Elective section or natural? Pros, cons, kindness pls

[Haveallthenamesgone]

Hi, I’m very nervous first timer, due early January. I’m looking for experience and facts, not judgements. Ladies who’ve had both CS and natural, can you tell me:

• which is worse for unexpected pain?
• post birth, do you get scary things going on in your downstairs area for both types of delivery? Hearing a lot about pads and not really sure what that entails…
• is it right that in a natural birth, the contractions are worse than the pushing pain?
• in a C-section, what are some of the realities of post-operative recovery? I know things like bending down is obviously difficult, but what am I not thinking of? Please be straightforward, not horror stories.

Is there anything else I’m not thinking of? I just can’t decide what to do. My priorities are staying in control as much as possible, a shorter time as possible, reducing pain and not bothered about sentimentality. Just wanted to meet a healthy baby.

Post birth bleeding you will have either way and it’s not scary so much as bleh. As in oh, I see the skipping period for nine months as a plus is immediately withdrawn by having nine periods worth of bleeding after birth. It’s more annoying as fuck than scary.

I've only had planned sections so I'm not going to compare, say much etc, but please be wary of those that are comparing emergency sections and vaginal births, as the recovery for an emergency section is often a lot tougher than an elective. So they (on average) will be more likely to prefer vaginal.

And on the other side, those who chose a section after a horrendous first birth, you are comparing a worse than average vaginal birth. So they (on average) will be more likely to prefer a section.

So just be wary of why the posters had the births they did, as that will very much colour their opinion.

Following as I’m trying to decide whether to have a natural birth or ELCS for my second! So can’t answer many of your questions but to answer the one about pain in labour, I had no proper pain relief in my first labour and would say the contractions in the first stage (when cervix is dilating) got progressively more powerful/painful, peaking at about 8-10cm (which is transition).Then in the second stage (when the body is pushing baby out) the contractions were as powerful as they had been in transition, but more “productive” as you can feel baby moving down - mentally I felt better able to cope at that point than at transition as I knew the end was in sight and I just needed to push through (no pun intended). Then baby’s head crowning was a different sort of pain (stinging/burning) but over very quickly. That was just my experience though - just like we all experience period pain differently, we all experience labour differently!

That’s a really, really good point, thank you!

An elective section is always going to be your most reliably "pain-free" option, because you don't know what sort of labour you're going to have. So if you don't like surprises and would prefer some certainty then that's the way to go.

With a vaginal birth it's the luck of the draw. Many people say a straightforward vaginal birth is easier to recover from than a section (I wouldn't know), but then you have no idea if you're going to get a straightforward vaginal birth or not. So it depends on how much you want to leave it to chance.

Of my friendship group, I know just one person out of around 20 who had a straightforward labour first time round. The rest of us all had interventions, complications or finished up with an emergency section. Recovering from difficult vaginal births can be very hard. I needed surgery after mine, for example, as I suffered a lot of damage.

Second births were generally much easier for all of us.

The reality of a c section for me was that I was left infertile within 2 years as scar tissue and adhesions destroyed my tubes and I nearly died from 2 ruptured ectopics and had to spend £35k on 5 rounds of IVF to have another child

Sorry if that's straight to the point but there is no way of sugar coating my experience with a c section to be honest

I asked a similar question a while back and had loads of responses. the thread is below. I am now nearly 28 weeks and i still haven't decided. I thought i'd end up logical and choosing a c-section but i have become weirdly sentimental as the pregnancy has developed so i still have no ideas:

www.mumsnet.com/Talk/pregnancy/4330509-If-you-could-just-pick-would-it-be-vaginal-or-planned-c-section-Title-edited-at-OPs-request

I've had a semi-elective C-section for my first birth (baby was breech so planned CS, but went into labour the day before - it was still very relaxed and no rushing at all) then a vaginal birth for my second (ventouse birth with an episiotomy followed by a retained placenta and lost 1.8 L of blood - so not straightforward at all).

Personally, I much preferred my vaginal birth, even with all the complications. I was up and about so much easier afterwards, whereas after my C-section it took weeks for me to be able to move without pain. My second baby ended up staying in the neonatal unit for 10 days after birth, and I would have really really struggled to visit him and stay with him and express my milk every 3 hours if I'd have had another c section.

I did have a bit of pain in my episiotomy - but it was only bad for one night then totally manageable after about 24-48 hours.

The bleeding after birth happens whatever type of birth you have. Your uterus has to shed the really thick lining its grown through pregnancy and heal the large wound from the placenta detaching. I bled heavily for about the first 5 days then continued bleeding a bit until 5-6 weeks both times, so not much difference there.

If I was to have a third baby, I would definitely opt for another vaginal birth. The experience was so much more empowering and I genuinely felt high on happiness and oxytocin for days after, which I never got with my C-section.

However, it's completely up to you. I'm a midwife so I've worked with hundreds of women who have given birth - some prefer c-sections, others vaginal births. I've seen women struggle horrendously with pain/ infections/ immobility after both types of birth, and equally women who have been up and about and almost pain free after c-sections.

[quote Bells3032]I asked a similar question a while back and had loads of responses. the thread is below. I am now nearly 28 weeks and i still haven't decided. I thought i'd end up logical and choosing a c-section but i have become weirdly sentimental as the pregnancy has developed so i still have no ideas:

www.mumsnet.com/Talk/pregnancy/4330509-If-you-could-just-pick-would-it-be-vaginal-or-planned-c-section-Title-edited-at-OPs-request[/quote]
Oh wow, I have now seen your post, thanks for the link. It was so thorough. What was interesting was that the most extreme experiences were beyond anyone’s control, and outside of the extremes it was fairly evenly split between vaginal and elective. Ha!

I've had both. Technically my section wasn't elective (I had pregancy compilations) but it was planned albeit only with one day's notice and I never went into labour, so effectively it was the same as an elective. Then I had two vaginal births. First one, long drawn out affair with an epidural and forceps, second, fast, straightforward and drug free apart from a short use on entonox,
These are my experiences and views
Planned Section pros:
Predictable (relatively) and calm.
Quick
Happens in "office hours" so loads of staff around and easier for birth partner generally.
You've not been in labour so not tired in the same way afterwards
Procedure itself painless though there may be some discomfort
Less, but not no, risk of things like prolapse, stress incontinence afterwards.
Planned Section Cons
Risks of anaesthesia
Risks of surgery - neither of these huge of course, but they do exist.
Post op pain.
Restrictions on post op mobility.
Not being able to drive.
I recovered pretty well to be honest - was up and about next day, out and about within a couple of weeks (but that was delayed by other things wrong with me.) Insurers wouldn't let me drive for 6 weeks though.
Can make breastfeeding a but more difficult though personally I didn't find this.
Abdominal scar and potential "overhang".
Implications for future pregnancies- it does complicate your birth choices next time a bit. VBACs have their risks, but so do repeat sections, especially if you want more than a couple of children.
Vaginal birth pros
Unpredictable- could be a con, but I quite liked the excitement of not knowing what's happening when!
I have to admit that I had a huge sense of achievement and quite a "high" that I didn't get after my section.
Recovery was a lot quicker for me. I did have a good post section recovery but I couldn't believe how much better I felt after giving birth vaginally - even after having a forceps delivery. I was driving again after about a week, and probably could have done sooner if I'd really had to.
No pain on lifting baby etc. Breastfeeding my be easier.
No abdominal scar obviously!
Vaginal birth cons
Unpredictable (see above)
Tiring
Can be very long
Painful (though I didn't find it too bad really)
Still the risk of needing interventions including a section
Likelihood of stitches in your perineum fairly high and they are pretty uncomfortable for a while.
Greater risk of vaginal injury, prolapse etc.

Bleeding I found more or less the same. My milk came in at the same time too.
Overall I had good experiences all times. The section was very relaxed and no pain at the time, but the recovery, though straightfoward, was harder than after my vaginal births. VBs were unpredictable, but kind of exciting, painful at the time but less pain afterwards. My section scarred my abdomen and my VBs scarred my perineum so 6 of one and half a dozen of the other - neither are "bad" but I may have been lucky.
My "babies" are all young adults now and to be honest, apart from when someone asks, I don't give their births much thought, and there is no difference in their health or how I feel about them or anything. I enjoyed all my births and feel quite privileged to have experienced both a section and vaginal births without any major complications. (My pregnancies on the other hand were horrible!)

yeah it wasn't overly helpful in making the decision. But she's currently breach anyway so may not get an option

Not sure how helpful this will be k had an EMC last June due to failure to progress , failed epidural and a back to back baby after 26 hours in labour .. my due date is today and I'm really really hoping for a vbac so I guess that tells you all I need to say about my experience of a section. For those saying an elective and emergency differ a lot, not really. It's still the same major abdominal surgery but yes if you've laboured before you will be more tired than having a restful sleep the night before an elective, i was up and about 8 hours after my section but infection after infection it took me 4 months to feel anywhere near normal. I can't comment on vaginal
Birth hopefully I have a successful vbac so can come back and tell you but i defo want to try rather than opt for a section

Thank you so much MrsAvocet - really thorough and balanced

I have two planned c-sections due to medical reasons. I think people often assume it all the same. But I had two very different experiences!
First one was fine, other than bad wind pain (peppermint tea!) pain was ok and healed Was up shopping within a week.
Second time around a lot more pain and discomfort. Wound infection and very sore for weeks :( heavy bleeding as well. Movement was restricted bed rest for a while. Very frustrating after the first was so uneventful!

I think it’s hard to judge other experiences as they can be so different and nothing follows a text book!!

You’re totally right, everyone’s experiences is different. In fact the diversity of these replies just made me think there’s no point crowdsourcing, you just have to go with your instinct and whatever will be will be

I had three natural and a c section on Saturday.

The recovery has been really tough for me this time. I’m upstairs, in pain when I move and have to sleep sat up. With my others I was up and about like normal when i got home.

I’ve barely lost any blood this time, am breastfeeding really well and don’t feel like I’ve been hit by a bus!

If you have the support then a c section is ok. I’m very independent and am struggling with not doing anything!

Recovery from my elective CS was much easier than from my forceps delivery. 50% of primips won't have a straightforward delivery.

Two sections (one for breech/ iugr baby and one for failure to progress 🙄) and one natural here.

Section pros:-

• It's over and done with quickly
• No tearing/ swollen/ soreness to contend with
• Relatively straightforward recovery after first section
• Was driving again within a week or so
• Didn't affect breastfeeding though was more awkward initially

Section cons:-

• Major surgery and looking after a newborn is bloody difficult (you're essentially chopped liver to every visitor/ potential helper as they're there for baby not you)
• Infections
• My spinal failed in my first section. It was utterly horrendous and left me with PTSD/ pnd
• post second section ended up with a massive haematoma that needed surgical revision 10 days post op.
• The scar is tethered and the overhang is vile. I won't let my husband touch my stomach.

Vaginal pros:-

• I got my much wanted home birth with no intervention which was a salve to the previous birth experiences
• I've never felt a high like it
• I'd emptied my birth pool, cleaned the living room and sat on my couch within 3 hours of having my baby (endorphins- wouldn't actually recommend this but I honestly felt like I could run through walls 😂)
• Was taking the kids to school and nursery by day 3 with no problems
• I felt in control which was something that I hadn't in my two prior births (age, experience and an actual tonne of research probably helped there though)
• Didn't affect breastfeeding

Vaginal cons:-
*Tear and graze- the labial graze was uncomfortable for a couple of weeks. The tear wasn't that bad tbh.

• The swelling/ tenderness. I felt like i'd been kicked by a horse once the fuzzy make feel goods buggered off. That dragging feeling was uncomfortable and lasted about 3/4 weeks. I just wasn't expecting that at all.

Completely understand how you're feeling. I'm currently recovering from birth number 2 which was a planned c section. Ultimately like someone else commented earlier, there is no guarantee of outcome for either route you decide to pick, things can go well with a vaginal birth and a section... or not. A vaginal birth is luck of the draw, with an ELCS you are more sure of the outcome.

My first birth was an induction at 40 + 7. Was induce on Sunday and baby arrived on Tuesday. It was EXTREMELY painful and I felt like went on and on and on. Cervix stuck at 7cm for over 12 hours. Eventually got an epidural which allowed me and DH to finally get some rest for a short hour (on the labour bed nonetheless so not really relaxing but we were both so exhausted. I must stress here I had been given every drug in the world and I was in a complete daze for most of it - until the epidural gave me some peace). After sleeping for a bit I was told I wasn't going to progress further so within the hour I had the baby via emergency c section. I was very happy with this decision at that point and like you, was not sentimental, I just wanted my baby out. The section went super well, tiny scar, recovered super quickly. Was up walking around within 4 days, no wound/healing pains. Everything felt good. My DH was left with PTSD after this though, having seen me and supported me non stop for over 48h in intense pain without a break, it was hard for him. I saw the entire experience through rose tinted glasses... so drugged up and just completely in love with the baby. I was fine.

Second pregnancy - I opted for a planned section despite being told I could have a vaginal delivery. I wanted to keep some control over the whole thing. Going overdue was very hard for me and I am generally an anxious pregnant lady so I was just desperate to not go overdue this time. Add this to the fact that I never went into labour naturally (sure I could have waited to go up to 42 weeks but I couldn't face that), and add the fact that I didn't dilate more than 7cm and that in the end it ended in section anyway, I felt that a planned section was best this time. I've also always felt very queezy about forceps/episiotomy/tears/prolapse/incontenance etc and felt that if I opted for a vaginal birth this time round there's no guarantee it could be straightforward text book. I didn't want to risk ending up with one of the above I.e prolapse or forceps for example.

I'm now day 3 recovering from my ELCS and to my surprise it's been harder than the first. The op went well but a lot of pulling and tugging during the op has left my lower belly a little bruised (nothing major but my tummy is tender and a bit sore). The scar is healing fine but obviously it's painful and I can't walk around much so lots of bed rest - but this really isn't a bad thing! My DH is doing all the house stuffs, bringing me things of course and we're managing fine. It's not easy, but who said having a new born is ? Turning over in bed is painful but it's getting easier day by day. I just don't remember being in so much pain first time round... ?! But I'm 3 years older with a pre schooler, that could also be why. Each day is getting easier. Perhaps I just got extra lucky with the emergency section previously, as recovery really was seamless. Having said that, I don't regret my decision as I think I have a bit of fear around bad tears, sex problems after childbirth etc etc... therefore I'm just grateful that my intimate area is untouched and in working order. Damage down there was a risk that I personally did not want to take and would rather ride out the bruised tummy and a painful incision for a few weeks.

And best of luck! Hope you get the best outcome possible whatever you decide

Sorry I realise I didn't finish by saying that ultimately it's about figuring out what matters the most for you. Or which of the following "bad" outcomes could you not cope with ? Kind of like a game of would you rather...
a- a straightforward vaginal birth but this isn't guaranteed at all.
b- or pain in your intimate area like a tear
c- or pain with an incision with a c section

Unless you are lucky enough to have a wonderful vaginal birth with perhaps just a little graze, there will be a certain amount of pain and recovery needed so it's just a question of where would you rather that pain and recovery be ?

It can seem like a bit of a loose/loose situation, that's how I feel really.

@mrssunshinexxx did you get your vbac?

Hi @mightbeyesmightbeno sadly not got to 10cm and pushing and her heart rate went into distress transpires the cord was round her neck twice and my scar was paper thin so the right decision was made but feeling very disappointed I went through all that to end with major surgery again and went into life with a new born having been through both labours and not slept for 40 Hours just totally wrecked to begin with . Been strongly advised next pregnancy should be elective which I will not ignore but will be gutted to have another caesarean recovery although I know an elective would be a little easier than emergency x

I’ve had 2 ELCS and despite finding the pain afterwards for next day etc horrible (low pain threshold here!) I would have one again. I had a fantastic surgeon for the second one (operates at top London private hospital but I had him on the NHS) and I found recovery second time easier. Having an ELCS was so controlled - I know when the op was, I knew what to expect (ish) and baby comes straight out so imo it is safe for baby as fewer risks re oxygen deprivation etc. Agree with Rosyrose above that it depends what your personal preference is for location of pain and recovery. Whichever decision you make it is not the wrong one!

@mrssunshinexxx really sorry to hear that :( At least you sound confident that there WILL be more so it hasn't put you off too badly!