Should I request a c section? FTM

[Riverrushing21]

Currently 30 weeks pregnant and v anxious about childbirth, to the point where I’m wishing I had just requested a c section- is it too late now??

I’m not actually worried about labour itself or about being in pain. One big fear is of tearing and having a horrendous recovery, incontinence, sex issues etc afterwards. I’ve read many horror stories about the recovery (or lack of) after 3rd or 4th degree tears and I don’t want to be in such a bad state after birth that I struggle to look after baby.

Another fear is of going overdue, (I know this is very common for FTMs) as I know someone who went overdue and had a stillborn, after no other issues throughout the whole pregnancy. If I had a c section, going overdue wouldn’t happen, and labour wouldn’t be able to develop into any emergency situations.

I know it may not even happen to me and I could have a textbook labour- is it crazy to even consider ELCS for first birth? Will I just get told no straight away? If it’s too late for me to request it now, any tips on how to approach a vaginal birth without all this anxiety?

@Riverrushing21 sorry to hear about your mums still birth it's not surprising it's playing on your mind. I don't want to play down your fears but I had an EMC last year with my first in hindsight I wish I had let them put me on the drip and try that rather than go for section it's a big regret it took my
Wound 4 months to heal and I HATE my overhang now even though I'm a size 8/10 I don't know how I will get rid of it yes that's vain but I'm just being honest. I'm pregnant again and will be going for a natural and trying bloody hard to get through it I do have same worries as your re bad tear but 3/4 degree tears are rare I will do perineal massage and ask midwife to hold compress firmly on when head is coming out x

Just to add to sarahxx13 post (which is exactly me experience too), once you've looked at Birth Rights for your area/hospital, I also looked up the individual hospital's policy. My most local hospital didn't have an easily available policy including the NICE guidelines so I self-referred to one a further 10 mins away whose did (literally just took me requesting to transfer and filling in a one page form before my first (booking) appointment.

No problems.

Aggy I don't wish to be rude but you're misunderstanding the statistics.

It's not that an individual vaginal birth will cost almost as much as a c section IF that one happens to require later intervention for incontinence, it's that overall a vaginal birth (taking into account those with no follow up and those with loads, and everything in between) costs nearly as much as a c section taking into account the same.

In other words, even when you only include the overall cost to the NHS of future incontinence as a direct result of vaginal births, you almost may as well have had everyone having a c section for all the saving it's made the NHS.

Not only that, but when you factor in the costs of litigation concerning injured babies arising from vaginal births gone wrong (bearing in mind that such claims, while relatively rare, will typically run to many millions of pounds each) then c-sections start to look like seriously good value.

I hate the cost nonsense. My vaginal birth required two surgeries to fix, one under spinal which took about 4 hours and one under general which took about 2. Plus a year of pelvic health physio and at least 5 follow-up appointments with gynae consultants. I’d like to bet my birth cost the NHS a damn sight more than a mum having an elective section.

Just wanted to say you are not alone and I completely understand how you feel. My DM also had a late term stillbirth when I was a child and old enough to be aware, and I don’t think I realised how much this had affected me until I had DC myself.

You must do what feels right for you and your emotional well-being and mental health are just as important as your physical health and an equally valid medical need. You will want to take a number of factors into account, such as your medical history, how you feel about different birth scenarios, what the most unacceptable outcomes/risks are to you, and what birth method reduces the chance of these happening. You might also want to consider factors like family size - if you want a big family, you might decide to try for a vaginal delivery but if you are confident you only want, say, two children, this might not be a consideration.

I had a failed induction followed by EMCS first time round and went for an ELCS second time round. I found the first birth traumatic but the second was a really healing experience. I never really realised an ELCS was an option first time round - my hospital gave you a pack with the first page stating not to bother asking for one as they wouldn’t give it to you - but there was no issue about having one second time round at a different hospital. There are risks, but there are risks in all births.

Good luck

No you are not crazy to want ELCS and it's not too late. They will refer you to the perinatal mental health team for a chat - don't fight it, just engage with it. Ring the midwife tomorrow and ask to be referred to the consultant. ELCS is a valid choice.

@Aggy35

I'm a first time mother to be and I think c sections should be reserved for when medically necessary unless done privately. Harsh as it sounds those possible problems are a part of having a child.Should we all get c sections because we want everything down there to be as before?

Yes, if we want CS for that reason, it should be allowed. And it is allowed.

I had EMCS with my first (undiagnosed breach after failed induction). I was advised that due to previous CS, induction is avoided. That meant that if I went overdue, I would have a planned CS. The consultant said that if I went into labour before the CS date, I could safely try for a VBAC. I just assumed I’d go overdue and have a Cs, but ended up going into labour.
Honestly I was scared because I hadn’t planned for it, but it was the most empowering and wonderful experience of my life. Yes it hurt, I got a tear (mainly because I wouldn’t listen to the MW telling me small pushes!) but it was amazing.
I left hospital the same day and whilst I fell brushing down there, the was nothing compared to the pain of trying to breast feed when you have been cut in half! Whichever way it goes, it will go that way. You will get through it and it will end in the most amazing miracle!
I had similar worries due to family history but you have to remember how medicine has advanced since then x

*bruising not brushing!

There’s 2 issues here: 1) fears for you and 2) fears for baby. They’re both valid. The first one you can’t really mitigate. No one knows how birth will go but if it helps I was also terrified and had a great vaginal birth with no lasting damage.

On the second if you don’t want to go overdue you can ask for an induction. I had reduced foetal movement but had already gone into labour naturally. We induced as I was concerned about baby’s welfare and I wanted to stay in the hospital vs waiting at home to see how I progressed.

Stillbirths are incredibly rare and honestly no one knows exactly why they happen x

OP I did exactly this. I requested it late and they could only fit me in at 40+2. I went into labour at 40+1 (Sunday) and they just slotted me in and delivered him by Caesarian. It was the right decision for me. I would highly recommend asking to speak with an obstetrician at the hospital. I did as my midwife was confused why I wanted to, and the obstetrician was so helpful and supportive. It was the right decision for me.

@Aggy35 I think it's easy to judge others' choices, but it's best not to until you know all the reasons etc.

One big fear is of tearing and having a horrendous recovery, incontinence, sex issues etc afterwards. I’ve read many horror stories about the recovery (or lack of) after 3rd or 4th degree tears and I don’t want to be in such a bad state after birth that I struggle to look after baby.

You need to do what's right for you but I had a CS (breech) & a non intervention VB. Looking after the baby was far harder with the CS.
Important to remember that CS reduces the risk of incontinence & prolapse but doesn't eliminate them. Pregnancy alone weakens the muscles & then other factors.

@HangingChads really? So we want the baby but don't want to push and that's OK as goverment will lift it out?
Whats next i don't want to carry it?
Its already going that way with let's just do what easier for me thinking all around.Who needs birthing or breastfeeding etc.

I have French family & what is wrong in the UK is the lack of care. Far more pelvic floor exercise therapy should be the norm.

Wound 4 months to heal and I HATE my overhang now even though I'm a size 8/10 I don't know how I will get rid of it yes that's vain but I'm just being honest.

I feel your pain. I don't have an overhang luckily but the skin doesn't lie flat or as it was before obviously because there is a scar. Pisses me off!

The only thing I find weird about these threads is that people are terrified of giving birth but no one seems scared of surgery. I've had operations before & the days leading up to my CS I was so anxious & scared. I hated the catheter, hated the feeling of not feeling my legs, hated the lack of control etc. Maybe it's just me!

Aggy You seem very cross about this and your first reason was cost for the NHS. When it has been pointed out that there is little to no difference in cost, you seen to have moved into some nebulous moral failing in women who'd rather not give birth vaginally due to the risk of long term damage.

Could you please expand on this a bit further?

Do you believe that ELCS carries a greater risk to the baby than vaginal birth? (Happy to discuss if so, as this is not the bourne out by research I've seen). Assuming the level of risk to mother and baby is the same for an ELCS and a vaginal birth, would you still have a problem with it?

If so, can you articulate why?

Do you believe that ELCS carries a greater risk to the baby than vaginal birth?

I do worry about the gut bacteria thing, I was also born by CS.

My eldest is 4 and I've had another baby since and I didn't realise you could request to have a c section until seeing it on here tbh. I always assumed it was only if medically required.

All I can say is I had two big babies and have had none of the issues you mention and they were both induced and again I didn't have a whole host of intervention so just remember not all v births are horrendous.

@bananamushy

The only thing I find weird about these threads is that people are terrified of giving birth but no one seems scared of surgery. I've had operations before & the days leading up to my CS I was so anxious & scared. I hated the catheter, hated the feeling of not feeling my legs, hated the lack of control etc. Maybe it's just me!

I'm like this! To think of being awake on an operating table being cut open behind a sheet makes me feel a bit sick!

One thing I will say are post-delivery wards are fucking hideous and having a c-section doesn’t mean you’ll get a side room automatically.

I had to stay in after giving birth due to strep-b checks and I had to beg them to discharge Dd and I because I couldn’t sleep a wink, curtains had to be open so I was trying to breastfeed with random men staring at me.

A poor woman next to me had a c-section and could barely walk, didn’t have a partner and couldn’t lift her baby up. I had to pass him to her when he screaming because the nurses were too busy.

I’d go vaginal just to get out of there!

I tore, it was sore but Vagisil cream is a wonder and it healed well with no scarring or continence issues.

glad it's not me, I wanted to throw up! I just felt like an alien. Everything was calm, the staff were listening to the radio & I was like get me out of here!

The only thing I find weird about these threads is that people are terrified of giving birth but no one seems scared of surgery. I've had operations before & the days leading up to my CS I was so anxious & scared. I hated the catheter, hated the feeling of not feeling my legs, hated the lack of control etc. Maybe it's just me!

Those things are scary - but I think it’s because people are aware that surgery is not an unusual outcome of vaginal birth. I spent 4 hours in theatre having my 3a tear stitched up (not even the most serious kind of tear, by far). Spinal, catheter in for 36 hours after, antibiotics, anti-blood clotting injections for 10 days, the works. So some people look at the potential outcomes of vaginal birth and think ok, one of these options definitely involves surgery and the other one could involve surgery, but the chances of the option that definitely involves surgery causing life-changing injuries to my vagina/anus/bladder/bowel are lower.

bananamushy Here's just one summary of a study on the gut microbiome thing, for interest: www.newscientist.com/article/2216818-c-section-babies-have-a-different-microbiome-but-not-for-long/amp/

The other one I read was a study breastfed c section babies picking up what might have been missed during birth which I will dig out if interesting to you.

bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02433-x

Here's one fairly limited study, and not the one I had in mind, I don't think, but more recent.

One other point I’ve not seen mentioned on here is that after the birth you are back under GP care, so midwives and obstetricians don’t really have any incentive to look at the long-term situation. It’s notoriously hard to get an (in-person) GP appointment these days let alone get one to assess your post-birth state properly.
Because of the Government response to covid, there’s a huge waitlist to see a pelvic floor physio and currently around TWO YEARS to even see a colorectal surgeon. That’s an awfully long time to be walking around in adult nappies or unable to have sex.
Anyway, this is the actual document they are likely to refer you to so that you can assess the risks for yourself either way: www.nice.org.uk/guidance/ng192/resources/appendix-a-benefits-and-risks-of-vaginal-and-caesarean-birth-pdf-9074971693