Honest CS v. vaginal birth thoughts?

[kallia]

I'm 13 weeks with #1 and absolutely TERRIFIED of giving birth and all that surrounds it. I have a low pain threshold and am very bad with pain (usually pass out on my period, even with painkillers) so had been thinking about having an ELCS as the thought of giving birth sends me into a daily panic. However when I was doing research/talking to midwife I found it really hard to find an honest and fair weigh-in on pros and cons - she gave me a leaflet with supposedly all the "pros and cons" of all the birth choices but it only had pros for vaginal birth and cons of ELCS.

To help me decide I wrote down my pros and cons here (might help someone, you never know) - if I've missed any, or you have any experiences you want to share which might help me make my decision, please do let me know!

Vaginal Birth
Pros

• If all goes well, quicker, easier, and less painful recovery
• Home sooner, and possibility of home birth which would be much less stressful
• Water birth option, which I know would help me relax
• Various pain relief options, including epidural, if and when I want them

Cons

• If I tear/need stitches, recovery could still be painful and long, with potential risks (e.g. scar tissue, incontinence)
• Unlikely to have home birth if I want pain relief
• Might get denied pain relief, which would terrify me
• May not get a water birth depending on Covid restrictions/if it's busy
• Trickier to plan, you're at the mercy of your body/hospital on the day
• Nudity (I know, I'm a massive prude, but it really does bother me, I don't want strangers seeing/measuring/examining areas I'd rather keep private)

ELCS
Pros

• Anaesthetic guaranteed :)
• Much quicker actual birth
• I will know in advance what day it's going to happen, and what will go on
• Much calmer as it will be planned
• No risk of tearing/cutting/stitches/permanent injury down there

Cons

• Slower, more painful recovery
• Small risk of serious complication, e.g. infection, which would make recovery even slower and more painful
• More days in hospital
• I think there's a limit on the number of CS you can have? Not that I'm even thinking about #2 now, but I had always wanted a larger family...

That's about all I've got. If anyone has anything they want to add in which might help make my decision, please do let me know!

I had two planned caesarians (arthritic/immobile hips). I found both births (dare I say it) calm and enjoyable. The only issue I had was with the epidural for the first one, which pierced the spinal column (?) and left me with severe headaches and I had a blood patch.

In terms of recovery, I didn't find it too difficult. Probably quicker with the second, I left hospital the next day and knew more what to expect second time around. I was mobile once I got home although it was painful for the first few days.

I'm firmly of the view that everyone has the right to decide their own birth plan so good luck with your decision and hope it goes smoothly.

In the interest of fairness, I should probably add that my sister's emergency Caesarian was a totally different experience. Had to have a general anaesthetic, her baby had to go into the special care unit and she developed an infection in her wound so had to go back into hospital. I don't want to imply that all caesarians are a breeze and you're running marathons within 7 days...

@UsedUpUsername epidurals are not without risks either. Personally I was more worried about the idea of a giant needle in my spine and the potential for needing assisted delivery eg forceps than I was about the pain of childbirth. That said, I don't think it should be denied if someone really wants it and there's not a legitimate safety concern preventing its use.

I had an EMCS with my first and was hoping for a VB with my second but I went a week overdue and they wouldn’t induce so had to have another section. I recovered well from both but found the EMCS a better experience as I had no time to think about it. I had a washboard stomach before my kids and even though I’m slim I hate my CS scars (they don’t completely overlap so I have like two smiles at either end) and the overhanging numb bit of skin above them. The scars are right on the waistband of knickers/bikinis which is uncomfortable and means the overhang is very obvious. I also had diastasis recti that has never properly healed so get occasional twangs of pain when I do a sit up type movement. If I could have avoided my CSs I would have, but the grass is always greener isn’t it.

I have c sec scar overhang too, a bit annoying but my DSis had a worse complication, she had secondary infertility caused by an infection and adhesions from her C section. It's not as rare as you would like. She has an only child when she wanted two or three.

@Wbeezer

I have c sec scar overhang too, a bit annoying but my DSis had a worse complication, she had secondary infertility caused by an infection and adhesions from her C section. It's not as rare as you would like. She has an only child when she wanted two or three.

I also had secondary infertility and lots of IVF before having my second. A link was never drawn between the first section and the secondary infertility but I have always wondered, as my scar does seem anchored in the middle iykwim, it’s like it’s been stapled over in the middle.

Between the first section and the second, that should have read...

[quote Cowgran]@UsedUpUsername epidurals are not without risks either. Personally I was more worried about the idea of a giant needle in my spine and the potential for needing assisted delivery eg forceps than I was about the pain of childbirth. That said, I don't think it should be denied if someone really wants it and there's not a legitimate safety concern preventing its use. [/quote]
No, they aren’t without risk. They do increase the risk of instrumental birth. I said that I would not consent to forceps and preferred to go to csection if things didn’t look good.

I was refused an epidural for my first birth and was left in agony (gas and air just made me vomit). I wanted to make sure that wouldn’t happen for the second.

@UsedUpUsername why did they refuse? That must have been awful.

I was fearful of birth when I became pregnant, have a low pain threshold, hate needles, faint at the sight of blood etc. I decided to do an online Hypnobirthing course (the positive birth company). It completely removed all of my fear and I ended up aiming for a pain relief free natural birth. In the end I ended up with a long labour, requested and epidural, had forceps/episiotomy/tear. Even though I didn't end up with the natural water birth I was hoping for I can honestly say giving birth was one of the most empowering and rewarding experiences of my life. The healing process was quick for me, I took over the counter pain medication and barely felt any pain after.
I haven't had a C section so I can't compare the two but would 100% aim for a vaginal birth if I became pregnant again. For me the labour pain was manageable until it got to the point that I was so tired because of the length of time I was in labour for and then pain relief was available. Every birth is different but remember our bodies are designed for this, you can do it!
I would give birth again tomorrow, looking after a newborn again however....

I have had 2 elective CS for both my DC- with the first DC1 I got my GP to refer me to the local Obs & Gynae team, to the lovely lead (female consultant).

This was at around 36 weeks so I really was cutting it fine, had an appointment within the week & date booked in for 39 weeks

I realised later how lucky I was that my local NHS trust (SE London) did not have a blanket ban on elective caesareans. Many others in London appear to and they make this clear on their literature/in the maternity notes

For me the 2 CSs both went smoothly, luckily. Had a spinal and was breastfeeding & discharged after 2 nights with DC1 and after just 1 night with DC2

It was only after having my first that I realised exactly why women choose to go for a home birth- hospital post natal wards are the absolute pits (maybe it's a LOndon thing?)

I never wanted the 'experience' of a VB, for me I was always certain a CS was the right thing for me. There was no mental health background or issue- I simply felt that a CS was the right choice for me.

Sometimes friends/acquaintances ask if I feel like I've 'missed out' on the childbirth experience, and the answer is a hard no- I got what I wanted & obviously 2 healthy children with it. There is not an ounce of regret and I don't know why people (mainly women) have to turn it into a thing.

I don't go round asking woman who have had complicated VBs, why did you put yourself through that? For me, I'm very secure in my birth decisions, I think maybe it's just that people can find it difficult to process that I chose to have a CS. Oh well, really not my problem.

A good friend wanted all natural, birth centre, no drugs etc- she had to transfer to labour ward, had an episiotomy which unfortunately extended into a severe 3rd degree year & instruments- both ventouse & forceps.

For me that would be my ultimate nightmare, but for her she was just massively relieved not to have had a CS. Even her having to endure months of symptoms & repercussions from the birth injuries & reconstructive surgery.

Horses for courses I'd say.

"hospital post natal wards are the absolute pits (maybe it's a LOndon thing?)"

Nope

Epidurals are amazing and I have no idea why they aren’t more widely used in the UK (although actually, maybe due to cost?)

Cost may well be a factor, but they're not totally without cons in the practical sense. A whole host of studies have found that epidural analgesia significantly increases the risk of needing an instrumental delivery (which themselves - forceps in particular - very significantly increase the risk of third and fourth degree tears, anal sphincter injury and levator avulsion).

www.ncbi.nlm.nih.gov/pmc/articles/PMC5136389/

The extent varies, but this study found that the risk of an instrumental delivery more than trebled with the use of an epidural.

I think it's abnormal to not fear birth particularly as we are so used to controlling everything these days.

I had a no intervention VB & a elective CS. The VB was very painful as I couldn't get pain relief, it was ridiculously quick however it was over in a few hours with a couple of stitches & recovery was a breeze. the CS was the right choice for dc2 (complications) however I hated the experience & stupidly thought I would have the same recovery. Can't frigging stand the little overhang either, no issues breastfeeding though & on paper it was a good recovery. I just expected zero pain.

Tbh I was way more conscious of the nudity during my CS then my VB.

Epidurals are amazing and I have no idea why they aren’t more widely used in the UK (although actually, maybe due to cost?)

Or possibly in countries with privatised healthcare they’re used widely because of cost, and births are more medicalised, because of cost?

In for-profit medicine it’s not unusual to perform procedures in order to charge for them, rather than because it’s best practice. As pp’s links show...

"hospital post natal wards are the absolute pits (maybe it's a LOndon thing?)"

Nope

To clarify this comment, in my circle of friends, who have all given birth in and around SE/SW London, we all seemed to have pretty shit experiences on the post-natal wards, and we were mainly in different hospitals.

Having to wait for hours for pain relief, being looked after by staff who really clearly did not seem to have cared less about caring for women who had just given birth, women talking on their mobile phones speaking at full volume in the middle of the night, blood on the floor & walls in the shared bathroom.

Just a snapshot of my own delightful post-natal ward experience.

The only ones who had a fairly positive experience were those who'd had home births or who were in birth centres and luckily never made it near the post-natal ward!

It's an unscientific study, but it's based on my own and other friends' experiences, which happens to be across a selection of London hospitals.

I gave birth at a big London hospital & paid for a private room after, only had to wait 15 mins for one to become available.

@TurquoiseDress

"hospital post natal wards are the absolute pits (maybe it's a LOndon thing?)"

Nope

To clarify this comment, in my circle of friends, who have all given birth in and around SE/SW London, we all seemed to have pretty shit experiences on the post-natal wards, and we were mainly in different hospitals.

Having to wait for hours for pain relief, being looked after by staff who really clearly did not seem to have cared less about caring for women who had just given birth, women talking on their mobile phones speaking at full volume in the middle of the night, blood on the floor & walls in the shared bathroom.

Just a snapshot of my own delightful post-natal ward experience.

The only ones who had a fairly positive experience were those who'd had home births or who were in birth centres and luckily never made it near the post-natal ward!

It's an unscientific study, but it's based on my own and other friends' experiences, which happens to be across a selection of London hospitals.

My point was that it's not a London thing and it's shit everywhere. Combination of underfunded NHS and maternity care not being a priority.

Admittedly I should have written that and not just "Nope"!

I have a pretty low pain threshold, but being in labour is a different feeling for me. Both my labour's ended in emcs, and they weren't great, I found being paralysed from the chest down while a strange men rummaged around down there deeply traumatic. I have ongoing issues with surgical adhesions that affect my quality of life.
There simply isn't a straightforward risk free way of getting a new human out of a woman's body, but you can do your reseaech and give yourself and your baby the best chance possible. If it's within your means, find a doula who is scientific, medical informed and understands birth trauma.

From Good housekeeping, myths about c sections:

"That you can ‘keep your figure’
The idea that some women choose to have C-Sections to ‘keep their figure’ is really outdated. Unless you had a washboard flat stomach to start with, C-sections are likely to leave you with a ‘belly pouch’ – where your lower abdominal muscles have been operated on, they won’t connect smoothly with your pubis and there will be a noticeable change to your shape. Unlike pregnancy weight loss after a natural birth, this can’t be fixed through diet and exercise and some women even opt for tummy-tucks after a C-Section."

Post natal wards are dire. It's almost a joke how horrible it is to be on one.

I'm going to go against the flow here - the post-natal ward I was in was lovely! (Smallish Welsh hospital.)

@Cowgran

They said the baby’s heart rate was worrying and wanted to wait and see.

Yet, when I was discussing this issue with my second pregnancy, the consultant was confused as to why that happened (if the baby was distressed, you’d want the epidural so you could do EMCS if necessary, she’d explained).

I think my first pregnancy was just poorly managed.

@sheetspread

Epidurals are amazing and I have no idea why they aren’t more widely used in the UK (although actually, maybe due to cost?)

Cost may well be a factor, but they're not totally without cons in the practical sense. A whole host of studies have found that epidural analgesia significantly increases the risk of needing an instrumental delivery (which themselves - forceps in particular - very significantly increase the risk of third and fourth degree tears, anal sphincter injury and levator avulsion).

www.ncbi.nlm.nih.gov/pmc/articles/PMC5136389/

The extent varies, but this study found that the risk of an instrumental delivery more than trebled with the use of an epidural.

I was told that it could increase the risk of instrumental birth, but in the US, for instance, 70% of women get epidurals, but forceps are very, very rare (for liability reasons). I think they must manage it in a different way, probably via EMCS.

My first birth, I was only given gas and air. I was in complete agony but they wouldn’t give me an epidural (back to back labour too).

Second birth was in a different country and I had an epidural straight away and the experience could not be more different. It was calm and quite manageable.

I was told that instrumental birth risk was higher, but I told them I wouldn’t consent to forceps and to go straight to EMCS if it looked dicey.

Luckily didn’t need either.

I don't think there is an "easy" choice OP. And it really depends on individual experience- non of which can be predicted!!

Some women tear badly, need forceps, CS involves huge abdominal surgery and pain afterwards. I believe that an uncomplicated vaginal birth is the healthier option for a baby- being pushed through the birth canal stimulates baby's breathing and cardiovascular function.
Personally I found my vaginal births easy, only gas and air, no tears or stitches, was driving and felt well within a day or two
I would choose that any time over a CS.