Birth Options WWYD

[Sparklyuggs]

Apologies for the length, trying not to dripfeed.

I'm 32 weeks with my first and I've got a mild heart condition which means I have a fast pulse, fatigue and BP was low but has stabilised in the third trimester to normal. I've been signed off work since 28 weeks and advised to rest 3-4 hours a day.

Cardiologist is happy for me to give birth vaginally but says I would need continual monitoring and advises an epidural so I don't tire. However my research suggests that I would need to be lying on my back in a bed with the epidural/monitoring, and this leads to an increased chance of forceps/ventuouse/EMCS.

I'm terrified of instrumental delivery to the point of panic attacks. The Obstetrician has said I can have an ELCS but I'm confused as to which option is best- an ELCS is obviously surgery but can be planned and managed including the recovery. A vaginal birth would be a shorter recovery and better for baby but the chances of instrumental delivery are high and I'm terrified about it (history of sexual assault so have high levels of anxiety regarding vaginal delivery).

I'm not in the UK so a mobile epidural/monitoring device is not an option.

Any advice or thoughts?

I was made to labour on my back and I ended up with a ventouse delivery.

If it makes you feel better, I actually had no idea it even happened until my husband told me afterwards. The contractions were so awful that I didn't even notice a huge 6ft obstetrician wrenching the baby out, so I would say the ventouse was not the worst thing about my delivery!

I did have some follow up issues though - my episiotomy has caused a lot of pain during sex and I ended up with some kind of pelvic inflammation that let me immobile for weeks. Vaginal delivery might have a higher chance of quick recover but I don't consider my own recovery to have been quick at all.

Two of my friends have had ELCs and both have raved about how great it was. One of them had a previous vaginal birth so she knows the deal.

Also, good luck OP

Would you have the option to attempt a vaginal delivery, under the understanding that at the first sign intervention being required you are allowed to have a caesarean? A friend of mine with MS had that arrangement with her OB consultant for the delivery of her DD.

From my own experience - I had continuous monitoring when DS was born and I was allowed to sit on a birthing ball while still hooked up to the machine. Would it be worth seeing if that was an option?

My concern in your situation would be based around your anxiety - you might find anxiety hinders your progress in labour, making intervention or an EMCS more likely. Is there a mental health midwife you can discuss that with? If your main wish for birth is to avoid forceps etc, and your OB agrees, a EMCS could well be your best option. Yes recovery may be tough, but so can recovery from a vaginal delivery and you'd have the reassurance of knowing exactly what the process will be.

Good luck!

Thank you for experiences. No mental health midwives here and no option to be on a birth ball either, I'm sat on mine now as it's so comfy to bob about :) I've chatted to DH and I'm leaning towards an ELCS but I've still got some time to decide.

I would go ELCS. I had a forceps delivery with DS and honestly, the recovery was much longer than a CS recovery would have been. I won't go into details but I would have been far, far better off with a CS.

I am a mother of 3, first 2 via vaginal delivery and emcs for the last. I understand your dilemma but my emcs recovery went so well that I wish I had csections for the first 2 and saved my bits.
To be honest with all these stitches you get after vaginal delivery and feel like something hit you down there for a long time, the recovery is about the same just different. I went into my last delivery with a plan to have an epidural, refuse instruments if things not go well and go into csection. My csection experience was very positive but I wish they let me have planned csection as my dd was never in a right position

I have to admit that given the context, if it were me, and I knew i'd be in a situation where intervention was more likely but I psychologically couldn't deal with it, I would opt for the CSection

I'd go for the section. But I say that as someone who chose a section as maternal
choice, not for any medical reason. It was wonderful. Very calm, well planned and the recovery was very quick, certainly far quicker than friends who had instrumental deliveries.

Thanks everyone, I feel much better now. I felt guilty for leaning towards an ELCS but it's reassuring to hear that you would choose similarly. I know I'm lucky to have the choice too, I love the NHS but I know that getting a maternal request c section isn't always easy.

Part of me worries I'm missing out on the experience of labour but my Mum pointed out that I simply won't care once the baby is here safely and I'll be in a better position if I'm not going into this feeling scared and anxious.

My vaginal delivery has left me with a birth injury from which I will never recover. And I had a calm, drug free water birth! If you're leaning towards a CS then go for it and feel no guilt.

Thanks for all the opinions, really helpful.

A local NCT volunteer made me feel awful for considering an ELCS that's part request, is it so awful that I'm scared by instrumental delivery? I've just been told so many horror stories about third degree tears, long recovery times, incontinence etc.

Some hospitals will do a so called walking epidural. The dosage is lower, so that you can still feel your legs and are able to move around/stand up. I'd ask about this option if that sounds like it could work for you.

double helix that's not an option at my hospital (not in the UK). It's full epidural or nothing.

I had an EMCS after a four day labour and ALL the meds - if I had my time again I'd choose an ELCS every time!

I had an EMCS followed by an ELCS. I don't feel I missed out on giving birth at all. My ELCS was calm, and as relaxed as these things can be. I was able to hold my babies (twins) within a couple of minutes, and recovery was OK, although of course there was some discomfort. Nothing unmanageable though.

Have had both. In your shoes ELCS seems sensible. It's like being handed a present! My vaginal birth was super easy but was still like pooing a melon as the saying goes.

In your position, an elective section sounds like a good option. I've had 2 hospital transfers after un- productive attempts at home birth, I chose a c section rather than continue and risk a damaging instrumental delivery. My advice would be to talk through with those responsible for your care any invasive procedures that may be involved in the c section. For example, shaving pubic hair, vaginal examination, insertion of urinary catheter and analgesic suppository so that you and they are best informed about what the procedure will involve. I hope all goes well and your recovery is swift.

From what you have said, a section sounds like a great option for you. Your mental health is well worth protecting, particularly with your history of being abused. Your cardiology history is also hugely important in choosing.

On the epidural/instrumental issue though, just to say the evidence isn't clear that epidurals cause more instrumental deliveries. It may also be the other way around - poorly positioned babies are likely to need instrumental delivery but poorly positioned babies also cause longer and/or more painful labours so those women are more likely to choose an epidural. If you are still considering vaginal birth, speak to your doctor about this so you have the latest evidence.

In any case, all birth options, section, planned epidural, induction, are perfectly valid options. But reading your posts, a calm, planned section sounds like a good option for you.

Gherkin's idea above of agreeing a very low threshold for c-section if you do choose labour is also a good idea. But just be aware that not all situations that require forceps/vacuum manifest themselves early enough that a section is still a feasible option.

You say your cardiologist isn't specifically advising against vaginal birth but have you asked her which option she would recommend as safest for you? You have strong reasons to protect both your physical and mental health.

Best wishes.

Do not feel guilty about pushing for an ELCS. I assume they have targets to encourage vaginal delivery but you are not a statistic, you are a person. Also, forceps recovery is awful. Sorry!

And I don't often swear online but if I did, I'd have a string of expletives for that disgusting NCT volunteer. How dare he or she? Please don't listen to people who try to bully women into reflecting their own choices.

I had an emcs after a failed induction (5 days between induction start and dd being born)and to be honest all I wanted was my baby out safely.
It was a lovely experience, very calm. The anaethetist kept me informed if what they were doing, dh was still able to tell me the sec of our baby and cut the cord.
I didn't get to hold her straight away but about 20 minutes later we had skin to skin in recovery.
My recovery was fine. I was up and about the same day and apart from being a little sore, I've barely noticed it.
I will opt for a cs next time.