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 can honestly say I have no plans on going through another natural birth and will be having a c- section if I had another baby .
That being said I actually enjoyed my labour to a certain extent it just turned into a very difficult forceps birth due to pretty rubbish care at my hospital ( I now know that pushing for nearly 4 hours is absolutely ridiculous and I should of had intervention much quicker !)
Everyone I know that have had a planned c-section say what a lovely calm experience it was although yes the recovery is tough Atleast you can be prepared for it

It's really hard, because you will read stories on here with positives and negatives to each type of birth - and in your head you will, naturally, give weight to one set of stories over another. I know that this is what I did when I was trying to decide what do with birth number 3 (offered an elective but could have had vaginal).
The frustrating thing about birth is, there are no guarantees that either method would be better!

In my experience, my elective caesarean was the worst of the 3, but now, with hindsight, time(and some counselling!) I realise the outcomes may have been worse with a vaginal birth...and I think I have come to terms with the fact I don't know.

I’ve had both and elective c section for my twins and a home VBAC for my third this year. Definitely pros and cons for both. Elective was good as I knew the day, it was all very calm and peaceful. Cons - recovery was longer, limited movement for longer, although I can’t say I found the recovery more painful than my VBAC just different. I struggled with not being able to move as much. Longer time in hospital.

VBAC was very quick and I ended up with deep 2 degree tears. But again as long as I kept on top of my paracetamol marginally better than the c section recovery pain wise but I could move more easily and didn’t have to be in a hospital obviously as I was at home. I hated being left alone so much after my section and I struggled to lift the babies which I believe gave me PND. Was VBAC painful......yes.......however not a pain out there I could even compare it too. But for me it was manageable knowing each one was done when it was over. If you have fear it will absolutely impact your birth. There is no doubt about that. There are wonderful options such as remifentinayl that you can have. I absolutely don’t regret my VBAC and I’m so proud of myself that I did it. It’s a test of endurance.......riding those contractions and the sheer power of your body is incredible and can be overwhelming but it was so worth it. Maybe have a look at PBC course it really helped me x

I haven't RTFT but either way I think it would be well worth investing in hypnobirthing because whatever way it goes, it'll be useful for calming you.

I had two home water births and they were wonderful. I had a private midwife though which I think made some difference because I 100% trusted her and had built a relationship with her during my pregnancy. Worth looking into if there's any way you can stretch to it.

Thanks everyone. You've given me a lot to consider which I will try and do objectively!

The nudity/prudishness is probably the most minor consideration. Obviously I know if it's needed, it's needed, and I know everyone will be professional about it (I'm comfortable with smears etc.) - it's just I'd rather be as clothed as possible.

The impacts on the baby are definitely something to be considered, but the risks from a CS seem negligible especially when compared to a vaginal birth, which isn't risk-free either. I'm also feeling a bit disheartened at the moment that the midwives/GP don't seem too fussed about me provided the baby is fine. (One midwife said there was no point giving me any antiemetics for HG unless the baby was malnourished or dehydrated - thankfully the GP vehemently disagreed!)

@NameChange30 thank you for the links. I didn't know that stress could make labour slow down or stop, which is definitely something to consider.

Sounds a bit woo but have you looked into hypnobirthing? Everyone I know who has done it (including myself) have been amazed at what a positive experience they had from VB. I can genuinely say I felt no pain at all.

The argument "it's major surgery" also scared me and gets packed out with every debate about CS

Yes, although what is often not said is after major surgery you'll usually have a rest and recovery period. If you started lifting 10lb weights and getting up 6 times a night to feed and toilet another human after a hysterectomy, appendectomy or other surgery people would tell you you're insane! even after wisdom teeth your supposed to have 3-5 days off work.

It's not so much the "major surgery" in itself, it's the fact you have to suck up the pain and discomfort to look after a demanding newborn. You can't just take to your bed.

Problem with all these anecdotes is it will not tell you how your individual birth will go. The uncertainty is hard.

Two other quick thoughts. 1) people that had straightforward labours don't tend to share their stories for fear of upsetting/annoying others/sounding smug. They do exist - I don't have a high pain threshold by any means but two births with just the birthing pool, both back to back labours. I'm pretty sure I would have been in agony had I been in hospital on my back though 2) you'll be naked on your lower half for CS and a lot more people will be able to see you than a VB. In the pool I had enforced space around me, noone could touch me. Either way though, they've seen it all before and won't bat an eyelid.

I would always try for a vaginal birth. I just think its so much less invasive. As for private parts you being a prude, you do realise they will be seeing your actual insides with a c section?! That's much more private surely, even your DH doesn't see those bits

I had a vaginal and was home 5 hours later cooking lunch. Girl in my NCT still has an unclosed C section wound 1 year later. It's infected and won't closed, that was from a planned c section. Equally some will have horrific natural births and great c sections.

They don't like you to have more than 2/3 c sections but if you keep getting pregnant they will keep doing them.

I also think you should invest in hypnobirthing course, to give you some positive associations with birth. I was terrified before hand, couldn't' think of the baby only what the pain would be. It really helped lessen the anxiety.

I have a great lady and happy to ping you her details, she's in Buckinghamshire but doing online things now. She used to work in the city and had 2 c sections herself so isn't super hippy dippy "natural is the only way".

[quote kallia]@bluebluezoo My concern with an epidural is that doesn't it make assisted delivery and tearing more likely, and therefore recovery longer and more difficult?

Also, I'm told it only works fully for 7 out of 8 women... knowing me I'd be #8 and it doesn't work...[/quote]
Hi,
My friend's a midwife and says there is some evidence epidural makes tearing less likely (as you follow the midwifes instructions rather than feeling such a urge to push too strongly). There is correlation between epidural and more intervention but no where have I seen any evidence of causation (ie more difficult births will be more likely to have both not that epidural causes interventions)

I had two vaginal births, epidural at 4cm both times, although I was being induced so perhaps that is different? Both very straightforward births

You must remember that the birth stories you hear are the dramatic ones, I don't tell mine much because they are a bit boring!

Agree with @Thickhead on hypnobirthing, it really really worked for me.

A c-section isn't pain free, it's massive abdominal surgery.

I had 2 births without pain relief. Not intentionally, during the first the epidural didn't work then with my second it was 2 quick. Honestly wasn't that bad.

I would never, ever choose a c-section. I know of two separate people who had serious bladder damage during the surgery, where the knife cut through the bladder. Also know of one baby who was on NICU at term after having a c-section for GD and the lack of being 'squeezed' during birth nearly killed him.

I honestly don'tthink there is a 'good' way to give birth!

I'm undergoing a hypnotherapy course at the moment. Done 3 weeks so far, I'm really hoping it'll help me feel no pain or at least be comfortable with it! I'm not sure it's done much to relax me yet but it's fun trying.

I haven’t had a CS but nearly had one with my DS as my induction nearly failed. From my point of view, I wanted a vaginal birth as a C section is major abdominal surgery. The lifting and driving restrictions afterwards would have been hard. Plus, unlike other times you have surgery you can’t exactly rest afterwards as you have a newborn to look after.

There are obviously very valid reasons where a c section is required but if it’s just pain you are worried about, I think you should explore pain relief options with a vaginal birth first.

You probably already know this, but for 10 days after a C-section you have to give yourself an injection in the stomach every day. If you have a really low pain threshold, will this be a problem? I found it really hard because I have a bit of a thing about needles.

If it is a problem, but you do want the C-section, might be worth thinking if someone else could do the actual injecting for you - maybe your DP?

I've had both. What I would say is people are very quick to tell you a horror story they've heard about VBs because it's more interesting than a story where nothing dramatic happened.

In my experience both were fine but during Labour you experience the pain before the baby comes out and for a c-section the most painful bit is after the baby's out ie during the recovery. But for both drugs are an option to help deal with it!

Neither are an easier option (nor are they horrific) they're just different.

@PinkFondantFancy

Two other quick thoughts. 1) people that had straightforward labours don't tend to share their stories for fear of upsetting/annoying others/sounding smug. They do exist - I don't have a high pain threshold by any means but two births with just the birthing pool, both back to back labours. I'm pretty sure I would have been in agony had I been in hospital on my back though 2) you'll be naked on your lower half for CS and a lot more people will be able to see you than a VB. In the pool I had enforced space around me, noone could touch me. Either way though, they've seen it all before and won't bat an eyelid.

This is so true. I had a great labour but hardly ever mention it when labours are spoken of as I feel like it's sounds smug. 24 hours labour at home, 3 hours in hospital, baby out with gas and air, no tears. Found the afterpains worse than the contractions. Fanny looked normal a day later.

More woman have super easy births than you hear about.

Also if you want to breastfeed, your milk can take a bit longer to come in after a c section. Also baby can be a bit more bunged up and doesn't get all the microbiomes from your fanny.

I have had 1 CS and more than 1 NB. I would say natural birth all the way. Its easier with far less complications. over 15 years on from my CS I still have issues with my scar area. Plus the healing afterwards was not fun (and it was my first child and I was younger than the others).

The impacts on the baby are definitely something to be considered, but the risks from a CS seem negligible especially when compared to a vaginal birth, which isn't risk-free either

the risks from a cs are much higher, which is why they are avoided unless necessary. Consequences are much more serious too, bowel damage, bladder damage, infection, sepsis. If you intend to have more than one child the risks increase with every surgery, and scar rupture is a known risk of subsequent pregnancies- ideally you'll need to space out pregnancies to allow healing, and preferably no more than 2 or 3 sections. Of course people do have more, but usual advice is that more than 3 sections are too much of a risk to mother and child.

Not trying to scare you, but don't underestimate the risks of a surgical birth. "negligible". they are not.

@bluebluezoo - true, but these are all risks to the mother. I don't think the risks to the baby are particularly more severe with a CS? I know there's a slight increased risk of asthma, or cuts which should heal. If there's anything I've missed do let me know.

Also I have no idea at all of this is true so please don't take this as a fact but somebody once told me how you experience period pains will be how you experience your contractions. In my case it was true so I don't get particularly bad period pains and they're all in the base of my spine. That's where I felt my labour pains too - it was like intense period pains coming and going in my back. Very weird but not unmanageable!

Also I was terrified of tearing and I ended up having quite a bad tear and I can honestly say it didn't feel how you would expect it to feel. Now this might just be because I'd spend 9 months fearing it, but it definitely didn't feel anywhere near as bad as I'd thought it would.

@kallia

I'm undergoing a hypnotherapy course at the moment. Done 3 weeks so far, I'm really hoping it'll help me feel no pain or at least be comfortable with it! I'm not sure it's done much to relax me yet but it's fun trying.

That's great!

I wouldn't say it makes you feel no pain but more it helps you take control and understand the pain will pass. You just have to focus on breathing. Hyponobirthing will teach you which breathes to use when.

Is your course also teaching you about how hormones during birth work? That you basically need to let nature take over, things like talking, bright lights, having to use your brain can slow labour and they interrupt the hormones. I went into hospital in sunglasses and made DP do all talking, I feel silly looking back but it kept me in the zone

Whatever you choose is right for you, also you have long time to decide, dont rush!

I have a very low pain threshold. I cry if I stub my toe, but personally, I didn't want a CS.

I ended up being induced via drip. The pain was manageable, then I had gas and air and it was still manageable. Then it got to a point where it wasn't and that's where the wonderful drugs come in 😂 my first epidural failed because I couldn't keep still so they gave me diamorphine which was fun 😂 it didn't take away the pain but I was away with it so it didn't matter! That started to wear off so they tried the epidural again. It worked that time and was absolutely great. Mentally I was with it, but didn't feel a single contraction after. I actually had to ask the midwives if I was still contracting! Could still move my body with the epidural, just couldn't feel pain.

When it came to pushing, I could feel the head, but in a way I was kind of glad. My worry with an epidural was pushing, but not knowing how I was getting on, or not knowing when I was done. It was painful, but the feeling of relief when the head came out. He even started crying with his head out while I was waiting for my next contraction to push him out 😂

You will know what is best for you, but honestly, don't rule out a vaginal delivery because of the pain as it can be managed.

SIL had a CS. If it's pain you're worried about think hard before deciding to be cut open, she was in agony for weeks as she got an infection. MILmoved in with her to help out as she couldn't even lift the baby.

Incidentally, I was utterly terrified of having a C-section, ended up having to have one, and it wasn't nearly as bad as I'd feared! I'd still prefer to have a vaginal delivery though (if/when the next baby arrives I'll be trying for a VBAC if the midwives/consultants are happy).

May not matter to you but also be aware that a C-section will impact not only how many children you're advised to have but also how closely spaced they should be. I've been told no getting pregnant for at least a year, and they'd prefer longer - up to two years. That may of course be fine with you (it is with me) but if you'd wanted closely spaced siblings, you should be aware.