Who's had natural and planned C-section deliveries?

[Courtney555]

Had an elective C-section with DS 11yrs ago (he was huge, I was tiny, talk of pelvis fracturing...) The whole thing was an absolute walk in the park. Only pain was the scratch in my back to numb before spinal anaesthestic administered. Up and out in 48hrs. All good. Have been in full support of C-sections as a result of my experience.

Now, we're having twins, and they've booked me a planned 37 week C-section, booked in one of my first appointments weeks ago, based on preferred delivery last time.

The consultant we saw today asked "how prepared are you feeling in case you go into labour early and it's really fast (both highly likely with twins) and you are too advanced for a C-section by the time you get here?"

I replied "fine, if they're early, they'll be small, and therefore I'm not petrified of a long labour with a fractured pelvis, I'm happy to attempt a natural birth, but of course, if it's not a fast labour, they'll just do the c-section as planned"

She replied that this was correct, they would try and perform one as I was on the list as C-section delivery. But then went on to say, why on earth was I on that list if I was considering a natural birth too.

I said, I wasn't really considering one as my experience last time was so pleasant, so whilst this time, I'm not dead against a natural birth, why would I not want a C-section given the zero pain and home perfectly healthy with DS within 48hrs.

She then went off on one to be honest. Not in a bad way, but in astonishment it seemed. How could I possibly think a C-section was a good idea, there's so many more risks, the healing time is so much longer and I just got lucky before, I shouldn't look at that experience as normal, it's best for me and baby to have a natural birth, even when it's twins. How had I not been asked this question before? Why had I not been seen by anyone to discuss this and just been automatically put on a C-section list.

I've come home a bit overwhelmed. I appreciate she's seen 1000 births, and I only know how I experienced one, so I take what she says very seriously. But in balance, whilst I know every birth is different, why should I not think it plausible that my body will recover in at least a similar manner, plus of course, zero pain again.

Sorry for the essay.

I know many people have had bad experiences leading to, and resulting from, emergency sections, so I don't want to bring that into the mix. I understand it's very different to walk in very calm, ready, mentally and physically prepared for a planned C-section, to having "ok, we're going to perform emergency surgery" after you've been in labour 15 hours, wanted/expected a natural birth, then experience complications and get rushed off to theatre.

So, may I ask, those of you who have experienced both a planned C-section, and a natural birth, what was good/bad about each? Does one make you think, I wish I'd never done it this way, the other way was so much better.

Thank you x

The midwife needs to wind her neck in. Its a highly personal choice, and why would you want to risk a pelvic fracture and the time it would take to recover whilst trying to look after newborn twins? You do whatever you think is best OP. If thats a c section, go for it. i had an emergency c section with DS, have an elective c section planned for DS2 in a few weeks. No regrets and my.hospital couldnt have been more supportive!

But considering that it is A) Twins and B) VBAC, would an ELCS really be the riskier option than attempting a vaginal birth? I’m surprised the consultant reacted like that. I would wonder what your risks of an EMCS or instrumental would be with both of those factors.

I don’t know whether ELCS would necessarily be safer but surely both paths would come with their own set of risks?

I've had 5 very different births including an elcs and 3 vaginal births. I'm not sure which was the worst out of the elcs or the induced attempted vbac that ended in emcs anyway. Both were horrific and I had ptsd twice.

My straightforward vaginal births were great with easy recoveries. 1 was born at home and the other 2 we were discharged after 3 hours.

The only advantage to the emcs was by the time it got to the stage when the c-section was happening I was so ill and out of it I wasn't really aware of what was going on so I wasn't as scared as with the elcs.

With the elcs there was a long wait because understandably emergencies go first. So 23 hours nil by mouth, gowned up and on a stuffy ward. Then bumped down to the next day's list, allowed to eat/drink for an hour and back to nil by mouth again.

Finally down to theatre and they do the operation. I hated the feeling of not being able to move, felt like I was being held down in a really awkward position. I couldn't see the baby. DH held him for an hour and then he was taken to neonatal.

Pain afterwards was worse than labour. It was manageable if I was lying in bed but agony if I moved. I remember crying on more than one occasion in the ward kitchen while waiting for the sterilizer to finish so I could make up a bottle and go back to bed. It took 4 weeks to not need painkillers and over a year for the dull ache to go away.

Having said all that in your shoes I would choose an elective section. You have had a straightforward elcs before and although an uncomplicated vaginal birth would probably be better than an elcs I think the risks involved with a twin vbac when you haven't had a previous vaginal birth would be too high. If you had a elcs before and had a good experience I would go for that again.

Ask her to show you the official stats for risks for VBAC twin delivery versus ELCS twin delivery.

I had two planned c-sections due to particularly bad hyperemesis that continued until they were both removed from me !! I felt so weak after multiple hospitalisations that they suggested elective . Absolutely loved the whole experience . The strongest painkillers I took afterwards were paracetamol. You know yourself it's a bit sore but you manage . If I had any more I'd need a c- section again and be totally happy with it

Your recovery doesn't sound like a fluke, it sounds normal.

2 planned sections here and zero regrets. Very little pain and out and about getting in with life within a few days.

My recovery was much easier most of my friends vaginal births.

NO WAY would I even be attempting a VBAC with twins after having had a section.

Did the consultant mention potential uterine rupture?

Next time you see her stay calm, repeat ad infinitum, yes, I want a section.

God knows why she'd try and persuade you otherwise because of the cost

Elective c section here too, and was a lovely experience. Needed a bit of a hand (as in being pulled up) by my DH to get out of bed for a little bit unless I did the side roll thing, but otherwise no complaints. No infection, quick to heal, I was up and about quickly.

Everyone is different but having seen a lot of friends go through some really gnarly natural births around the same time, I would personally choose a c section again in a heartbeat.

There is huge risks with twins and natural birth lots resulting in natural birth for twin one and c section for twin two! Really suprised at her opinion! Lots of women who have had natural broths successfully before are encouraged for c section for twins ! 🤷‍♀️

Your recovery doesn't sound like a fluke, it sounds normal.

This!

I haven't had both but my first cs (planned due to breech) and recovery couldn't have gone better. For my second dc I told the consultant the cs had been a wonderful experience that I wanted to repeat. They agreed.

In your situation - twins, previous cs, age (sorry just guessing this due to your dc1 being 11) I would go for the cs every time.

Also your Dr is being a bit tricky by asking what you would do if it was too late for a cs, then using that against you. If it was literally too late then there wouldn't be any choice.

What did she expect you to say - "ah well if they shot out vaginally I'd shove them back up there and wait for my cs date"

I’m not a doctor and haven’t had a caesarean so can’t comment on medically the right decision for you, but I would ask to switch consultant. Getting “passionately cross” and “going off on one” about you wanting a caesarean is unacceptable.

I had a normal delivery first then a 48h notice section for fetal reasons.

Section was great and made a quick recovery - was walking toddler (uphill) to playgroup with baby in sling after 2 weeks.

I know I was lucky to have a straightforward section but I think if you concentrate on keeping fit and active in the pregnancy it does help recovery.

In your situation OP I would definitely go for a planned section. I too would be interested to see the figures for VBAC with twins. I'm a health professional.

I had Gestational Diabetes, so I was induced at 39 weeks for fear of a big baby. First stage of induction took 2 days before I was put on the hormone drip then all of a sudden the contractions came thick and fast and hit me like a train! 2 days with no sleep food or water as I just couldn’t keep anything down. After 9 hours of these intense contractions I was 9cm and told to start pushing, however every time I did DS’ heart rate dropped drastically. Emergency button pushed and a dozen people came running in! Terrifying! They told me I either had to have foreceps or ECS. All the while I was absolutely exhausted! I had been awake for close to 3 days and severely dehydrated. In surgery and told forceps wouldn’t work, so they proceeded with ECS. Turns out DS had cord around his ankle so was effectively bungeeing out of me and bouncing back up! During surgery I was uncontrollably shaking and vomiting so much that they cut through an artery and I lost a lot of blood. All in all it was incredibly traumatic. HOWEVER, if I have any more children I will 100% have an elective c section. My recovery was textbook although 8 weeks on and I still feel a bit bruised around the incision and I did find it frustrating to feel so weak after blood loss and struggling to pick up DS for a couple of weeks. But I just felt so frustrated to have been through all that labour and still have a c section so I want to eliminate the element of surprise next time. I don’t feel any less of a mother as some people do the important thing is you and your babies are safe and well! Best of luck with the births x

Given the high number of second twins who have to be delivered by CS, following vaginal delivery of the first, by opting for a vaginal delivery you are potentially taking a significant risk that you will be subject to the risks of both delivery methods. Whereas opting for a CS automatically eliminates the risks associated with a vb (already higher in your case, as it would be a VBaC with twins). Something to consider.

I agree with Quaffy that the consultant’s attitude was unacceptable.

Given the high number of second twins who have to be delivered by CS, following vaginal delivery of the first...

Well. This is interesting. Because I said I thought this was quite common. And she replied that each year there were 200-300 twin births in the hospital, and in the last 5 years, only two of those had been first out naturally, second out C-section. So in 1000+ births, it had happened twice. Is this not right?

Small baby does not mean unproblematic- DC1 was a tiny 6lb and got all sorts of stuck. Needed forceps after almost 4 hours of pushing. I had significant, long lasting pelvic floor damage.

I’m sure what I read was more like 30-40%. There should be stats available for the UK. I would be sceptical if the hospital’s stats are wildly out of line, and if they were I would want to know why, eg different demographic, lower level of CS, but higher level of morbidity as a result (ie that lower level of Cs is not actually a positive), etc etc.

Apologies, I have checked and I had got confused between the stats for combined vb and C’s twin births, and the stats for how many VBaCs end in CS. It seems that the number of twin births that start off vaginally and end with the second being delivered by CS is indeed low at 5%. However, the % of vbacs that end in a CS is way higher - anywhere between 20-40%, it seems (check that before speaking to her!). That would seem the more relevant risk here for you. Given your earlier history I would be concerned you might fall at the upper end of that range.

@Tolleshunt this is my serious concern. That I'll end up all kinds of battered having natural (and potentially difficult) birth with the first, then because it's pretty common for vbac to end up as a cs anyway, getting an emcs thrown in for good measure.

That's naughty of the consultant, to explain that it's really uncommon for them to be natural followed by c-section because they're twins, but then for her to know, but not say that it's very common to have emcs if I attempt a vbac with any baby, twins or not. And I'll be attempting a double vbac

I'm not impressed with that particularly.

Yes, I think it’s naughty too. She should be giving you unbiased risks/stats, not a heavily partisan view that highlights all the risks of one option, while glossing over the (bigger) risks of the second.

I would be concerned in your shoes too.

However, I think the hospital would find it impossible to refuse you an ELCS if you stick to your guns.

Remember, going for ELCS, while ruling out the chance of an uncomplicated vb (less likely in your circs anyway, I would have thought), also eliminates the risks of EMCS, whereas the VBaC results in you running a significant risk of EMCS, which carries the highest risks of all.

At least you have her number now, and know you will have to be firm.

Sounds like she's trying to pull the wool over your eyes

I'd be looking elsewhere tbh

Not in a bad way, but in astonishment it seemed. How could I possibly think a C-section was a good idea, there's so many more risks, the healing time is so much longer and I just got lucky before, I shouldn't look at that experience as normal

Never had a vaginal birth but I had a very easy recovery post my first emcs following 75 hours of back labour (first contraction hurt as much as the last even though I was on the drip turned up to full for the last), pushing and failed forceps. Dc1 was six pounds nine ounces and well and truly stuck. I asked my consultant about recovery with my 2nd and she said if I'd had a good recovery the first time, I'd most likely have a good recovery the second time and she was right.

The only medication I had post theatre was cough medicine, up and dressed in a matter of hours. I was out for lunch and dancing with dc1 at Messy Church when dc2 was 2 days old.

I know 2 twin mums who ended up with both methods of delivery, vaginal for twin 1, emcs for twin 2 and that I would say would be the worst option. Opposite ends of the country though so they might just have been very unlucky.

I know 2 twin mums who ended up with both methods of delivery, vaginal for twin 1, emcs for twin 2 and that I would say would be the worst option.

Absolutely agree. And that's two you know. I know of one woman this happened to as well. I wonder if they all had a prior DC via C-section. Because the consultant is making out it's really rare, yet there seem to be a lot of these "really rare" vaginal then emcs twins

It seems that whilst twins born after a prior vaginal DC, or twins as first borns don't result in emcs, twins born attempting a vbac seem to result in the second requiring a CS.

Also the more I think about it, the more I'm miffed about her "have you thought about what happens if you labour early and fast" because whilst i hadn't really thought too much about it, it's pretty much "well, I'll have two kids flying out my floof at a speed of knots, or I'll be zoomed off for emcs, I'm not really going to have much say in the matter"