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!

@Metallicalover you can have gas and air at home. Some trusts leave air at your home ready and some the midwives carry it. I had a BBA and the ambulances had it too.

Quicker birth, in the sense that the baby will be born, yes, in the sense that your experience will be over, not necessarily. It took the surgeons several hours to put me back together because of some complications.

If you are pain averse, don’t get a csection by choice. It is major abdominal surgery and even with pain meds you will be in real pain for weeks.

Your stomach may never be flat again.
You may have incision site infections
You may have numbness that never goes away.
In reality, it can take a year to fully recover from abdominal surgery. That’s what a csection is. It’s not a little laparoscopic procedure that you can just bounce right back, it’s major abdominal surgery and you may live with the consequences of that for the rest of your life.

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.
The size of the numb area varies between women. Mine is about 4 inches wide and it’s very unpleasant.

Just for balance, it took me 14 months before I felt even vaguely 'normal' again after my VB. My delivery was straight forward and only a first degree tear but suffered other serious injuries (my pelvic floor muscles were torn off my pubic bone) which weren't picked up for months because they were hidden. I had an ELCS for my second and I'm so glad I did, recovery was so much easier and at 7 weeks after CS I felt as good as I had at 14 months after my VB.
Of course VB can be fine, and CS can go wrong but it's very much luck of the draw. I've not heard anywhere near the amount of complications from CS injuries as I have from VB injuries though.

[quote kallia]@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?[/quote]
You absolutely cannot compare early pregnancy cramping to being in labour in terms of the pain relief on offer...it’s a totally different situation. GPs are very limited in what they can offer whereas in hospital in labour there is a host of options available.

I had two induced births and loved my tens machine for the early stages and then moved on to gas and air. Both of those I could administer/control myself and I think that little bit of control really helped me manage things as I felt I had some agency in the birth. I also stayed upright throughout which again was really beneficial physically and mentally. And both were water births which helped with the pain too and prevented anyone examining me which I also didn’t want - being in the water keeps the midwives etc away from you!

I loved my section. 20 minutes in and out, painless and no fear of baby getting stuck with the cord round it's neck or any of that. Plus your vagina and arse remain intact. It's sore for about a week after but you get painkillers so it's fine. I don't get the big drama some people make about the evils of c sections. If you want one just get one.

I don't get the big drama some people make about the evils of c sections. If you want one just get one

It’s not about the “evils” of sections. It’s about the balance of risk. Vaginal births are statistically safer with fewer complications, and quicker recovery.

O/p is doing the right thing asking for as much information as possible so she can make an informed decision. She has every right to ask for one if she chooses, but any dr will make sure she has the full facts about the risks before allowing her to make that choice. “If you want one just get one” -it doesn’t work like that. You need to make informed consent before it can go ahead.

@harrietm1987 - I'm not really comparing the two (obviously I have no idea what labour is like!), but I'm saying I think that's where a lot of my mistrust of medical professionals has come from. I literally begged a GP for pain relief only to be told that nothing is wrong with me so they won't prescribe anything.

It's hard therefore to believe that when I'm in pain again (labour, CS recovery, either/or) they will care any more than they do now.

I've done EMCS and ELCS.
I have recovered really well both times but I have had my mum come and stay and cook and clean so I could just chill with the baby. For me having a week of proper rest made all the difference and I was able to go out and about with the kids the week after.
ELCS was really important for me 2nd time round. I had antenatal depression and was under the mental health team, was suicidal. For me, ELCS meant I knew what was happening, whereas VBAC would have been unpredictable.
It was a beautiful experience and I was home next day.
There is a lot of advice they can give you about accelerated recovery to help you feel better sooner. Also, take in some peppermint tea because you get pain in your shoulderblades after the op and it was awful! Avoided it second time round by chugging mint from the minute after she was born!!!

I haven't had any issues breastfeeding either, my milk came in at 3 days with both.
Whatever you choose, I hope it all goes really well for you.

Hi @kallia
Sorry, I haven’t read the whole thread so don’t know if this is relevant or not, but have you heard of tokophobia? It’s a fear of pregnancy and/or childbirth. Might be worth looking into - and if you think it’s relevant to you, get in contact with your local perinatal mental health team.

I've had both and the elcs was easier and quicker to recover from. However, I also really wanted to experience vb- which was amazing if somewhat traumatic.

My scar isn't numb at all - whereas my appendix scar which is much older still is.

@JemimaTiggywinkle I think I do have tokophobia; I mentioned it to the midwife and she said she'd put me on the waiting list for perinatal mental health support, but the waiting list is over 6 months long... I'm having private counselling and hypnotherapy in the meantime. I think it's more a fear of pain rather than a fear of birth though. The actual birth doesn't terrify me nearly as much as early labour or recovery.

No time to read the full thread. Having had both vaginal recovery was better in the short term but long term the issues with vaginal birth are worse. So actually I’d go with the cs.

@110APiccadilly

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?

Where did you get that from, unless you already have a medical condition that requires it?

I certainly never had to give myself any injections in the stomach (or anywhere else for that matter) after my c-section. Nobody I've ever spoken to did either.

I had two vaginal births and one emergency c-section. The first was very traumatic and gave me some serious tearing which needed a lot of stitches. It was around 6 months before I could sit down comfortably again, and in that time even walking could be a problem.

The second was better but extremely painful and no time for an epidural because it was progressing quite quickly.

My third birth was an EMCS and even though it was scary at the time, I was just so utterly relieved at not having to go through another vaginal birth. It was the best experience of all of them and I recovered very quickly. Much more quickly than I did from my first vaginal birth.

There are pros and cons to both, but to be honest, I look back on my vaginal births and really struggle to see any pros. I see plenty of cons though as they happened to me.

I can only see pros to my c-section. I much preferred it.

@kallia. Six months is outrageous! Are you in the UK?
I’m sure you’ve looked into it already, but I would contact your local mental health trust directly to make sure she has referred you.

I would also make a complaint to your local CCG/Health Board... 6 months is really not acceptable.

I should probably add that my c-section scar was numb for quite a while (a couple of years?) but isn't anymore. That "baby" is now 18 and at university. I honestly can't remember when it stopped being numb, but it never bothered me at all even when it was.

@JemimaTiggywinkle Yes UK, London based. She said that they don't tend to see you until you're in your third trimester. To be honest she didn't seem hugely optimistic by the prospect.

I'm not sure how to contact my mental health trust. I might ring the midwife again and ask if it's really going to be that long.

[quote kallia]@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?[/quote]
But pain medication stronger that what you can prescribe over the counter could cause serious problems with your baby. The doctor isn't being mean, there is a good reason not to just hand out strong painkillers to pregnant women because of normal pregnancy cramping.

I've been pregnant twice and had cramping both times, and it was nowhere near the level I would even need to take a paracetamol. I think you should seriously consider addressing this issue, could it be psychological?

If you are needing strong opiates to cope with mild cramping as your uterus stretches, I agree you will really struggle with a VB. But a c-section is painful too, I think you need expert advice.

If money is not an issue, could you consider a private delivery? You can have regular appointments with the same obstetrician throughout, which could put you at ease on the day. It is also less of an issue to get an epidural if you want one. It is expensive though, I only did it because most of my costs were covered by medical insurance through work, otherwise it would have been about £15k.

Topseyt it must be a new thing. I didn't have clexane injections after my first section back in 2003 but I did for my second and third sections. The injections don't hurt that much as the needle is small but after the injection the site burns unpleasantly for a few minutes. The first time I had one I wasn't warned about the burning sensation and I thought something terrible was happening to me.

@Topseyt I got that from my experience, which was less than four weeks ago, so it's pretty clear in my memory! I may have misunderstood and it may not be something everyone has to do, but it was presented to me as completely normal and just part of having had a C-section. I was told it was to reduce the chance of blood clots I think?

Clexane was standard in my trust post c-sections when I had DS last year.

Clexane was used in 2015 when I had my eldest.

I find it strange that you don't mention the baby