ELCS after difficult birth

[MissChanandlerBong90]

Hello

I just wondered if anyone opted for an ELCS for their second after a traumatic birth with their first and if so how you feel about that decision.

I am currently in the very early stages of pregnancy with my second. The gynaecologist who fixed some of the damage after my first said she wouldn’t recommend any further vaginal births, and wrote a letter to my GP to that effect - but obviously I won’t be seeing her in antenatal clinic so I don’t know what kind of pushback I’m going to get from whichever obstetrician I see when I get to that point.

I was 95% sure I wanted a section but I’ve just scared myself silly reading about the risks.

I had an emergency C section and it's no more riskier than normal birth in my opinion, the risks are just different. Any number of things can go wrong in a vaginal birth. You can ask the GP for a copy of the letter, you might have to pay an admin fee though.

I gave birth to my second child last week by ELCS.
My first birth was a traumatic induction, emergency csection.

I'm very happy with the decision and feel it was right for me and my baby. It wasn't entirely easy though.

I experienced flashbacks and panic in the delivery ward and operating theatre. The painkillers made me feel quite sick which was one thing I struggled with last time.

Definitely discuss with midwife and consultant as soon as you are able to

Have never given birth so can’t give any advice but I’ve had a huge fear of giving birth my whole life and have opted for a c-section. Have mentioned it at every midwife appointment and they have all been very understanding and supportive. I don’t think you’ll have much of a fight to get one when you have that letter of support! Due to NICE guidelines, if you have been offered advice/support and still don’t see giving birth vaginally as an acceptable option, you should be offered a c-section. I wouldn’t worry yourself too much about the risks. When I’ve looked into it all I found that actually the risks stated for a section are the combined risks of both an elective and emergency section. Obviously people walk into an elective section perfectly healthy whereas people go into an emergency section often in life threatening condition, so the outcome isn’t going to be risk free a lot of the time. When comparing the three ways of giving birth the safest was found to be an elective section, followed by a vaginal birth and then an emergency section. No one gets you to sign a consent form to agree to all the possible eventualities of giving birth vaginally. It’s only because we have to sign a form to agree to the risks of a section that it sounds so much worse! I was preparing my notes for my consultant appointment today and it would appear the most common risks are infection, which you’re given antibiotics for anyway. So the other risks (blood loss, DVT etc) are uncommon. Hope you get your section if that’s what you want 😊

I had an ELCS after a traumatic birth with my eldest. Midwife tried to put me off, referred me to a consultant to discuss it and he did the same. I just stuck to my guns and they agreed. Didn’t like having to argue my case but I got the result I wanted. Walked up to the reception desk on the ELCS date, wheeling my suitcase behind me, checked in and three hours later had my son. Best experience ever!

Thanks so much for your replies, I really appreciate it.

I dug through old paperwork yesterday and found the copy of the letter from the gynae to the GP that I received. It details the repair surgery I had etc then says ‘I have advised Chanandler that opting for a planned Caesarean section in future pregnancies will remove the risk of further trauma to the perineal area. Chanandler should be seen in antenatal clinic in any future pregnancies to discuss her birth options’. I distinctly remember her saying to me she wouldn’t recommend any more vaginal births but she hasn’t explicitly written that in the letter. So I don’t know what sort of reception I’ll get in antenatal clinic. I’ll have to see what they say. If the consultant says I should have one then that’s the end of the conversation really, I don’t know why I’m anticipating pushback.

@Screwcorona and @cavatron I’m so glad you had good experiences. I’m having this weird guilt about potentially opting for a c section because it would literally just be to protect me from further injury, nothing to do with my baby’s welfare. That’s bizarre and I don’t know why I feel like that - because I matter too don’t I?

@sarah13xx you are right. The fact is vaginal births come with all sorts of risks, we just don’t consent to them. After my vaginal birth I needed surgery twice - once under spinal anaesthetic, once under general - and obviously both those surgeries carried a risk of blood clots, infection, anaesthesia problems, just like a c section does. I needed to be catheterised for several days after the birth, lost a lot of blood, etc.

The thing that frightens me the most about a c section is the risk of problems in future pregnancies - placenta accreta, placenta previa, etc - or even an emergency hysterectomy if there’s bleeding. Even though I would only possibly want to be pregnant maximum once more after this (and even that’s far from a given). Perhaps I should talk to the consultant about that.

I just can’t go through what I went through last time again. I feel sick thinking about it.

I chose a section after my first and it was the best decision I made, It took time to get there tho, I knew if what happened during my first happened again I don't know if I would've been able to come out the other end physically and mentally. It took me a lot longer to recover from my first than the section. The section was a breeze even though I was extremely nervous but the staff were very helpful and talked through it all the way. The worst part for me was getting the canulla put it as blood started spurting everywhere 😂

I chose to have an ELCS after a traumatic first birth. It was on the advice of a specialist I saw after the first birth and the obstetrician I saw with dc2 agreed it was best option. It was great! Such a lovely atmosphere in the operating theatre. The recovery was painful at first and it took longer to feel physically normal because of the impact on my core, but it was overall a much better experience. If I had my time again I’d have two elcs!

I had an emergency section under GA 5 years ago and had an ELCS 6 months ago and the ELCS was such an incredible experience. It was everything I'd hoped for and mentally I have been so much better this time round for multiple reasons but having such a great birth i am sure is one of them.
I had absolutely no push back from any HCP, the registrar who I had my 'consultant' appointment with talked through the risks etc and said about how it is major surgery and potentially more difficult recovery than a VBAC but didn't try to persuade me either way. After telling me the risks etc they asked if I was still happy for a ELCS and I was and that was that. I wasn't booked in for it until 36 weeks though and I'm not sure that was in case I changed my mind or if that's just when they book you in!

I had a 4th degree tear with my first birth, and surgery with a spinal afterwards to repair the damage. It took months to recover.

Afterwards in follow up appointments I was told the chances of me tearing again were fairly low, but if I did tear again the consequences could be severe - potentially lifelong faecal incontinence, colostomy bag, etc.

I'm now pregnant again and have told everyone that will listen that I want an ELCS this time because I'm not taking the risk of further damage. Like you I was expecting push back from doctors, midwives etc. To my surprise, everyone has been entirely supportive of it, a doctor told me a couple of weeks ago that my reason didn't even matter to her, it was entirely my decision and she would refer me to her colleague who would get it all signed off nice and early (the appt is when I'm 20 weeks).

I don't feel like I'm being selfish in my decision, I feel like I'm making the best choice I can to enable me to provide adequate care to both of my children afterwards. If I gave birth vaginally again and tore again, I could end up in surgery multiple times, likely spend a week or so in hospital after the birth, possibly unable to see my eldest DC (if covid restrictions are still in place), take months to heal again with constant hospital appointments, pelvic floor physio appts etc. I couldn't sit on the floor or walk further than a mile or so for about 3 months the first time. From everything I've heard and read about, that is very different to most outcomes from ELCS.

I hope you get the same support to make whichever decision is best for you

@Liervik and @TheCheeseBadge

You’re both right and very wise. The truth is my first birth absolutely destroyed my mental as well as my physical health for the first few months and I’m ashamed to admit it but honestly, I was not a good mother to my son in that time. I looked after him and kept him fed and clean and safe but I couldn’t bond with him at all for months.

He’s two now and the absolute love of my life. But those early weeks were such a dark time - entirely because of the birth and the follow-up surgery.

Cheese I’m so sorry you had such an awful first birth experience. I had a third degree that was misdiagnosed as a second degree and stitched up by the midwife. I then became quite ill and they found I’d continued to bleed and a haematoma had formed behind the stitches. I had to be unstitched, have the haematoma evacuated, and restitched under spinal in theatre, which was when they discovered the third degree tear. Then I had further repair surgery under general when it didn’t heal properly (as a result of being stitched twice the first time) a few months later. I found that absolutely brutal and I can’t imagine what a fourth degree must have been like. But I’m glad to hear everyone has been supportive of your request for a section.

@Cherrytree1621*@MinimumChips and @currentlynotavailable* I am so glad you had such good experiences with your ELCSs!

God, @MissChanandlerBong90 that sounds dreadful. I'm not surprised you felt traumatised afterwards, and you absolutely should not feel ashamed that the experience caused bonding issues with your son. You've really been through the wringer, and the people who treated you really let you down.

Did you have any counselling afterwards? I had a counselling session booked for an unrelated issue (IVF) and I hadn't realised how much DCs birth had affected me until the counsellor started asking me about it 3ish years later, and I ended up booking a birth debrief session with her. After the first session I actually started to process everything that had happened and honestly felt like such a weight had lifted. I would strongly recommend a birth debrief of some sort if you are able to access it.

I’m so sorry OP! Not as bad as you, but I had an episiotomy, 3b tear and lost 2.3l of blood (suspected placental abruption) when our daughter was born. My bladder also took a battering and no one could tell me at the time if I was looking at long term incontinence (it’s since more or less back to normal but not perfect). I said right away that if we were lucky enough to have another child it would be by ELCS. The consultant I spoke to in my debrief and the perineal midwife who did my last appointment were both very supportive of a C section. In fact the midwife told me from the beginning that the trust offers the option of a planned section to all women who had a previous third degree tear. I can’t remember the numbers right now, but she was very upfront that another vaginal birth substantially increases the risk of another third degree tear, and also of faecal incontinence. We are about to start TTC again and it’s still on the understanding that I’ll be having a C section.

As several posters have said, an elective c section isn't any riskier for either mother or baby than a vaginal birth. The risks are different but also similar in some ways. Blood clots is one of the main risks following c section but then I ended up with an even higher risk of blood clots following a severe bleed from a tear followed by spinal to repair it.

I really think the choice is down to personal preference - with ELCS you retain quite a bit of control, you know when it will happen and what to expect, yes the immediate recovery will probably be painful and may take longer. With a VB you have a fairly high chance of a much easier time and faster recovery the second time, however there's a lot of uncertainty as you just don't know how labour will go and there's also a smallish chance of things going as bad or worse than before. So it depends on your attitude to risk, whether you are a bit scared of surgery, how happy you are with a certain degree of uncertainty.

In terms of the ease of getting a c section, my experience is that midwives are in general not pro c section, but they don't try to sway you one way or the other. If you go.in saying that a c section is what you want, due to your previous birth experience, I doubt anyone will try to change your mind. Or at least most won't - there's always the risk of one rogue midwife and you may get the odd throw away comment about "major surgery" etc. You will probably have to attend a clinic to discuss it but that is quite helpful anyway I think. Also you may be consultant led due to your previous experience and they in most cases seem either neutral or pro c section.

As a midwife I can’t see that you’ll have any problems having an ELCS OP I actually think that’s what they will advise. Don’t worry at all. Definitely a good reason to have a c section and that included with the impact on your mental health from previous birth.

Hi @MissChanandlerBong90 I just wanted to revisit this thread to give you an update on my own care.

When I was booked in for my 12 week scan I received a couple of letters for other hospital appts as well. One was this week (17 weeks) and I had no idea what it was for. I duly went along and was called in by the doctor. She literally opened the conversation with "So, you had a dreadful experience last time, are we planning a c section this time?". And that was it. We had a bit of a chat about ELCS vs vaginal birth, and she was quite stern with me about how damaging a second vaginal birth could potentially be (in a nice way). We talked briefly about the procedure, and she booked me in for an appt with the anaesthetist for 36 weeks for my pre-op.

I know not everyone gets such straightforward agreement but hopefully this reassures you that not everyone has problems getting it agreed either

Hi! I’m sorry I didn’t return to the thread after my last post, I didn’t get the notifications that there had been replies!

@EarlGreywithLemon I’m so sorry to hear about your first birth experience. That sounds incredibly traumatic. But that’s really interesting to know that your trust offers a section to all women who’ve had a previous 3DT. I don’t know whether that’s the case at mine but it really helps to know that it’s the case at other trusts, so thank you for sharing!

@Mummyto293 thank you for your reply, that is really useful to know.

@TheCheeseBadge thanks so much for revisiting the thread to update on your experience. I’m really pleased you’ve had such a straightforward experience. When will they perform your caesarean - at 39 weeks?

I’m still in my first trimester so haven’t had any of the important appointments yet but I will update the thread to let you know how it goes. But I feel a lot calmer from reading this thread that I may not face the level of pushback that I thought I might!