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

Hi, I had a vaginal birth for my very premature, stillborn baby only, so quite different and no tearing etc. Baby number 2 was born prematurely by emergency C section (but I was awake) and so I didn't have much chance to consider it. It was ok and I recovered ok.
Baby number 3 was full term. They did try and persuade me to have a VBAC but in the end I was booked in for an elective C-section. Things I noted:

1. I was consulted beforehand on my wishes for the birth this time, and was able to have everything I asked for - baby put on my chest right away, etc. It was all very calm and peaceful and quick.
2. Recovery wise after I'd had one c section already I knew what to expect, but the recovery seemed worse and I had significant overhang which persists today still.

On balance though, in your position especially, I would go for the CS.

I think in your situation I'd want to do loads of research about tearing - how much and why it happens, whether the risks increase or decrease if you've torn before, what can be done to redice the chance, things like that.

This youtube channel has been really good for me recently. She is a little bit shouty but does seem to have really good well evidenced info. She has a c-section vs vaginal birth video as well.

I had a 3B tear with DS1 two years ago and I’m currently 38 weeks pregnant with baby number 2. I’ve really wrestled with the decision as I enjoyed my first birth and want to experience it again (obviously minus the tear!!) BUT I’ve spoken to several consultants and they’ve gently persuaded me that a c section is the most sensible option for protecting my long term health/continence. There risk factors for me tearing first time around were low - small baby, no intervention/instruments etc which could indicate a physiological reason and apparently increases the odds of me tearing again. The fact they’re encouraging a c section makes me think it’s probably for the best; I know they don’t hand out ELCS all too easily.

It’s not my preferred birth plan and I’m honestly terrified but I know I’d never forgive myself if I had another tear and developed issues further down the line. Although midwives I’ve spoken to have been more optimistic about the likelihood of tearing again one consultant I saw said it doesn’t really matter whether or not I had another tear; pushing another baby out would weaken the repair job which would likely lead to problems in the future.

I’ve really agonised over the decision. It’s not an easy choice to make but I’ve tried to go with my head over my heart.

Good luck with your decision OP

@BertieBotts

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.

Sorry to derail the thread, but I don't buy that. In my trust, unless there's very heavy bleeding and/or baby's condition isn't great, we try to do delayed cord clamping for every baby. However, once the placenta is out (normally a minute or two after baby), the surgeons really do have to crack on. So baby has to be out of the way by then. It's also bloody freezing quite chilly in theatre, so they need to get baby off your legs (which might be wet as well from amniotic fluid) and dried off and wrapped up as quick as possible. Even with that, we can still spare a minute or two to delay cord clamping.

No actual advice from experience (as I’ve never had a caesarean) but I am in the same position of needing to make this choice, for the same reason, so you have my sympathy. I’ve been researching it quite a lot.

Obviously you already know the cons of vaginal birth as well as I do 😂 It seems to me that the pros of vaginal birth are that a) IF it goes well, you’ll have a shorter and easier recovery than from a c-section and b) there’s evidence it’s good for the baby (again IF it goes well) because they get the fluid squeezed out of their lungs and it may be good for the microbiome.

The pros of a c-section are obvious - no 3rd or 4th DTs. And much easier to plan childcare for DC1.

The cons I’ve been able to find are - general risks of surgery (eg blood clots), risk of infection in wound or even in lining of womb, risk of damage from catheter, baby doesn’t get the above-mentioned benefits of vaginal birth (although doesn’t get the risks of it either!), longer recovery time than straightforward vaginal birth, possible impact on future pregnancies (eg placenta acreta and placenta previa more likely in women who’ve had previous sections).

At the moment I’m leaning towards a section because the way I see it there’s a hierarchy of births:

• Straightforward vaginal birth
• ELCS
• EMCS
• Traumatic vaginal birth.

I realise that’s oversimplifying a bit as some people have awful experiences with sections. But basically I figured since I’ve already had a traumatic vaginal birth I’m more likely to have another and I may as well settle for the second best kind of birth rather than aiming to experience the best and ending up with the worst (again).

I will ask Dyra if I need to have one - currently baby is head down so fingers crossed I won't. I'm not in the UK though so hospital won't be following NHS policy but they do tend to be quite up to date.

I guess I'm kind of seeing baby getting wrapped up and dried as an activity which can happen anywhere, it doesn't need to be in a specific location? But at the end of the day I am not someone to make a big fuss and demand things are changed. I want them to be comfortable with what they are doing, not flapping around some unfamiliar protocol. Also totally not interested in having the screen lowered or reaching down to pick up the baby myself or any of those things I've read about!

I agree with your hierarchy Chanandler, although I'm not really sure about EMCS and traumatic VB - I would probably put them both around equal since it's hard to quantify, and a difficult VB may well result in EMCS anyway.

The other advantage of an ELCS is that it doesn't hurt, at least while they're doing it, although you get pain for the next couple of weeks as part of recovery, but it seems this pain can be managed with drugs and also isn't so severe that you can't live your life to some extent.

Whereas VB is painful, intensely so (couldn't possibly focus on anything else kind of pain) for several hours, but once it's over it is only sore for a day or two unless there are injuries/complications.

I am two days post elective section and have zero regrets. It has been a wonderful, healing, clam experience and the pain and side effects of the section far easier to manage than my previous 3B. Felt like I experienced every moment, took in every detail and am enjoying my newborn so so much more.

@HotPregnantLady aw amazing, congratulations! Glad you had such a positive experience. How is the recovery? What was the worst part? Was the spinal bad?

The spinal was fine - I had a spinal with my first when complications arose (VB) and couldn’t remember it going in. I did feel it this time but zoned out and it was ok. Uncomfortable but ok.

Recovery is so far ok. It has been easier than my VB experience. More manageable and predictable. No chunks of flesh floating in my urine containers. The hospital staff were amazing and very hands on and attentive with DH not being allowed to stay on the ward. I’m very comfortable today but mindful of taking it easy.

The worst part was moving from hospital to home. The walk to the car was too much and the journey home uncomfortable. But got back on top of pain relief shortly after. Feeding little one myself which has helped as less moving around and DH being way more helpful than with our first!

@HotPregnantLady aw that’s great! Thank you so much. Hope you continue to feel better and stronger. For some reason I’m building the spinal up, I think it’s just because it’s in a weird place and I’m overthinking it 🤦🏼‍♀️ I think the walk to the car will be a lot! Take it easy x

I've had a vaginal birth (awful) and an elective section which was lovely in comparison.

Can I ask how people's c section scars have healed? Is the scar really obvious or does it fade over time?

I've not read the full thread but thought I'd post my very positive second birth story.

I had a third degree tear with my eldest, he was 9lb1 and I delivered on my back and pushed hard. I healed well and had no issues.

I had my daughter almost exactly 2 years later. I wasn't offered a c section and would have gone for another vaginal birth.

My second birth was beautiful. I had her on all fours in the pool. I assumed I'd tear again, but I didn't. No tears at all! I was surprised to say the least. She was larger as well at 9lb3!

I do have some tailbone issues, sitting for a long time on a hard surface can become painful, but it's not horrible. I have no issues with leaking or anything like that.

@princesslarmadrama

Can I ask how people's c section scars have healed? Is the scar really obvious or does it fade over time?

Yeah the scar is quite small and fades over time. They cut below the hairline usually so you might find your pubic hair covers the scar anyway.

I am 14 days post section today and about 95% pain free and lochia seems to have cleared up also.

Thanks for posting this question OP. I'm in the same situation as you! It's such a hard decision to make! When is your baby due?

@princesslarmadrama that's a good question, I do wonder how much of my will end up being scar tissue after I've finished having children  also don't like the thought of the CS flap of skin some women say they get (I know that's vain, I'm just being honest.)

@Twizbe it's so good to hear you had a positive experience of your second birth! I think my concern is that a lot of people describe their second births as you have, but that was my first... gas and air, in the pool for delivery, all very relaxed. I think, although can't get a straight answer other than 'some women tear and there's no explanation', I needed more guidance when it came to pushing. By the time I did I got DC out in 3 pushes and think it was just too fast for my body. But I'm left with the fear from that now and not feeling like I could trust a different MW next time.

@dreamygirl25 there's been some great posters here so I hope reading their responses helps you too I'm due in October, how about you?

I will say I was also lucky to get the same midwife both times and she was amazing.

I'm not sure I did anything different to not tear second time around. If I'm honest I went into the birth assuming I'd tear again but at least this time I knew how the recovery would be. Both me and the midwife were surprised with the lack of tearing.

Like I said, I wasn't offered the choice of a c section, but if I had been I'd have turned it down.

I had a terrible first birth. Episiotomy, forceps, foetal distress, 3L blood loss, retained placenta. Recovery was long and painful.

Elective caesarean 10 months ago - it was amazing and recovery was great.

I had 3rd degree tear with first baby, then 2nd with babies 2 & 3 and then only grazing for 4th baby. All were big babies for my family (married a tall husband...).

Elective c-section wasn’t even mentioned as an option so never crossed my mind. The 2nd degree tears were along the scar from my first DCs 3rd degree tear and so it wasn’t bad healing or a battle field down there.

If I had been given a choice, I don’t know what I would have done? I don’t envy you your decision.