on hand). I have a friend who had 5 ELCS & not one of them was as straightforward as she would have liked.

One question... if you weren't traumatised, which option do you think you'd want, if you were not emotive about it all? Just thinking logically about the risk-benefits tradeoffs, what would you decide?

I like what HardertoKidnap said, basically keeping you in charge of your options.

Hi! I'm new here and pregnant for the first time so you don't have to listen to my advice, but I thought I'd share my feelings with you anyway.

First of all, I admire you immensely for even considering another baby and I'm so sorry to hear about your experience. I'm having an ELCS for my first for the simple reason that I cannot even contemplate the idea forceps. They scare me. A lot.
If I were you, I'd go for the ELCS. I was reading an article the other day that said CS are a lot safer than they were due to better techniques and the fact that most obstetric consultants are very adept at performing them since they are so common now. As for forceps, they were called obsolete and unnecessary. Most hospitals in several other countries apparently don't even have forceps! They manage to deliver babies just fine:)
I had the same doubts as you, and much against the wishes of my DH and his interfering old bat mother, I have decided on a CS. I'm paying for it myself btw, because DH thinks that it is a waste of money. However, since I've already had a minor uterine prolapse I don't want to risk any further damage.
Your decision will be influenced by how many children you plan to have after this baby. If you want no more or just one more, I don't see why you shouldn't have a CS. It is most dangerous when done more than 3 or 4 times. The important thing to take into account is the effect on future pregnancies. I don't plan to have more than two children, so I am happy with my choice. I would be alright with just one as well. It is all a matter of personal preference.

Things can certainly go wrong with a CS as well, but it is a question of weighing the pros and cons. I would prefer to go with the risks of a CS than risk another forceps birth if I were you. I agree that a second forceps birth is uncommon (although I've never found a convincing explanation why?) but it certainly happens. An uncomplicated natural birth is tempting to everyone ( I wish I had the courage to have a home birth!!!) but we have to accept the fact that it isn't always all that simple.

I sincerely hope that whatever option you go with, this birth is a healing experience for you:) Best of luck!

My experience was the other way round so it may help. Had ELCS for breech then EMCS (but not really emergency) for failure to progress. Both great - really happy, rarely gave them another thought. DS2 decided to surprise us and I had a very traumatic VB - felt panicked and out of control, afraid we would both die. DS2 was ill and I ended up with PTSD.

If I had another (and it's a good job DS2 wasn't my second as I love having 3) I would take a c-section in a heartbeat.

But you sound like you have analysed the VB/ELCS question in great detail. I think perhaps when you feel you have worked out every angle in your own mind, you will reach a decision you will be happy with.

Hi Thandeka
I'd just like to second everything qtpie said. My elcs was just fantastic - a marvellous memory. I'm still on a high 12 weeks later. It was painless. Like qtpie I had some discomfort getting out of bed for a week, but it wasn' actually painful. The recovery was really quick and easy. I recovered more quickly than the ladies in my antenatal group who had vbs. In fact, most of them ended up having emergency sections anyway.
Best of luck with whatever you choose.

"DH is fairly adament he can't be my birth partner at a section ........I know he would probably prefer me to VB again but he is supportive of whatever I eventually choose"

That is not supportive that is emotional blackmail, honestly tell him to man the fuck up, find his balls and as the CO-PARTNER in this baby he will be where ever you decide/how to labour. You don't get the choice neither does he. (Sorry but unsupportive partners annoy the fuck out of me, quite happy to be their at conception wasn't he?)

Anyway back to your actual dilemma I just want to add 2 things, firstly if you decide that you are going to try a VB but if things get out of your control you are going to request a CS then please remember you will NOT be a priority (i.e. if the surgeon is doing an EMCS already then you will have to wait). So it is not simple a case of saying bored now please give me a CS (IYSWIM).

Secondly not all EMCS or ELCS have a difficult recovery time, having had both I have far less horror stories than some of my natural birth peers.

the not their.

"DH is fairly adament he can't be my birth partner at a section ........I know he would probably prefer me to VB again but he is supportive of whatever I eventually choose"

So, its not just my DH. He calls me an "idiot" for wanting a c section.
I tell him he should try opening an umbrella up his ass.

Interesting that some of the midwives who are posting are suggesting VB is the way to go but most of the women who have actually been through the experience (myself included) would opt for the ELCS.

Actually re DH, I wonder if a certain amount of sympathy might be due because some people just can't hack the sight of blood. That said, my DH said the ELCS was far easier to watch than the admittedly horrific VB.
I, like you, did get a bit sucked into the idea of a repeat VB at one point but am overwhelmingly glad I stuck to my guns. I got lots of pressure about how 'healing' a better VB would be. In fact, the ELCS was very healing and a fantastic, calm experience - I can't believe the VB would have been any better but it could have been one hell of a lot worse. I do not have a moment's regret.

Wish you luck whatever you decide:)

"Interesting that some of the midwives who are posting are suggesting VB is the way to go but most of the women who have actually been through the experience (myself included) would opt for the ELCS."

My friend always says, if midwives believed in c sections they'd be obstetricians!