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!

For everyone who says recovery was easier with VB, what was recovery like? Because I can't imagine easier than my ELCS. Barely any pain, a bit sore the first night but nothing awful and then I felt fine. Stitches were dissolvable so I never had to do anything with them. Didn't feel any pain or discomfort or anything, really.

I've never had a vaginal birth so can't compare but I can't imagine it would be any easier than that.

@boymum88 I would love to speak to anaesthetist - do you know if I can just contact a hospital and see if anyone would be prepared to speak to me informally?

My concern is that medical professionals have already refused me pain relief. I'm currently in pain due to severe cramping and abdominal pain in early pregnancy and 2 GPs have refused to give me pain meds because it could harm the baby. I'd honestly rather have a VB, but my fear is that I will beg for pain medication and get refused it, just as I have during the pregnancy. I don't think they can refuse anaesthetic for a CS, unless I'm wrong?

Every birth is different and, unfortunately, you can't predict how it will be for you. I remember thinking after my cs with my first that it seemed about half vb stories were better than my cs and about half were worse! Didn't help me decide on second cs versus vbac.
It's a completely personal choice. I think a csection is a much more predictable path - complications do occur but they are rare in non-emergency situations. Vb is unknown until you are in it. The uncertainty may be a factor in your anxiety.
It sounds like you are having a complicated pregnancy and maybe the birth anxiety reflects that. Either way, I'd start by trying to treat the anxiety rather than force yourself into a birth decision, neither of which will sufficiently calm your nerves. I didn't find hypnobirthing particularly helpful but some people do. Cbt might help. Xx

I've had three births. Two vaginal one CS. One vaginal with all the pain relief, gas and air, epidural - hence very little pain. One super quick vaginal only about half an hour, so no time for pain relief. Very painful but nice and short. CS very straight forward and quick. My conclusion - recovered within a few days for all of them. They are all only a few hours out of your life, honestly not worth worrying about which is more painful.

The hard bit is looking after the baby afterwards and the shift from worrying about yourself to worrying about your baby. Ramped up with Adrenalin, but exhausted from no sleep and the birth, and no break at all from the baby, or more accurately from focussing all your energy on the baby.

Oh and I wasn't baked for any of them. There was no difference in the amount of nakedness, I wore the same for all three - a big black nightie which could be hitched up and down easily, with short sleeves and breastfeeding button access and with poppers at the back for epidural injections. I think it was from happy mama on amazon.

I would love to speak to anaesthetist - do you know if I can just contact a hospital and see if anyone would be prepared to speak to me informally?

Ask your m/w to refer you. I didn’t even know you could, but when taking my history an I mentioned a back injury, I was made an appointment to chat to the anaesthetist, in case there might be any issues with a spinal, for both pain relief, and also if I did need an EMCS I would have been made general only.

Poor man was horrifically busy, anaesthetists are one of the most in demand specialities as they cover the whole hospital. But he gave me some very good advice, including ask for the epidural as soon as labour starts as they are so busy it’s often simply there isn’t anyone to come and start one. Ask straight away, an usually at some point in the next few hours someone will manage to get to you.

Barely any pain, a bit sore the first night but nothing awful and then I felt fine

This was not my experience at all. CS recovery was painful and drawn out (maybe because I was only given OTC painkillers ...)

Felt like the stitches were going to bust every time I sneezed or coughed, which seemed a lot more than usual 😢

Definitely was not traipsing off to the shops afterwards!!!

Also, I still feel sensitive there and am still cautious about lower abdominal exercises. I’ve never been able to regain that core strength I used to have. It’s perhaps more of a mental than physical thing at this point, though

@ZenNudist do you actually have a clue what you are talking about?!

I didn't have a great C section recovery but certainly not pain for 6 weeks! You're not supposed to drive before then but not because of pain.

A close friend of mine had a 3rd degree tear. Trust me that hurt for months.

Sorry @kallia it's so hard - neither option is great and it does just depend on the individual. Although I preferred my C section birth, the pain was severe for the next few days. Others barely feel it. You would definitely have a spinal for a CS.

For VB pain relief they shouldn't deny you although I don't trust most midwives as far as I could throw one I'm afraid. And the Shrewsbury scandal shows why. Do you have a good advocate for your birth partner?

There are risks to baby with CS although I think most of the breathing mucus issues are very short term. Far more significant risks if you end up with shoulder dystocia or forceps during a VB.

@BiBabbles I'm so sorry to hear you went through the same as me. I had MROP as well, with no pain relief as it was a crash team situation, and it was the worst experience of my life. Also due to bloody stupid midwife yanking the cord and snapping it.

I was scared too and was nervous about both options

I decided to take every piece of preparation I could and attended positive movement meetings and also did hypnobirthing (much to partners delight) and we also went to NCT meetings. Once I started to look into it more, I realised that I didn't know much about childbirth and had feared it all my life.

If you can afford the hypnobirthing and NCT it's worth it

The positive birth movement, if you in your area, is free and can be very empowering

Either way, I'd start by trying to treat the anxiety rather than force yourself into a birth decision

Agree with this. You have plenty of time and can make a more knowledgeable decision then

Also there are great options for pain relief. I got by on gas and air, but would have had other pain relief if needed. I also used a tens machine early on Labour pains

I would agree with trying to treat the anxiety and no matter which option you go for, try to be the one in control.

Despite having complications with physical C section recovery, that is still the better experience for me as I chose it and was treated well. The VB had a simpler physical recovery, although still hard because of how badly it went, but I don't think the emotional scarring will ever go away.

I would never have another child now. My DD was desperate for a sibling and I wanted the chance to enjoy a second baby in a way I couldn't with my first due to shock. But I could never put myself through another pregnancy and birth.

I wish my elcs had been like that @ForestNymph. I much preferred my vaginal births where the pain almost went as soon as the placenta was delivered. My elcs was so much more painful in comparison and I ended up crying from the pain on day 3 and begging for morphine but not being allowed any until a student midwife took pity on me and persuaded her supervisor to give me some.

I've had 3 vaginal births, an elcs and an emcs. I much preferred the vaginal births. I found the pain after the c-sections were about the same as the pain during labour but the c-section pain lasted longer. Also in labour you have your birth partner encouraging you, passing you drinks, rubbing your back etc. Afterwards you have a lot less help and with a baby to look after as well so I preferred to have the pain during labour. I had short straightforward labours though which I'm sure had a big influence on my choices.

My concern is that medical professionals have already refused me pain relief. I'm currently in pain due to severe cramping and abdominal pain in early pregnancy and 2 GPs have refused to give me pain meds because it could harm the baby. I'd honestly rather have a VB, but my fear is that I will beg for pain medication and get refused it, just as I have during the pregnancy. I don't think they can refuse anaesthetic for a CS, unless I'm wrong?*
*
A GP prescribing drugs for abdominal pain in early pregnancy and pain relief during labour are very different. GPs are limited to what pain relief they can give to pregnant women.
During early labour you can have paracetamol and some codeine and maybe some gas and air (depends where you are... if you at home etc then obviously no gas and air) then in established labour you can have gas and air, pethadine, diamorphine and an epidural.
I think you need to speak to your midwife re your anxiety and what support they can offer you.

Also you can have a tens machine

@kallia I think your midwife or gp should be making you a referral to the pain clinic now as if ur in pain now that needs addressing now. depending on the type of pain you have now I'm sure their are plenty of different options for pain relief than just medication like acupuncture / massage etc and maybe referring you for some therapy to try and help with the anxiety.
Or I know most hospital now have consultant midwifes ( not sure if consultant is the right term) but lead midwife that are there to help you make a birth plan and go through all ur options so u can make an informed decision.

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

Two of my four births were like this - under general anaesthetic. The first was horrible, when I came round I was so groggy and confused that I thought my baby had died. The second time wasn't as bad but it still took a while for my brain to start working again and to feel coherent. I couldn't do anything for my babies at first, not even hold them. I honestly wouldn't recommend it even if it were an option.

I also had a Caesarean section while awake which was fine, almost boring as I couldn't see anything and I couldn't understand the medical talk. I got shown the baby quickly then they took him away to clean him up so I didn't get to hold him. My one vaginal delivery was the best birth by far and a more pleasant experience all round. I did have an episiotomy which made recovery a bit harder.

I have an extremely low pain threshold. Juju Sundin's Birth Skills teaches ways to manage the pain, especially early on. If you feel you aren't coping with the pain then there are lots of options. Gas and air works well or you can opt for a epidural. I found gas and air best as I felt I wanted to be upright to give birth which isn't possible with an epidural.

At the end of the day it's entirely up to you what you decide, there's no right or wrong way to give birth and there's no prize for a "perfect" birth. That stupid idea of "too posh to push" has done a lot of damage to the way we perceive birth choices.

My emergency was under a general anaesthetic and it was scary due to the nature of the emergency, but the actual experience of giving birth unaware was actually quite nice. I have no memory of it and just woke up to find it done.

Had it been under better circumstances id have absolutely been pleased. Its funny how people perceive things differently.

The recovery from a traumatic vaginal delivery can be worse than recovering from a c-section. I've had 4 emergency c-sections including 1 crash c-section, I recovered well from them all.

It’s very common for the surgeon to sever nerves during surgery. Not just a CS but any surgery. It causes numbness in the surrounding area that can be permanent. A significant proportion of women lose the feeling in part of their stomach or leg.

I think you're right on focussing on the anxiety.

My plan is not to make any decisions for a bit, but every now and then when I remember I'm pregnant I realise that one way or another I'm going to be in pain and it overwhelms me. I think the fear will be worse than the pain. I was actually pretty knowledgeable about it before I got pregnant (for some reason our sex ed in school included birthing classes and how to deliver a baby on a train!) but since getting pregnant fear has overcome me and I can't really do much research.

I did speak to the midwife about my concerns at the booking appt and she put me on the waiting list for perinatal mental health support but said it would be at least 6 months and possibly not before the birth. So I decided to get private therapy which I think is helping, but not solving all my fears.

@NeurologicallySpeaking I agree with you on not trusting midwives, I haven't had a great experience so far. My DH is amazing and supportive but, if I'm honest, crap in hospital/medical situations (I had a kidney infection a couple of years back and he just went to pieces at the thought of me in a hospital, I had to go on my own so he didn't see me in pain!) so we've mutually agreed he won't be there at the birth. He almost got thrown out by security at the first scan.

I'd love a female relative or friend but there's no women I'm that close to, so I'll probably hire a doula. I'm hoping they'll be able to advocate for me to get pain relief I need.

@DonkeyMcFluff

It’s very common for the surgeon to sever nerves during surgery. Not just a CS but any surgery. It causes numbness in the surrounding area that can be permanent. A significant proportion of women lose the feeling in part of their stomach or leg.

I can't feel the area around my scar. I'm unsure why thats a problem though, I've never missed not being able to feel a small area of my stomach.

@ZenNudist

It sounds like you really are very anxious about VB. Thing is it really is the lesser of two evils sorry.

I have 2 dc, both VB. I have many friends who had CS and the fact is you are then in pain for 6 weeks and can't drive at a time you need to get out the house to baby appointments. You also wont be able to lift baby or do as much round the house. So you will still be taking pain meds and wincing and expecting help from family weeks in. Now if you end up with EMCS this can't be helped but I wouldn't voluntarily opt for it.

The reasons the docs talk you out of CS is they aren't nice. I dont get why, scared of tearing, you'd opt for being cut open.

Tears dont really hurt. The contractions hurt (which can request pain relief for) but IF you tear by that time you really don't care.

It's one day of your life, worst case a bit longer, better that than weeks of painful recovery from CS.

I get you are scared. It's really not as bad as you think it will be. You recover really quickly. There's such a wide variety of birth experiences. Most people find it hurts but not enough to stop them having more dc. Trust your body.

If you want a second child you will want a VB to avoid having to deal with older dc and a baby whilst healing from CS. So you're going to end up having a VB at some point. My second VB was way way easier than my first.

That's a bold post for someone who hasn't had a c section. I had an EMCS I wasn't wincing in pain. A vaginal or anal tear is not the same as a c section wound. They're close to an area where urine and feces comes out. I've had anal tears, I winced more with them than I did with my c section scar. Op don't let someone who hasn't had a c section scare you with a stupid post like that. It's different for everyone but personally for me it wasn't that bad.

@bluebluezoo I never got my epidural despite asking before labour started! Mine was a September birth and all the hospitals in the area had already been closed twice that week to new deliveries. There was no-one available to get to me in the end.
My labour progressed very quickly which added to it, so possibly wouldn’t have had it anyway but I did “waste” some of the time waiting for the epidural I thought I was having and resisting the contractions-if I’d known it wasn’t coming I might’ve cracked on faster.
In the end I’m glad but it’s funny how things go.

I'm unsure why thats a problem though, I've never missed not being able to feel a small area of my stomach

It’s harder to engage that area of the core, maybe not a big deal for some but I am fairly athletic and definitely notice this.