Could do with some advice. ELCS or VB after traumatic first birth?

[karensb]

I am an emotional wreck after meeting with the consultant today. I had a horrific first birth 6 years ago that left me with what I am sure is PTSD and PNT ( got over that on my own after about 9 months) . It took me 4 years to even consider having another and only after I checked with the GP that I would be allowed a ELCS.

Things didnt go so well initially and I had 3 successive miscarriages. This pregnancy is now at 30 weeks and I am terrified.

The consultant has said I can have a CS but wants me to go and have a debrief and look around the birthing centre nearby. She thinks that giving birth out of hopsital would be a totally different experience and even wanted me to have a homebirth.

Trouble is I had a PPH so would never consider home birth and also am worried about pain relief on top of everything. I had continual vomiting from first contraction and gas and air made me vomit too. I eventually had pethidine but would never consider that again as made me feel so out of control.

I did not want an epidural as wanted to avoid ventouse/foreceps but ended up with ventouse anyway.

I just dont know what to do. I dont think my emotional state is that good as when dc was one my sibling was diagnosed as terminally ill and diied 9 months later. So basically I just feel emotionally worn out as last 6 years have been rather hard going.

I want to just have CS and not face all the emotional turmoil of waiting for labour for next 10 weeks but know there are risks attached there too.

The consultant has been really supportive and just wants me to know all options. I just dont know how to make this decision! I would love to avoid major surgery but since no one can guarantee that this birth will go smoothly< i just dont know how to cope with lack of pain relief and labour etc. Oh and both current dc and this dc have crazy big heads, off the scale on the measurements! A family trait from dh!!

Sorry for ramble, but could really do with other people's views who are in or have been in this situation.

If you want an ELCS, then go for an ELCS. Yes there are risks, but at the cost of your mental health I'd be inclided to go with what you want.

I had an awful labour with DS1 which ended in an EMSC and I had PTSD and really bad PND. I knew that I did not want a repeat of that so insisted that I have an ELCS. The ELCS was much more relaxed an I felt in total control as I knew what happening, it wasn't rushed and I can remember the first days of DS2s life, I cannot still now remember anything of DS1s first 4 weeks .

Your consultant might actually be supporting of your CS deep down, but has to be shown that you've been given the opportunity to consider everything and are making an informed choice. I hope (and reckon!) you'll get the birth you want. X

Thanks for that. Its hearing stories like yours that make me have some hope. I know an ELCS has risks and they can be serious but I desperately want to enjoy the experience this time round.

The whole first year of my dcs life is bit of a blur and I cant really remember anything from the first few weeks. I was bed bound for 3 days and the lady opposite me had a CS and was up and out way before I was. I remember feeling incredibly jealous of everyone who had an OK experience.

I do feel that my mental health would suffer if I went for a VB as would stress for next 10 weeks. The flashbacks have been awful since I got pregnant and I have to really stop myself thinking about the birth.

Its just friends keep talking about risks of CS and how second time around, it cant be that bad etc. I want an ELCS but now keep worrying that I am being silly and should just get on with a VB like the rest of the population.

My midwife thinks I am making a good choice with the ELCS and the consultant did say that she would not be doing her job properly if she did have me explore all the options. She is definately happy for me to have an ELCS if I want to still at 36 appt.Its just she has started me thinking and panicking!

The debrief is worth having. Also in my area there is a mw who specialises in helping with birth options if you've had a difficult labour, any bereavements or anxiety issues around birth. Ring the MW office and ask if they have anyone who does that and if so ask for an urgent appointment to discuss your birth options - would an early epidural be a possibility? Or an agreement that if you haven't delivered after x hours you can be listed for c section?

I think the consultant is missing a trick to be honest, if she had booked you for a CS I think you'd feel much more open to the idea of a VB!

ps I am having ELCS. Had EMCS before after a long difficult labour.

I think you sound horribly scarred by your first experience, and if you think you will suffer mentally trying to have another VB, then don't let ANYONE else push into something that is going to stress you out.

Until someone has been through what you've been through, no-one can understand how emotionally damaging it can be to consider going through it again.

Did you consider a VB? Have you ever felt like you were putting yourself or baby at risk with major surgery? What about feeling like you are being a 'wuss' by not attempting a VB?

Sorry, I just dont have anyway to ask these questions to as none of my friends have been in this position.

My ELCS was a lovely experience, calm, relaxed and controlled.

You know you can have one if you want one - so choose to have an ELCS. You are in control of this situation and a CS is a valid choice.

I'm no wuss. I didn't get any G&A til I was fully dilated and pushed for 3 hours on just G&A.

I could have a VBAC to "prove" something but I don't feel like I have anything to prove and with my history I think a planned CS is slightly safer for the baby.
Yes, it's "major surgery" but there are risks with a VB - my friend had a 4th degree tear, way worse than uncomplicated CS recovery if you ask me. She was in hospital for a week and is still suffering 2.5 years later, I was home within 36 hours and have had no issues.

Normal deliveries are great and I fully support anyone's right to choose one but a CS is the right thing for me.

If any of your friends are spouting shite of the "positive mental attitude hun" type then please ignore them. You need to decide on the basis of your own health and sanity what's going to be the right thing for you.

OP, for me personally DS is an only child and will remain so (mainly because of the birth experience). In answer to your questions, if I ever decided to have another DC, I wouldn't even consider TTC before I had an absolute guarantee of an ELCS.

DS went through hell with my VB, so I would consider an ELCS safer (as it's
almost always more calm and stress free than an EMCS, which by its very nature is rushed and in response to difficulties).

And I CERTAINLY don't think I (or you, after what you went through) am a wuss - DS and I nearly died, and there's nothing weak or pathetic about that.

An ELCS was definitely the safest birth for me mentally. As soon as I was pregnant with DS2, at my very first MW appointment I told the MW there was noother option and it was never discussed otherways.

I honestly don't think your MW would have let you get this far thinking you would have an ELCS if there was no chance of you having one. Your 36 week appointment is standard, and you will be given a date for the ELCS then as well if that is definitely what you want.

Nowaynohow thats exactly how i have always felt about having another. However, after the death of my sister, I did not want dc to be alone in later life and miss the experience of having siblings.

The birth has always been a major fear when trying to conceive but the recurrent miscarriages eventually overtook that fear as there was no point thinking about the birth when I couldnt even keep pregnant. I went to the GP when first trying to concieve and only carried on as she was certain I would be allowed a CS.

This pregnancy has been very stressful with severe sickness and so far just even keeping the baby has been the focus. now that time is looming towards the birth, those initial fears have come back.

I know an ELCS is the best for me and particularly my mental health and that of others in my family, who have to put up with my stress. Its just I keep panicking about it. I should stop and just focus on having a healthy dc at the end of all this and not being the mental wreck I was last time!

Thanks for all your messages. It just helps to talk things through and get other peoples outlooks.

I am 35 weeks and have just confirmed my elcs after horrible birth experience with ds. For me the risks are managed ones with cs and that is the only way forward for me. Actually I got agreement from consultant before ttc so just needed to book the day. By far the majority of planned cs that I hear about are positive experiences. I would go for cs and then give yourself permission to relax.

Thats exactly it Anchorwoman I feel that the risks of the CS are mainly known and I can cope with at the best, pain for 4 or so days if all goes well. Who knows what could happen with VB!

I have many friends who have had numerous CS because of medical reasons and all are positive. JUst none who have had traumatic VB! Lucky buggers!

If I was in your situation I would have the ELCS, in a heartbeat.

I had an EMCS and the section itself was actually not that scary or painful. I was home 36 hours later and it was really more discomfort than pain, they give you good pain relief usually.

It sounds like you want the ELCS but are afraid of being seen as weak or something for not just 'getting on with it'. But this is definitely one of those times when you should not give a hoot what other people think! Do what's best for you, no one else is going to have your baby for you so they don't get to have an opinion on this.

When I was in your position, the only way I could cope was to try distance myself from the emotional side of it and immerse myself in the evidence and facts. I found the RCOG guildelines very useful -this link takes you to them: www.rcog.org.uk/womens-health/clinical-guidance/birth-after-previous-caesarean-birth-green-top-45 , and also the NICE guidelines.

In the end I went for an ELCS, it was the only decision I could get comfortable with, both in terms of the clinical evidence and my mental state. It was definitely the right decision for me, ELCS went smoothly and was very calm and managed, and I walked out of hospital less than 2 days later with an entirely healthy baby. No regrets at all, it was quite a healing process for me.

It sounds like for you the emotional risks by far outway any physical ones. I would also think about your future plans too. An ELCS might limit plans for future pregnancies. I've just come home after my third CS (the 1st two were emergencies). All the way through this time, I've been warned about increased risks. The 1st 2 were ok, although you do feel pretty useless afterwards but this last CS was far less straight forward and very uncomfortable. If this is your first and only CS then sounds like a good plan for you. If you might be considering more childen later then it might be worth reconsidering all options. At the end of the day all births carry a risk but you go with what you feel happiest with.

Have the ELCS, definitely. You have thought this through already. 'It sounds like for you the emotional risks by far outway any physical ones' - this, exactly.

You are not a wuss for choosing a c-section. I had a 4th degree tear & traumatic birth recently and was told before I went into surgery to be stitched back up that I wouldnt have another baby 'naturally' and that any more should be a c-section (which is a huge weight off my mind, now just to work up the courage to have sex again ). You have had a VB, it wasnt a great experience so there's no need to even think about risking going through that again.

Just want to agree with everyone's posts. OP, you sound like you have made up your mind but perhaps you feel that a VBAC is somehow expected of you? Try to have the courage of your convictions and tell yourself you are an intelligent person who has made your decision for the right reasons.

The medical community will all think differently - I am in similar position although my first birth was not overly traumatic so I am genuinely considering a VBAC. I've seen two hospital midwives, both of whom clearly have differing personal opinions which has rubbed off on me each time! One thing I have been told is that around 32 weeks, your body produces a hormone which is designed to help women feel mentally able to prepare for childbirth. Maybe give youself a couple more weeks before you make the final decision, as I understand you don't have to do it until 36 weeks if you want the ELCS? I was told yesterday that I could proceed to full term and then decide to have an ELCS instead of induction, pretty much at the last minute.

Keep telling yourself - it's you who is in charge. No-one can deny you the ELCS, all you have to do it say, yes, I want it. You are in total control of this situation.

Good luck
x

I had what, on paper, was a fairly normal birth. Albeit ending in a 3rd degree tear.

However, I found the whole experience utterly traumatic. I hated the whole thing, and dreaded going through anything remotely similar in the future. Suffered flashbacks and bad dreams for about a year following my daughters birth, with the dreams coming back as soon as I was pregnant this time.

I have swung backwards and forwards through this pregnancy. Not knowing what to do for the best.

I know all the pro's of natural birth, I have lots of friends who had beautiful natural lovely births - but I cannot get past the feeling that I JUST CANNOT DO IT again. No matter how lovely it may be - I just cannot take the risk that I'll end up with a repeat experience.

I think big factor for me is that I know that in order to birth well, I need to be relaxed and trusting in my body and those people around me. But my previous experience means that I know I won't be able to that in a month of Sunday's - no matter how positive I try to be. Which means I'm more likely to end up with intervention and another bad experience. It may seem negative. But I feel I have to be a realist in order to fully risk assess.

I also have the 3rd degree tear to consider, as I still have symptoms relating to that 2.5yrs on from my daughters birth. The general consensus on that front is if you're experiencing symptoms related to the damage, a subsequent vaginal birth may make those symptoms worse - regardless of whether you tear again or not.

So I'm having a c-section. I'm proud of all the research I've done. I'm not copping out. I've opted to go through a major abdominal operation in order to preserve my mental state, and what's left of my perineum!

I am similar to Cosmic in that my birth wasn't nearly as traumatic as some, and in many ways I don't even really understand why it has made me as anxious as I am.

Essentially I had a pretty trouble-free labour, managed pain well to 5-6cms, then got epi, nice and relaxed etc, but had long second stage (2.5 hours) and ds got stuck, had to go to theatre and be prepped for section/ have him pulled out - Kielland's forceps. They lost his heartbeat and he didn't cry for a minute BUT he was back with me quickly, it was apparently a "textbook" forceps delivery, very "straightforward" etc according to debrief...

And yet...

For me, the mental pressure all comes from the fact it was so calm, and then it was so chaotic and I didn't really know what the hell was going on and no one really explained any of it, or spoke to me about it afterwards. I actually had a total out-of-body experience, I was convinced that my baby was going to die throughout (even though notes apparently indicate that it was all hunky dory for them) and my "flash" memory if of him being held up and looking so blue and limp (his Apgar was lowish) and really believing that he was gone.

The funny thing is, if I had to do THAT labour/birth again I could cope.. but I think that it just highlighted the potential unpredictability of it, and I am not coping so well with the "what ifs" of what could happen that would be much worse. Statistics don't reassure me, facts don't reassure me, I just feel a bit in a state about it and also quite sheepish/foolish as rationally I know that it doesn't make a huge amount of sense that I am as afraid as I am and that really, birth can be messy/difficult and there are a LOT of women who have been through a LOT worse.

But what can you do? I can't seem to control my thoughts on this one... so midwife is saying I should think about elcs just to take that panic away.... only 23 weeks yet so don't know.. but do find myself willing baby into a breech position so choice is taken away from me!

Good luck with your decision...

My first was a c section and my second was a vbac (followed by huge PPH). I still preferred the vbac to the c section! However that was a c section after a horrid labour and a planned one would be different. I think so much of how you feel about a birth revolves around how supportive the team were that deal with you, the midwives etc, whether you felt in control etc. I ended up in intensive care the second time but the first time was more traumatic for me for those reasons.

However I was told by my obstetrician that after a huge pph they would rather I had a natural birth next time blood loss was more likely after a c section than a natural birth (the womb not contracting is a major cause of PPH and in a c section I thought this was more likely as it had not been through labour).

After 2 difficult births there isn't going to be a next time sadly.

Obviously my advice was from an obstetrician to me - in your case its obviously worth talking through your notes from your last birth with an obstetrician so you can have a proper clinical viewpoint

My experience is similar to working and CosmicMouse

Debrief suggests a fairly straightforward birth and that everything was handled very well... my notes do state that I requested analgesia at the beginning of the second stage, but this was refused (including gas and air) and over 4 hours later hadn't been reviewed. Eventually had a forceps delivery with spinal, but I was certain we were both going to die and wished it would just happen quickly.

I cry every time I write/talk about it. DH thinks I'm obsessing. I'm trying to consider all my options and I'm just going round in circles. What I want is a VB but scared that I won't be able to handle it and will have to go through the same thing again (sure part of the problem last time was the panic and confusion I was in). Support was supposed to be put in place at the hospital but it's not being followed through and I'm sick of feeling like a pain in the arse trying to chase it. Honestly don't know what to do :(