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Childbirth

Share experiences and get support around labour, birth and recovery.

Unsure - ELCS or natural birth with Epidural. Advice please!

33 replies

gemmakate · 15/04/2012 10:22

I'm currently 33wks pregnant and need to make a decision re delivery.
DS1 was 10lbs and following an induced, very long labour I ended up with v bad tear (and subsequent incontinence problems).
I'm due to see NHS consultant on Friday to discuss delivery and make my decision, but I'd really appreciate some advice!
I think if I could guarantee an epidural I would try to deliver naturally again, but despite my telling my midwife this at every appointment, nothing has been added to my green notes (on asking why I was told it was too early?!). I've heard so many stories from friends (and the dreaded OBEM) where epidurals seem to be denied with a "your doing so well without" attitude, perhaps due to cost?
I met with the consultant at 20 weeks and although kind, he seemed very blasé towards my tear and concerns, saying at 5'8 tall I should expect a big baby and it's perfectly normal. (I wanted to say it doesn't mean I've got a big fanjo!) My husband offered to pay for an epidural but this was shrugged off and told one would most probably be available!!
I am so scared of starting off and being denied an epidural due to no anethastist available etc, and ending up with the baby getting stuck/tearing again/ending with an EMCS, that I'm beginning to feel perhaps I should put my foot down on Friday and opt for the CS.
But then there's the recovery with a 3yr old to look after.
My midwife assured me I was expecting a very small baby this time when she assessed me on weds, only to be told yesterday at a private scan that the baby is already well over 5lbs, with 7 weeks to go, and is on course to be another 10lbs plus whopper!
Just some advice from anyone who's been in a similar situation would be great.
Thanks.

OP posts:
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Ushy · 15/04/2012 14:31

If you have had incontinence problems, follow your instincts re elcs.

If you have a bad tear and incontinence following it, you are more likely to end up with worse incontinence afterwards if you opt for a vaginal delivery. It is not a certainty - just more likely.

You do find lots of midwives and obstetricians pushing vaginal birth so that can get their caesarean stats to look right. That is completely wrong IMO.

They should be honest and give you the facts so you can make your own decision. There is no absolute 'right' decision but it is going to be you not them that lives with the consequence.

Good luck Smile

Pitmountainpony · 15/04/2012 15:22

I had a10 pounder plus first time....ended up with an ecs , opted for elective c section next time.......as soon as I had the epi and they offered vaginal if I wanted to give it a go, I felt I could have but dh was adamant I have the cs.......he had seen how hard first time had been and just wanted healthy outcome.
Now dd was average sized baby....maybe I could have pushed her out....but I am happy with c sec......the worst is to end up with ecs...odds of bad outcome are much higher. There is no way I would risk birthing a big one without an epidural....li think it barbaric. They cannot guarantee you will get one.
I was up and about 6 days after cs.......but walking on day 3 with painkillers.
My dh has looked after ds and now 2 weeks later I can manage but avoid lifting.

Do what you feel you prefer.....I would be going for the c s as I have had excellent experinces of them.....particularly a planned one.

fruitybread · 15/04/2012 15:26

gemmakate, I'm sorry you are in such a dilemma - I haven't experienced anything similar so can't offer anything from that POV, but I just wondered -

An epidural won't lessen the chances of you tearing again - and as Ushy says, having experienced incontinence issues before, there is an risk that they will get worse after a VB. That's the main reason they are discussed for subsequent births.

I can't quite tell from your post if it is pain during labour or tearing that you want to avoid this time, is all.

But in any case you are right to be wary about the availability of an epidural on the day. For all sorts of reasons, there isn't a guarantee you will get one, no matter what is in your notes. That sounds very negative, sorry - but given your circumstances, I don't know that it would be helpful for you to go ahead with the knowledge that you should get an epidural but might not.

Btw, your consultant sounds like an arse, sorry. You can always ask to see another one.

MsMoo · 15/04/2012 17:01

Try and get hold of 'Caesarean Birth: A positive approach to preparation and recovery' by Leigh East www.csections.org It has a full analysis of the pros and cons of both VBAC and repeat caesarean.

It is a real and valid concern to worry about whether or not you will get your epidural in time. It is unfortunately the case that delays happen and you pass the point at which an epidural is possible. However a planned caesarean, while having a lot of pros above an emergency caesarean is tricky and with a toddler around needs extra planning. The book talks about how to prepare for and recover from caesareans and also addresses the issue of preparing the home and family for a surgical birth.

The best of luck to you. I am convinced information is power and feeling in control of the decisions can go a long way in influencing how you perceive and recover from your birth - which ever way you choose to do it.

Good luck.

gemmakate · 15/04/2012 22:21

Thank you so much for your replies.
It's great to get as many angles on this as I can.
I think I've got the old fashioned attitude of being respectful to the consultant and taking his lead, I never thought of a second opinion. But deep down I know their advice can be driven by funding and not what's best and will ultimately be more beneficial to the patient.
So I'm going to get the book you suggested MsMoo and go into my appointment on Friday armed with knowledge and as much info as possible, and if I don't like what I'm told, I'll ask to see another consultant as fruitybread suggested!
Thanks again fellow mums xx

OP posts:
elizaregina · 16/04/2012 09:14

www.mumsnet.com/Talk/childbirth/1443854-Who-has-had-normal-birth-and-a-c-section

Hi don't know if this link works, I got some really positive feedback on here about ELCS>

From what i have read on mumsnet I am shocked at consultants, I really am. I just don't believe alot of them give two hoots about the person in front of them and what they have been through or what damage " natural" labour has done to them.

I also hate the pressure as well that having an ELC is somehow not natural, its natural for our times of living right now! If my friends had had natural births, without intervention - 5 of them would be dead right now and one baby did indeed die. As someone on here said before - the best outcome from any birth is a safe and well baby and a safe and well and not damaged mother!

What we want is the proper pros and cons with each individual situation but they just seem to push "natural" no matter what. So I don't trust them one little bit.

i too by the way would be more inclined to consider " natural" if I could be guaranteed an epidural but last time there was no sign of one at all, I kept asking and it was never the right time. Now of course after reading on here that they try and fob you off - I just dont trust them! You arnt even guaranteed you can get into the hospital to have the baby!!

Potol · 16/04/2012 09:32

Was booked for an ELCS but had an EMCS as I went into labour but it wasn't an 'emergency' iykwim. It was relaxed and lovely, the doctors were chatty and friendly and the anaesthetist was discussing the morning's cricket score. Took painkillers religiously- totally fine without a twinge in a month. Also breastfed in the recovery room, got given plenty of bf support, and have continued to bf without problem since. Had I been able to deliver naturally I would have definitely asked for an epidural but as you pointed out, there is no guarantee of getting one. Also, if you have a child already, having an ELCS may help you plan childcare etc. yes, the recovery is a bit longer BUT I have friends who had terrible vaginal deliveries (and you sound like yours was fairly traumatic) who took just as long to recover.

gemmakate · 16/04/2012 09:50

It just seems there is such a lack of choice for women, surely we should have enough information available to be able to make an informed choice as to the best delivery for our particular situation.
I feel like I'm going to have to fight for my right to an ELCS on Friday and it's something I'm worried enough about going through anyway!
Thanks for the advice and support, I'll keep you posted as to my outcome.
Gemma

OP posts:
elizaregina · 16/04/2012 10:24

I feel exactly the same, I am very early with my current pregnancy but every day I am worried about the birth, and I know I am going to have to fight for an ELC too.
Knowledge is power and try not to be intimidated by a consultant....My line of attack will be that they cant even guarantee I will get into the labour ward, ( I know of lots of people turned away as too busy), after last time, they cant guarantee me epidural and they certainly cant guarantee me a straightforward birth!

However with an ELC I should be guaranteed getting in ( what have things come too), only a handful of things can go wrong, compared to many more with V delivery, one cut - nothing else below....and thats it really!!! All much more assured....

xkcdfangirl · 16/04/2012 11:47

I have a friend in a very similar situation. She's going for ELCS and and it sounds like this could be the right thing for you too gemmakate. The scar tissue from your previous tear will be more susceptible to tearing again than unscarred tissue and any incontinence probs will almost certainly get worse even if you don't tear as badly. An epidural won't prevent this (could actually increase the risks of tearing as with your nerves all blocked you'll have less info about what is going on down there and will be totally reliant on the midwife's judgement about when to push/not push).

I think you may be confusing the issue by focusing on VB with epidural as the alternative to ELCS - your MW and consultant will be taking this to mean that your main issue is the pain of the actual birth and they are doing their best to encourage as many women as possible to avoid the expensive CS option. Focus instead, when you talk to them, on your very real and reasonable concerns that a VB, with whatever pain relief, has higher long-term risks than you are happy with because of the seriousness of the tear last birth. Explain that you understand the risks of CS but that you find these more acceptable than the risks of a second VB in your particular circumstances.

There are definitely risks to a CS too and a straightforward CS takes much longer to recover from than a straighforward VB. You will have difficulty looking after a 3yo and a newborn when you have a CS wound trying to heal, but I think if I were you I'd consider these risks worth taking

Pitmountainpony · 16/04/2012 19:19

As long as your partner can take a bit of pat leave I really do think recovery from c section is more straightforward, as long as surgery is regular and no complications occur. Two weeks on.....my scar has totally healed, I am off painkillers, able to start doing housework.
I guess I would not drive yet so that would be a concern perhaps but if my dh was going back to work today I would be confident to look after my toddler, just avoiding lifting him, staying close to home.
Never had a vaginal so I cannot compare but I was walking on day 3 with painkillers and out to a park on day 6......so I do not think recovery is as tough as maybe it used to be in the past but of course we all recover differently.
Elective has been much easier than emergency......all that pushing for nothing.......my bones ached for months afterwards..that was worse than the c sec wound which did make me think maybe recovery from a grueling vaginal could be worse that an uncomplicated c section.......but of course surgery is not without risks so you are right to consider all your options.

gemmakate · 16/04/2012 21:49

Thanks again for taking the time to reply.
I'm now feeling more confident about going through with a ELCS. I was really surprised when speaking to my parents that they also both think it's the safest option for both me and the baby, and that has got to be the main concern... A healthy baby with a safe delivery.
The book MsMoo suggested is arriving tomorrow, and you're right xkcdgirl, I was confusing the issue by focusing on an epidural not being available, rather than the fact that the problems I've had with incontinence are due to delivering a big baby first time around (let alone second) and that the tear can and probably will tear again.
All in all, I feel much better about facing the consultant with my request for an ELCS, i will have my answers ready and can always ask for a second consultant opinion if needed.
I will let everyone know the outcome, thanks for your time.

OP posts:
gemmakate · 20/04/2012 18:52

Well I went to my consultant appointment today...
Firstly, I didnt get to see the original consultant (who suggested an ELCs back in January) the lady I did see had no idea why I was there and sat reading my notes while the mw took my blood pressure etc. I had to calm myself down as I felt worn out at the thought of starting all over again to state my case and had been told previously by a mw friend that this particular consultant is totally anti ELCS!
To cut a long story short, it was obvious that the consultant was not keen on granting me the ELCs, despite admiting my tear was a v bad one (she pointed out that it was millimeters from my anal sphincter so could have been worse, dont know how i didnt laugh) and that the incontinence (bladder) I suffer from will almost definitely get worse. She actually suggested that I go for a VB, that tear would most probably re-tear badly but then I could have it all mended in one go afterwards!
I said I'd never heard anything so barbaric! Told her I'd read all the risks involved with a planned c-section, wasn't making the decision lightly but felt it was a known quantity (with a VB being a very unknown quantity) and that I had lots of support at home from husband/parents/in-laws etc. I also said id made an informed decision and could not see myself going through a terrible VB again and that I'd go private if necessary. I also showed her results from a private scan I had on Saturday (I knew I'd get no growth scan today) showing my baby is again predicted to be very big like my first and the head is on the 98th centile again.
At this point she made a call to see if an incontinence specialist was available to see me to asses my case. She wasn't, so I now have a second appointment on Tuesday. I asked the consultant what my chances were of her agreeing as time is going on and I want things sorted. Basically, I was told if this specialist agrees then the consultant will (reluctantly) agree to the ELCs.
I feel exhausted with it all and in need of a glass of wine!!!
What are your thoughts ladies?!!

OP posts:
Ushy · 20/04/2012 22:00

Gemmakate I think you have been treated appallingly. I would complain but what about also asking for an appointment with the original consultant who seemed much sympathetic.

Good luck Smile

Potol · 21/04/2012 12:06

Appalling is the right word. She really has no right to push her agenda on to you. I'd complain AND ask for the original consultant as Ushy suggests. The mind boggles, it really does.

xkcdfangirl · 23/04/2012 22:40

Don't fret too much till you've had this other appt, the most likely thing is that this second specialist will agree and all will be well. However, definitely request a 2nd opinion from the January consultant if it doesn't get agreed. Good luck!

gemmakate · 24/04/2012 10:53

Thank you. Am off to appointment now and I feel really nervous!
After another night of tossing and turning I've got to fight my case!
I will update on here later.
Gemma

OP posts:
xkcdfangirl · 25/04/2012 21:17

So - I hope it was good news?

gemmakate · 30/04/2012 11:29

Well the second consultant I saw firstly asked me why I wanted a c-section, then went on to point out all of the risks (including things that you can be more at risk from in ten years time after a csection like increased risk of hysterectomy ((??)) and future birth delivery issues) and then asked me if I still wanted an planned csection.
I said yes, that the known risks were preferable to me than the unknown risks/issues that could and most probably occur from a Vb.
So I've been accepted for a planned csection and should be on or around 25th may (week 39)! I feel like a weight has gone off my shoulders and now feel calm and ready to meet my baby.
Dh has booked time off work and family are all prepared to help out.
I've been reading the book MsMoo suggested above and all in all I feel really relaxed and happy about my choice.
Thanks everyone for your posts.
Gemma.

OP posts:
bristolboop · 30/04/2012 13:03

Hi gemmakate I'm really pleased you managed to get your elcs. I am also expecting a giant baby (head and stomach at 99th percentile) after 3 growth scans but I am a 5ft ftm with size 3.5 feet so I have also managed to obtain agreement for an elcs at 38+5 this Friday! Like you, it's a weight off my mind and I'm actually getting excited about baby getting here! Good luck Smile

Potol · 02/05/2012 20:01

Excellent news. If you have any other CS questions feel free to PM. Would advice buying some mesh knickers, taking all the painkillers they give you and taking it easy. I hope you have a relaxed experience and let us know once you have met your baby!

xkcdfangirl · 15/05/2012 18:53

Really glad to see that it's been agreed now. Wishing you all the best for the 25th!

LullabelleStar · 16/05/2012 15:42

Midwives do not push vaginal birth because they want the stats to look better- they are advisors and safeguarders of natural birth and they want what is best for the women in their care- and should support whatever decisions that woman makes as long as she has been given all of the facts to make an informed choice. They know and have also cared for women experiencing natural birth, and caesarean births, many times over- before, during and after. They know the risks and benefits of both and so naturally promote the option that is associated with the least complications- and this is vaginal birth. This is not the case for every woman, but is is for the majority.

It is easy to doubt their methods, which they may not always get right, but don't doubt their intentions.

Elective caesareans don't come without risks of their own, as I'm sure has been explained to you- there's the risk of major surgery- infection, bleeding, anaesthetic complications and hysterectomy resulting from sever post-partum heamorrhage. The recovery time is longer, mobility is restricted and there are risks to the baby as well- no labour= no expulsion of fluid on the lungs and babies who are born via elective section are more at risk of respiratory distress.

VBAC (vaginal birth after caesarean section) is (as I'm sure you know already) associated with a smaller increase in the chance of sustaining a womb rupture, though this is a very rare cmplication. VBAC success rates currently sit at 70-80% depending on which hospital you go to.

Epidurals also come with risks of their own- they're a medical procedure performed by an anaesthetist- most hospitals have anaesthetists on call specifically for maternity, but not all. Anaesthetists don't just deal with anaesthetics- they're called to cover the ITU often, required in emergencies and resuscitations in a+e, and have to be present in caesarean sections in maternity. They also have to give care to other labouring women and are somtimes not always available on cue.

Epidurals are the only form of pain relief that aims to take away the pain of labour- they act on the nerves that supply the uters, though they often do not remove the sensation of the baby descending, and of pushing. The most common complication is that they don't work effectively- they have to go in to a specific space in your spinal area and sometimes they're not in the right place as everyone's anatomy is different. Sometimes the anaesthetic doesn't always 'hit the right spot' so to speak. Epidurals are associated with an increase in intervention- needing your labour induced or augmented (this is a risk factor for womb rupture) and you're more likely to need assistance to give birth- either with forceps, ventouse or a caesarean section.

There are also risks of a dural tap headache- where CSF leaks out and you are left with a crippling headace (though this is rare) and risks of permanent or temporary paralysis (even rarer)

They restrict your mobility significantly, meaning that you can't stay upright, gravity doesn't help to bring he baby in to the birth canal in a better position and labour can be prolonged.

I hope the above has helped- it's important you consider the facts before making a decision, though ultimately you must make one that feels right for you.

Have you considered writing a birth plan? This could express your wishes when you are otherwise engaged (ie. with contractions!) and help your caregivers to understand your wishes, requests and reasons for doing certain things.

Good luck! I hope your experience is a very positive one x

elizaregina · 16/05/2012 16:47

Lulablle star I would love to belive what you have said but many women on here seem to have had horrid problems from a 1st labour and asked for a second so stop futher damage and they seem to have had a really hard time getting one.

Also many many women including myself now - know - ie far far too late that infact an epidural is not " on tap" ......no one told us this when we were happily naively " choosing " our pain relief and ....writing this into our birth plans!

I like many women read alot and carefully considered the difrent pain relief options only to be totally strung along when in pain.

1st timers especially need to know that in fact - you may write in your birth plan you want one, but that indeed - the person who does it -is as you describe often un available.

Therefore you may be left in pain with whats available that simply isnt helping you. Everyone has seen one born every min, where a woman is left like a wild animal in un beqarbale pain, to be given an epidrual and suddenbly they are sitting up - back to normal all hapy.

My own small circle of friends all had horrific vaginal birth complications including still born. The women I know who had breech babies and had c sections all said it was a lovley wonderful experience. I have never heard a woman say that about labour.

I am so glad for mumsnet because I think alot of women do think that the caregiver/midwife - consultant is thinking of whats best for them, and from evidence of many personal experiences on here that frankly does not seem to be true.

LullabelleStar · 16/05/2012 18:33

The thing to remember with OBEM is that it is edited- long sections, interactions etc. They also pick the cases that are the most dramatic- it is not representative of all experiences as they simply pick the ones that make the best viewing.

Similarly to negative birth stories- people love to share the drama, but not so much when things have been straight-forward, particularly when things have 'gone-wrong' for your friends- why brag about your natural birth and potentially make them feel guilty (I know some women do this regardless but the some women I know have kept shtum about their amazing experiences for fear of being trambled on/making their other friends feel negative for their not so great experiences).

It is so important to be aware of all options in labour and birth- and not just pharamcological pain relief either- alternative methods, such as water, aromatherapy, massage, hypnotherapy- have all been shown to be effective coping mechanisms in labour by those who are trained to use it. This may not be everyone's cup of tea, but it is worth exploring- that way you are fully informed and perhaps have other means and choices in labour in case stronger methods are unavailable at the specific time when you want them, an unfortunate side-effect of putting your birth management in someone else's hands.

There's alos a need to understand the basic biology behind birth and the way that it works- women labouring physiologically, who are well supported, allowed to labour and birth in an upright position, who are made to feel safe- produce very high levels of oxytocin (the hormone that makes you contract and labour more effectively) and endorphins (natural pin-relievers) that allow a woman to progress and cope with the labour experience.

Hospital environments, when brightly lit, bustling, with care-givers who do not promote a safe and supportive environment, in contrast: reduce oxytocin levels leading to more interventions, and encourage women to produce adrenaline. Adrenaline counteracts these hormones and endorphins, meaning women are more likely to feel more pain, and therefore lose control.

Hospitals and the medical model of birth do not understand this basic physiology, and so this has contributed to a culture of women who fear birth, and experience birth trauma at the hands of those who do not safeguard it.

I am not talking of the times when there are genuine birth complications, but it is well known that many of the complications are iatrogenic- caused by those who seek to improve it because they do not know when to stand back.

There is also the notion of imfored choice- we have a society in which this is promoted, but people need to know the risks and benefits, and the long term implications (for example research has now come out suggesting those women who are not exposed to these high levels of oxytocin, such as in induced labours and elective caesareans, can have long-term bonding issues wth their babies, leading to long term behavioural issues) of such options- and weigh that against their own personal views, not just the views, opinions, and experiences of others.

A completely 'natural' experience isn't always appropriate or wanted by some, but it is safe for the majority of women- but women also need to have options- through education and open discussion with Midwives and Obstetricians.

Sorry I'll get off my soapbox now. My advice would be never watch OBEM. It just isn't realistic and it scares the pants off me! x