I'm scared to give birth. Should I have an Elective C-section?

[Sazzamac1983]

I am only 6 weeks pregnant. I have always been worried about giving birth and have been a birth partner for my sister.

I am pretty comfortable with operations - I've had a few General Anaesthetics in the past and had to have a D and C last year for miscarriage.

I have always thought I would get a C-section as my worry about severe tears, forceps etc is a little overwhelming.

I would love some advice from anyone out there who has had both a VB and a CS.

What is the worst thing and the best thing about each?

Are they? I thought that risks for elcs were slightly higher, although possibly in different areas of risk to vaginal birth.

The point is, you can have a difficult birth whatever the method of delivery.

I'm thinking the risks with the C-section such as damage to the uterus or other organs are more rare but more serious (life-altering), while risks with VB are more common but less severe (such as 4th degree tear, temporary incontinence).....

Also I suppose the exposure to risk with a C-section would be exposure to human error while the exposure to risk with a VB is exposure to nature. (In very broad terms)

For some reason I trust people more than nature - is that weird?

Risks for ELCS are higher than VB (depending on the other risks involved) but much lower than the risks of EMCS.

I don't know about the nature V human error thing - vaginal birth becomes more risky for the mother as interventions increase, but the baby can struggle due to position (eg dystocia) the cord etc. ELCS carries a higher risk of breathing difficulties, and although soe of the maternal risks are due to human error, some are just part and parcel of the risks associated with surgery.

hazey and Lj
Did you miss this comment?
"I have a client who is an obstetric surgeon and I asked her [...] She said for women over 35 the overall risks are slightly lower with a C-Section"

Maybe for women under 35s it's the other way around. But the OP said she is 35.

And I was 40, and told the risks were slightly higher by my consultant before having ds. I am just giving my experience.

Also I would say that a 4th degree tear and incontinence (which can be permanent, not just temporary) are severe - not life threatening but they have a serious impact on quality of life.

I'd be interested to see statistics on ELCS v VB and what the differences are in terms of risks and outcomes.

I'm not denying that, I have continence issues from a 3rd degree tear which required extensive surgery) followed by a 2nd degree tear a year later. I'm just saying there are also long term risks to elcs (not just emergency sections), and some if those risks are increased in electives (breathing difficulties for example)

I was told in the various consultations I had before birth (I had to fight for a c section) by the consultant that risks were slightly higher, and several papers I read said the same. However, I believ in recent NICE studies, the risks have been more evenly stated - is the risks are similar, but in different areas

Sorry, typing one handed! That should be an ie not an is!

I didn't miss that comment. It sounds like the ops client was talking about her personal experience and opinion as an obstetrician, rather than actual evidence.
I'm basing my statement on evidence, even for a 35 year old primigravida.

I 100% second anybody who's suggested hypnobirthing

Everybody I know who has had sessions (myself included) has had an amazing, fearless birth where they've felt totally in control. The birth of my daughter was the best experience of my life.

Definitely worth looking into OP, and best of luck x

There isn't an increased risk of breathing difficulties if cs is at 39 weeks or later. Cs is really incredibly safe from baby's point of view. Although the stats regarding outcomes are broken down for elcs vs emcs, many of the elcs are still taking place for a medical reason and so the risks are already higher for that group. There are no stats published on women having cs for no physical medical reason- the risks are even lower for that group and are essentially those associated with any surgery. For a first time cs and especially if you are a healthy bmi the risks are absolutely tiny.

As I understood it, the breathing difficulties risk is reduced greatly at 39 weeks, but there is still a small risk, exacerbated by the fact that labour hasn't started (as would often be the case in an emcs) and the baby has not been squeezed through the birth canal.

I was a healthy BMI with no health issues when I had ds, although I guess being 40 (41, by the time I had him) may have could ted against me. Many of the risks associated with caesareans are things that could occur whatever your health.

I had a VB with my first and an ELCS with my second. Preferred my VB hands down, and on paper it was a difficult labour. Was induced, in labour for 3 days then baby was face presentation so really difficult to push out and had to have an episiotomy and ended up with a 3b tear. So possibly many things that you are scared of. I was adamant I wanted a VB second time round but changed my mind at the last minute when they told me I was fairly high risk of faecal incontinence if I did. I didn't like my section although it was completely straightforward and the staff were lovely.

When I was in labour I was an active participant being supported by others. With my csection I felt like a piece of meat on the table and also felt like I was a job to get done ready for the next one. Although the staff were engaging and caring I couldn't help but feel that way.
Despite my tear and everything I recovered so much quicker with my VB and found the csec sooo painful afterward. I couldn't lay down for over a week and hobbled everywhere whereas I was normal by the next day first time round. The only plus was a scheduled section was handy for childcare and I wasn't as tired when he arrived

I am also in two minds (not currently pregnant but thinking a out my next one)

This was my experience...

I had a fairly traumatic birth (55 hours labour, waters broke, induction, ending in c -section and a 7 day stay due to baby getting infection as it was 55 hours since waters broke)

The recovery was ok-ish..... The first 14 days were awful. I couldn't make it to the shower so had a bed bath until 48 hours after. Had to get HCA to shower me, very difficult and found embarrassing.

I couldn't change many nappies, had to get DH to change at night as there was no way I could kneel and bend over on the floor. Getting out of bed was a nightmare for feeds every 2 hrs and I ended up getting bad back from awakwardly moving about.

However after 2 weeks recovery rapidly improved and I felt completely normal by 6 weeks post c section.

I have had both a c section and a vbac which was very complicated with forceps, episiotomy etc. Even then the vaginal birth was much better than the c-section and the recovery is so much easier. Just my personal experience but i would never have a c-section by choice. Also i'm quite vain and i hate the ugly c-section scar, i feel deformed because of it.

mammabear
I did hypnobirthing and didn't have an amazing birth experience. It most definitely was not the best experience of my life. The hypnobirthing helped me feel positive and confident beforehand but it made f-all difference to the crap midwife who didn't give a shit about my birth preferences. My birth wasn't horrendous either but I certainly felt disappointed and slightly bitter about the promise of an "amazing" birth. There are no guarantees.

I've had both. Both were not great in different ways, but recovery from the elcs was much quicker than longer term issues from the vbac.

If the issue is control over outcomes, then I'd go for elcs every time, especially for a first child.

One of the disadvantages for cs is around health for the baby - non exposure to beneficial bacteria whilst in birth canal (I believe they are trialling swabbing vagina then baby's face in the USA, gross but gives the exposure which is meant to be good for immune system!).

Yeah it's called vaginal seeding I think, I know one or two people who have done it (in the U.K.).

Gretagarbled I think you hit the nail on the head!

It is control over outcomes that I want!!

I think I would put up with pain and recovery just to have that known outcome!

I think that's my decision made!

Thank you!!

I asked about it for both of my ELCSs and was advised against it both times because of the strep B risk.

Glad to have helped

Good luck - whichever way it goes there is more than a good chance you will have no serious issues at all.

Your body was not designed to give birth. It evolved, which is something entirely different. The way in which humans have evolved, with big brains and narrowish pelvises, makes child birth rather difficult for us, compared to other monkeys.

That's not to say you shouldn't check out hypnobirthing. It's good if you can make the decision by weighing up which set of risks you feel more comfortable with, rather than being scared.

Also, there's no scientific evidence whatsoever that vaginal birth is better for the baby's gut bacteria. We do know that the gut flora of babies born by VB and CS differs. We don't know whether this matters and, if it does, which is more advantageous. It's this inaccurate to characterise this difference as a disadvantage, although there's been a lot of very well publicised claims otherwise so I see why people would absorb the idea.

My first birth was at age 37 and was an EMCS, my second age 39 was an ELCS. That was 4 days ago. I went into it wanting control because of various risk factors associated with age and my body just not managing labour. I'm extremely grateful I did.

It wasn't an easy pregnancy and afterwards the surgeon told us DD had the cord wrapped 3 times around her neck so we'd made absolutely the right choice with a CS. I still go cold at the thought of what could have happened had I not gone with my researched decision of a CS.

CS isn't an easy option - nothing about birth is easy - but over age 35 there are some things it's worth knowing before you decide.

I think what's also important here is that I'm not spending the whole of my pregnancy worried about the Birth. I run a busy business and the most maternity leave I can take is 2 months (and even then, I'll have to remain tuned in)... my husband is literally amazing and he's going to take to take the following 4 months as paternity leave so I can get back to work.

If I have a C-section I can at least know I will need that 6 weeks to recover and maybe it will force me to rest and recuperate!

My biggest issue would be the unknown of a VB that went so wrong that I couldn't return to work in time.

I'm also planning to Breastfeed (if I can) for 6 weeks.

I know this all sound super control-freaky.

But my point is - if this level of control makes me feel better during a pregnancy then that's a good thing, right?!

(Disclaimer - I know best laid plans don't always work out!)