Deciding between vaginal delivery and ELCS

[stopknockingonmydoor]

So the choice is mine after a third degree tear during my last delivery, but my consultant is trying to sway me towards another vaginal birth.

I know that the choice is ultimately mine, but what were on your pros and cons list if you had to decide between the two?

I just want to make sure I'm making the right decision for me and someone may have thought of something that I haven't

I had a 3rd degree tear with my first and had an ELCS 2.5 years later because of it. Midwife didn’t even question me as it was such a reasonable request.

For me the reasons were that I had to have a year of physio after my tear to stop myself leaking and for a few months couldn’t get a tampon in after let alone a penis! So yes my body was v traumatised. So the 2.5 year gap seemed quite soon for my body to go through a tear again.

My ELCS was not straightforward at all but it was v unusual I’m told so I wouldn’t worry about that. DC3 I will most likely choose another c section; the recovery was FAR FAR FAR smoother and easier than my tear recovery.

I had a forceps birth first time around with episiotomy and a tear, 2+ hours of pushing, lost 1l of blood. ‘Minor’ prolapse since.

I’m not risking more damage down there and I’m having an ELCS next time. I’m under no illusion that it’s easy but I suspect I’ve pushed my luck with down there and I’m not sure I can do much more to my vagina without risking incontinence. So I’ll take the risk of surgery against never being able to run again.

I had a VBAC after being “convinced” by the midwife. Have an ELCS

I can’t actually decide between the two, because I have had both my children via cesarian.
I can’t compare a vaginal birth to a cesarian, but I want you to know that my 2nd cesarian (the planned one) was great. It was so relaxed, and although I suffered after (as I’m sure you did after your vaginal birth) I was so happy. It’s so easy because you know when it’s going to happen, so you can get plans in place for your first child.
I was very sore, and walked hunched over for about a week. But I used those stomach control pants, which worked wonders for me, and made me feel good and stand a bit straighter.
I hope you make the right decision for you, and don’t just go and do what your consultant recommends, but I want you to know that a cesarian isn’t a walk in the park. It does hurt very much. I wish you the best of luck. 😘

Here to say even planned CS can have unpleasant consequences. I'm still in hospital 11 days post ELCS having been readmitted day 5 with injected haematoma behind my wound. Told its just a bad complication from the surgery but have had sky high fever and on iv antibiotics whilst everything 'drains". This was after an EMCS last time. You've got a really tricky choice to make, chances are everything will be fine with ELCS but you did ask for a cons list!

*infected not injected!

Third degree tear here. Was made to feel like a section was not necessary for second birth. I felt bullied into a vaginal birth. so did it.
Had a fourth degree tear and it’s ruined my life.
Don’t risk it.

Weighing both up at the moment as baby is breech and may turn or not. I will decide based on position as I don't want to attempt a breech vaginal birth. But for me really it comes down to the fact vaginal birth is extremely painful but it's all concentrated into that one day really. Afterwards you're a bit tender but the recovery is generally quite fast and if you're lucky there are no lasting issues. I appreciate this isn't your experience if you've had a nasty tear before. I'd probably want to look at the stats for that happening again.

OTOH planned section is meant to be a lovely calm comfortable experience, but with a much longer recovery, particularly difficult if you have a toddler to look after, (I'm lucky to have DH around for several months so not too bad, but he won't understand me not being able to pick him up) and there are definitely permanent effects even if just the scar itself. High potential for things like adhesions etc. Also can cause issues with future pregnancies.

Having had 2x straightforward vaginal birth before I'm leaving towards that as the more preferable option for me, but since I don't really want any more DC and DH is around to help with DS2 I'm not too bothered about c section either and will appreciate the calm, predictable and non painful nature of it if I do need that!

Something that does bother me about a section is that they won't do delayed cord clamping at my hospital. It was explained to me that they don't wait because you're bleeding and they don't want to leave you open for an extra 90 seconds to wait for the cord. I understand that reasoning, but don't see why they can't take the baby and placenta out still attached!

I really feel this is important so I'm a bit unsure about that part, but will probably just ask about it again until I'm satisfied with the explanation. I like to think about balancing risks.

In your place I think I might opt for a C-section.

The problem is you just don't know how a labour and birth will go until you are in the midst of it.

C-sections aren't an easy option but what you describe with previous birth sounds horrendous so - better safe than sorry.

At least you will be awake and able to hold your baby straight away. In the past it was always done under GA and it took a while to recover from the anaesthetic. That was many years ago - I'm thinking of an aunt who had my cousin by emergency Caesarian and was cut upwards, not bikini line. Good result for her though, she was happy with her little girl but nobody has to go through so much now.

Good luck.

Take the section, make your life easier and baby's safer.

@SnotsGotTheBoobies

I can’t actually decide between the two, because I have had both my children via cesarian. I can’t compare a vaginal birth to a cesarian, but I want you to know that my 2nd cesarian (the planned one) was great. It was so relaxed, and although I suffered after (as I’m sure you did after your vaginal birth) I was so happy. It’s so easy because you know when it’s going to happen, so you can get plans in place for your first child. I was very sore, and walked hunched over for about a week. But I used those stomach control pants, which worked wonders for me, and made me feel good and stand a bit straighter. I hope you make the right decision for you, and don’t just go and do what your consultant recommends, but I want you to know that a cesarian isn’t a walk in the park. It does hurt very much. I wish you the best of luck. 😘

Can I ask where you got the control pants please? I’ve seen some in John Lewis that say they’re for a c-section @SnotsGotTheBoobies

Thank you all so much for replying, I really appreciate it and have read through everything you've all said 

@Terrazzo I'm so sorry that was your experience. I've been very lucky to heal well with no lasting damage, other than slight urge incontinence which the consultant said can't be attributed to the tear, could just be from the pregnancy. This is why she feels a vaginal birth would be fine for the me this time, but my concern is that the same thing could happen again and I may not recover as well.

@SnotsGotTheBoobies I absolutely agree that a caesarean isn't the easy way out or a walk in the park, I think I 'like' that I can prepare for that in as many ways as I can before baby arrives and if I feel better than expected then it'll be a bonus

@Inthesky42 so sorry this has happened to you, but thank you very much for showing me the other side of what can come from an ELCS. I hope you're feeling better soon and make a speedy recovery

@Delicatesubjectsadly this is my fear, I'm so sorry it happened to you!

@Maggiesfarm @Susannahmoody I'm swaying towards a section, but didn't want to put that in my OP. It's not just the physical aspects of it, although that does weigh on my mind. It's also the fear I have now. I wasn't afraid at all during my first pregnancy and labour, had just gas and air and delivered in the pool and I felt positive throughout. But I feel like this time would be different - I'll be nervous to go into labour and then fearful when it came to pushing and I just don't think that would be conducive to a positive birth.

I think the problem with a c section is that you can get hernias later down the line which require major surgery to correct. It happened for dsis 20 years later. She was off work for months and the recovery took over a year. Just something to bear in mind when weighing up the risks.

If there's any increased possibility of a traumatic birth I would say go for a section. I had a section planned and booked for this baby (breech) and then she turned. I decided to change then and go in for induction despite having had a previous induction and EMCS. The induction didn't work and honestly I feel since the minute I arrived in hospital I lost total control over my body and my birth experience and coming to terms with that has been really tough to come to terms with. It'll take a few weeks to get back to full power physically after the section but having a planned and well controlled birth protects your mental health and I think your children will benefit more from that than you being up on your feet but emotionally wrecked from a traumatising birth.

@sarah13xx I just got them from eBay. They were only a couple of pounds each, but they really helped me. They made me feel very secure and like I wasn’t going to rip the stitches open you can also stick a sanitary towel to them to cover the scar area. Xxx

I would go for an elective C section all the way! I've been left with lasting damage from my vaginal births, have already had one lot of surgery and will likely need more in the next couple of years. If I could go back I'd have opted for sections!

My first delivery resulted in a large but 1st degree tear (vaginal rather than perineal), and some relatively minor prolapse. I had another vaginal birth with my second which was a relaxed water birth but I got a 3C tear that required surgery with more problems down the line. I wish I'd had a C-section. I think its the less risky option especially long term for someone who had a 3rd degree tear.

I had a third degree tear with my first. With my second and third didn't have anything, not even a graze.

@Dollywilde

I had a forceps birth first time around with episiotomy and a tear, 2+ hours of pushing, lost 1l of blood. ‘Minor’ prolapse since.

I’m not risking more damage down there and I’m having an ELCS next time. I’m under no illusion that it’s easy but I suspect I’ve pushed my luck with down there and I’m not sure I can do much more to my vagina without risking incontinence. So I’ll take the risk of surgery against never being able to run again.

I’m in exactly the same boat, mine was a 3B tear, episiotomy and blood loss. Im having a c section in the next few days.

My biggest fear is my moderate prolapse getting worse - at the moment it impedes me but doesn’t totally stop me doing everything I enjoy. I couldn’t bear if it got worse and I could have prevented it.

I was actually geared up for a natural birth but the look on my midwives face told me she thought I was batshit. When I commented she said “most women would have a section now” the consultant said the only outcome they measure is faecal incontinence and not the things that are important to me - ie living a relatively active life and walking my dog without my uterus dropping out. She was totally supportive of my choice for a section but equally expressed it was unlikely a natural birth would go quite as badly as before.

@princesslarmadrama

I had a third degree tear with my first. With my second and third didn't have anything, not even a graze.

@princesslarmadrama that's interesting. If you don't mind me asking, were you offered a section for your subsequent birthday and declined or did it just not enter your mind to have one, assuming you healed well from your tear?

It’s such a personal issue. I had a vbac after emcs (failure to progress past 9cm). I had complications with c section and ended up with spesis. My dr wanted me to have an elcs with DD2 and I pushed hard to get what I wanted. I was so glad to choose to have a vbac as the recovery was so much easier.

I had a vbac with my second and the recovery was much worse than the EMCS I had with my first. Forceps, episiotomy, tearing, blood transfusion, prolapse etc. The thought of a baby squeezing through all of those parts that were stitched up 🤮🤮🤮
I am having an ELCS with this baby that I'm pregnant with now.

@stopknockingonmydoor I was offered the option of an ELCS but when I talked things through with a specialist and he read the notes of how I healed he was quite happy for me to have a VBAC.

Don't get me wrong I was very worried about how my second birth would go but I was put off having a ELCS after seeing how badly my friends recovery was. Do what's right for you and if you are worried about making things worse down there then have the ELCS.

Hi OP. I really feel for you. This is a really tough choice. Mine are teenagers now and I think the research has moved on a bit since. I had a ventouse and third degree tear with first. Traumatising birth and booked a CS for the second (under consultant who was very pro CS). Went into labour early with that baby and had a normal birth and a second degree tear. For me personally having that normal birth was very healing and a lovely surprise. But he was a couple of pounds smaller than DD. Third baby 2 years later, planned a normal birth but lost my confidence in the pregnancy. He was a bigger baby (my bump was massive) and like you I came to fear the pushing stage and felt like I’d lose it and possibly end up with a CS anyway. Also had an episode of faecal incontinence in that pregnancy which really panicked me. Had a CS which I was very much in two minds about still, but was very straightforward. I will say I definitely needed my mums help for a few weeks afterwards and recovery took longer than I thought.
It’s so personal to you but I’d say important factors are whether you have incontinence/ other symptoms now which could be exacerbated by vaginal birth (I think advice now is definitely have a CS if you do have incontinence symptoms). Trust how you feel about your own body eg after three pregnancies in four years I felt like my pelvic floor couldn’t take any more and I think for me personally that was right. Whether you have any personal attachment to the idea of a normal birth (not in any way saying you should have - just that some women do). And whether you have help afterwards. My third baby was 9lb 1 and looking back the CS was right for us. 13 years later I am just glad he and I are are OK.
If it helps you to read up there is research out there e.g. you could look up OASI which is a technique of supporting the perineum supposedly to reduce third degree tears. May be associated with increased incidence of other years though eg urethral.
Sorry that was quite long, but I hope it helps.