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 2 uncomplicated VBs and no stitches or long lasting effects at all. But I was very lucky. If you're anxious and being in control of the risks and situation in general, I'd go for a ELCS.

Sorry meant to say and being in control (as much aa possible) of the risks etc would make you feel better then...

[quote kallia]@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.[/quote]
It’s not just asthma, it’s diabetes and obesity and a number of other conditions. But the risk is very small. If your child got one of those conditions though then the impact on them could be huge.

Obviously though if you go for a natural birth you could still end up in an EMCS, or the baby could suffer an injury. The thing is that the risks from a c section are mostly pretty predictable, whereas a vaginal birth is a total gamble. If it goes well it’s the best thing for mother and baby, but if it doesn’t then it isn’t, and you don’t know in advance how it will be.

Honestly it's a hard decision and to be honest neither is easy. I haven't had a vaginal birth but 2 sections. Having been through labour though it was a lot lot more painful than I imagined so I'd choose a section maybe coz I know how that turns out. In your situation I think you wld be better with a section there's more that can go wrong in labour.

One emcs after a 15hr labour for various reasons and the other was planned section but waters broke and I had 12hrs in labour before she was born by emcs. Recovery was hard both times and I got an infection in my wound first time round. It took best part of a year to properly heal. It was still painful for months after when I was lifting the pram out the boot etc. Recovery wasn't great again it actually felt worse this time. Came home with a catheter in and was in a lot more pain but my wound healed quicker.

Couple of things to consider too. If you get induced you have to be on constant monitoring and you can't have a water birth. Also I don't think you can have an epidural if u plan to be in the water they leave it in ur back so it can be topped up.

Sections can sometimes effect ur milk. My milk never came in first time so had to give breastfeeding after a week she was starving. Second time round it came in and gave me the shock of my life!

Oh just to add the epidural is amazing if u so think about vaginal birth. Although mine stopped working down one side they tried to fix it but it didn't work. By that time knew I was going for emcs though.

I was similar to you re pain. I reacted badly I’m also small hipped and just small in general. Reacted badly to gas and air ( vomited down the nice student doctor’s crisp white shirt and tie while we had a chat).

But, had an unplanned epidural, ventouse delivery, with a tear on on perineum but it healed very well. From discussions with friends my birth was probably the best for me and my son.

I’m no natural birth convert and do not believe pain is ok in birth, ( I had midwives being cross with me for not wanting to ‘experience’ childbirth) . However I get others see it differently, it might be a natural process but I was terrified even after being induced and my argument runs that no one has their appendix out without pain relief.

The whole drugs issue re childbirth is contentious, but quite frankly if people want to be martyrs let them. Ask for decent drugs, insist if necessary. I believe there is a cult of letting women suffer in childbirth, it’s not ok, it’s not ok for the baby to have a mother who is traumatised by the birthing process, but understand my view is seen as prehistoric

Do what is right for you. Demand, ask and seek, I get there are pros and cons to ECS, drugs etc etc but the wider picture is happier less traumatised Mum easier transition to bonding IMO.

Also please be aware as you get to full term your fear will subside a little, but it was real for me and as unpopular as my opinion is the drugs worked and my boy was very healthy, if small. I birthed alone and saw it as a medical procedure to bring my boy into the world with as little fuss, and with the best outcome for both me and him.

Please just demand what will work for you.

OP I’m afraid the general attitude of focus on the baby and ignore the mother is standard everywhere! I’m not saying it’s right but I think it’s something to get used to now. As soon as you’re pregnant you’re viewed as an incubator and the concern is entirely for the baby. You’ll find most research and guidance is written with this mindset.
I would say I found my VB terrifying because of the pain. The baby was back to back and I was in agony which kept getting worse. The labour went on 50+ hours and honestly was horrendous. BUT. The second he was out I felt 100% fine. I was up and walking about and completely ok to look after myself and the baby. It was incredible.
I’m pregnant now and very scared about the pain but will be aiming for a VB again as they are better for the baby. There are studies showing it’s better for their lungs and they are less likely to have allergies. Also I want to try to breastfeed. The rates are lower if you have a CS and there are restrictions on the pain relief you can have afterwards.
On balance I’m more scared that I’d be in pain and immobile afterwards trying to look after a baby than I am about the pain before.
I’ll be in hospital without DH for two days after the birth due to the medication I’m on. The idea of not being able to pick up my baby if he needs me or get myself to the loo (plus being in pain) is worse for me than the idea of pain in labour.
Good luck with your pregnancy.

Thanks @toria658 - I think your view is probably closest to my own. I honestly think the options available to pregnant/birthing women are shockingly bad (ugh why isn't there a pain free option?!?!?)

In theory I'm happy to demand drugs, but I know that when I'm in labour I won't be able to be as insistent and I tend to just give in to people when I'm in pain. I'm aware there's a culture of letting women suffer, or not letting them have drugs, or shaming them for asking.

If I do go for vaginal birth I will definitely hire a doula to advocate for me. I hope my fear can subside a bit and I have have a "good" vaginal birth (my mother always talks about how amazing her births were, as she thinks we need more positive birth stories out there!). But as far as I'm concerned as long as me and the baby get through it alive and without permanent physical or mental injury, I'm happy. I just don't know what the best option is to achieve that.

Just to add to the 'major surgery' line that gets trotted out; I found it much easier to recover from my ELCS than when I had keyhole surgery to remove my gallbladder. Very little pain with the ELCS and no need for strong painkillers. I was running round the garden playing hide and seek with a friend's toddler at about 3 weeks. Ultimately, it's your choice though and it mainly comes down to whether you prefer the predictability of a ELCS vs the unpredictable nature of a vaginal birth (albeit there can, of course, be complications with the former). FWIW, I found both my midwife and the consultant were very supportive and went through the options with me in a fair and balanced way (albeit I think they were personally both pro-CS).

Not as terrified as you sound but I was definitely anxious about giving birth. I have now had three VB's, all water births, latter two were amazing home water births. Only used gas and air. Second one, just before actually giving birth I remember thinking, I'm actually enjoying this! I have friends with similar experiences. Morning sickness was way worse than birth for me 😅

@kallia one thing I dont think anyone has noted - CS doesn't mean no impact on pelvic floor. Quite a bit of pelvic floor damage comes from carrying a baby and the hormone shifts when pregnant and after you give birth. So you may still develop difficulties without necessarily pushing ever.

In terms of why cant it be pain free - 100% pain free would mean sensation free and you need to be able to feel some signals to push correctly

I'm happy for sensation free! Sensation free works! Why can't they just put me in an induced coma for a bit? /s

I had a very quick labour - a 2 hour constant contraction without pain relief (none at all no paracetomol or gas and air). And I remember thinking I know why people who dont know they are in labour may think they are dying.

But it was fine because I knew what it was - it wasnt scary it was doing something it had a purpose. And then when it came to push my body in effect took over.

Hi OP - I did VB first, just gas and air in the water, lovely experience. I do have some moderate but not life-changing pelvic floor damage from it though and that's why I'm ELCS this time around, so there's minimal risk of it worsening.

I am also hypermobile (Ehler Danos syndrome) which increases PF damage risk considerably - I wasn't diagnosed before birth number 1 and it might be a good idea to find out if you have this risk factor before letting the long-term damage risk to put you off completely?

One thing I haven't seen anyone say yet though is risk to future pregnancies. This is my last (2 and done!) so it's not a factor for us, but I have 2 dear friends who had to terminate much-wanted subsequent pregnancies because the fetus had attached into the scar tissue - they were told it would kill them to continue.

I think it's rare but it's certainly not unheard of, esp with c-section rates going up.

So the only thing in your post that gives me pause is that bit. If I wanted a big family I think I'd try a VB first just once to see how it goes for you. Best of luck whatever you decide! X

Agree with some posters in that you aren't going to get many posters talking about their easy vaginal births (it could be seen as a bit insensitive to those who have had horrific ones) But they do exist, and lots of them. Either way there is no guarantee that you will get an easy ride. Echoing others, continue with hypnobirthing, you can put that into practice whatever you choose. The main thing here for me would be to work on your anxiety as opposed to trying to find one method over another. Hope all goes well for you whatever you decide!

I havent read the whole thread but you really cannot write NO risk of permanent injury next to major abdominal surgery!.
You will sign a consent form that will list the likes of "scar tissue' - external AND Internal which can cause adhesions and fissures, may fail to heal adequately, and "damage to surrounding structures" eg bladder, ureter, bowel,kidneys, blood vessels! And more...

I can't give you an opinion either way but just make sure your pros and cons list isn't biased due to how you're feeling about vaginal birth!

The prude / nudity thing still is a 'thing' with c-sections. I'm not saying don't have one, but just something to consider. My friend had 2 c-sections and each time they basically had to see everything to insert the catheter and afterwards they inserted strong pain killers up her bum.

(you should be medically examined op...for passing out on your period because that ain't normal.!!)

I laboured for over 70hrs. And pain was on the list and exhaustion etc but being nude in front of others will become the last thing on your mind.

Had a scection for the second but that also involves pain. Before hand when they stick the hugest of needles in your spinal cord.. Afterwards.too.. not during though. And the fact that things stay painful for weeks... (or years for me as I got huge problems after the c section with my abdominal muscles)
But you are having a baby. It's worth it. Either way is going to be the wrong/right decision. You must prepare yourself

But seriously talk to a doctor about your period!! Plus op, a period is not slightly the same as giving birth. So it may be just a little pain. Or bearable pain 😊 The fact is; the more tense you are the more painful things become

Look into hynobirthing and read positive birth stories

I haven't had a CS so have nothing to compare the vaginal births I had to. My mum had a section with me, but that's nearly 40 years ago and was a crash section after 2 days of labour so maybe not representative of what you're asking about- but all she ever said to me when I started having dc was" do anything to avoid a section". She was so keen not to have another because of the recovery period.

In my younger days I was really gung ho about natural birth and now I wonder why it meant to much to me. I mean, I am still happy I had the births I did, but I also have prolapse and a broken coccyx and have been told by three (female, in case that matters) doctors now that these sort of long term issues are why so many female doctors opt for sections. The births themselves were all fast (2 hours forty minutes was my longest) and drug free, my second was an absolute dream and even the one I found the hardest was nothing compared to what so many women endure, recovery from all of them was straightforward other than the long term issues which took time to become apparent, breastfeeding went really well, there was something magical for me each time in giving birth... but I still am not really sure why, at the time, it mattered so very much to me that I did it naturally.

@Yeahnahmum I've been to the doctor, and after 3 ultrasounds, 3 internal examinations and goodness knows how many blood tests they still can't figure out why. All they've done is ruled out anything "serious" (no tumours, cysts, or fibroids). GP thinks I've just got a low pain tolerance.

When I wasn't pregnant I was on pretty hefty doses of naproxen most days which kept the pain at bay. Obviously now I can't have any, which is what's causing a lot of my stress/pain...

I think you're all right when you say there's no "easy" way out of this unfortunately! Sort of regretting getting myself into it...!

Would love to know where these hospitals are that allow elective cs because you don't want a vaginal delivery and not because of medical reasons? Never heard of that where I live. Only know of friends who ended up having emcs then being allowed elective cs in subsequent pregnancies.

You literally don't know how you will cope in a labour until you go through it and even then each labour is different. I was terrified of the pain and of tearing. And I had a natural delivery when I lost my daughter at 22 weeks so I was incredibly anxious.

I had contraction pains through my legs only and was told no pain relief would help as they target stomach contractions and factor in my pelvic girdle pain too it was agonising, I couldn't move or walk. And I am the opposite to you, I have a very high pain threshold. But the pain made me vomit throughout my labour. Then I also needed an episiotomy as my son was stuck which made me struggle for weeks afterwards as an episiotomy wound and pelvic girdle pain is not a good mix when you are trying to get out of bed or off a sofa. It's lucky I had my husband about because he had to get my son for me every time he cried because my mobility had been effected that much. Even after all that I will still be having a vaginal delivery if there is a next time. Being overwhelmed with love and happiness with your baby after they are born lessens the memory of the pain that's why women go on to have more children otherwise we would all be only childs. But I must admit I still get a sickening feeling when I think of the contractions.

Also on the incontinence, I never suffered whilst pregnant or after giving birth and mil had 2cs, no vaginal deliveries and is now incontinent, even if she just raises her voice at her kids so even though it's a common side affect doesn't mean it's a sure thing. Just like you may not need an episiotomy or assisted delivery, VB is very unpredictable but once you go into labour there is only one outcome, you are going to have that baby and you just want it out no matter how it happens.

Just for balance, I had a VB with no drugs at all and felt almost fully recovered a few hours later. I know I was very lucky.

Having had an EMCS and VBAC, I’d go with vaginal with epidural.

CS recovery was more painful (even when compared to second-degree tearing) and I didn’t feel normal for months. Laughing/sneezing/coughing hurt so bad and I was frustrated that I couldn’t do exercise for quite some time and lifting things was hard. I think I’ll always feel a bit sensitive around the scar ... even though it’s not really visible anymore.

I also think research is really lacking around CS adhesions, which can affect the organs later in life particularly the bladder.

But I would always choose CS over operative vaginal delivery since things can really go awry and affect QOL.

Not an easy decision...

Genuine question, I am always amazed that women go on to have a second or even third child after a horrible birth experience ... is the desire to have a baby so strong that you are willing to take the risk again?

I only ever wanted one child so I knew I would never, ever have another but it is something that (mildly) interests me.

NHS guidance makes clear that women who want one after a discussion of birth option be offered a planned caesarean. If your doctor is unwilling to perform the operation, they should refer you to a doctor who will.