Some stats- is a planned C section better?

[FirstTimeMama848484]

I am due to deliver in the next few weeks and after a lifetime of assuming I would proceed to labour and a straightforward delivery, I have started exploring the pros and cons of a vaginal birth. I’m 37, 32/40 just now, first pregnancy.

I understand that no option can be guaranteed to be risk free, however looking at the scientific evidence I wonder if an elective section may have the best long term out comes.

The chance of an uncomplicated delivery for a first delivery looks like it is about 50%. For the lucky 50%, the benefits include less respiratory issues for baby, sooner skin to skin, quicker recovery and same day discharge. Embarking on a normal vaginal delivery results in around 50% of with no risk factors, having complications such as the use of forceps or vacuum device, emergency caesarean delivery, obstetric anal sphincter injury, postpartum haemorrhage, or neonate born with an Apgar score of 7 or less at five minutes.

The unfortunate 50% in the latter group are potentially going to forgo their rapid recovery and other benefits. They may end up with injuries with a substantial recovery time, longer than that of a planned section. Admittedly a rare situation but, a 4th degree tear or significant pelvic floor injury may result in lifelong issues.

When looking at risks of an elective section, it is difficult as most articles have not separated out elective from emergency sections. My local unit quotes the risk of bladder or bowel injuries to be about 0.1% in women with no previous abdominal surgery and a normal BMI. There is a slightly higher risk of needing a transfusion (these are most likely to be emergency sections) and slightly higher risk of the baby needing NICU input (again, likely the emergency sections). Risks of abnormal placentation or uterine rupture in subsequent pregnancies are significant issues, however the risks mainly increase from the 3rd section onwards. Anecdotally, recovery time also appears to be quicker for Elective vs Emergency sections. There are many planned section units aiming for discharge within 24-48 hours, with only simple pain killers given for discharge.

I am really interested in the long-term pelvic consequences of both modes of delivery as I am very athletic normally and would like to get back to this at my previous level. Like any reasonable person, I am keen to avoid pelvic organ prolapse and incontinence issues. Another paper I found discussed the association of delivery mode with pelvic floor dysfunction (urinary incontinence, faecal incontinence, overactive bladder, pelvic organ prolapse) after first delivery. This paper quotes an uncomplicated SVD 15 year incidence of pelvic floor dysfunction at around 30%, operative vaginal delivery 40% and Caesarean delivery 17%.

Overall, it looks like a first time labourer attempting a vaginal delivery has a 50% chance of achieving this with no complications (although longer term risk of increased pelvic floor dysfunction) and any complications making the immediate and long-term situation worse. The best long term pelvic floor function seems to be those having a planned section.

So, assuming one has an uncomplicated elective section (odds seem to favour this) and could deal with the immediate recovery, is the way to go to ensure most optimal long-term outcome?!

@Movingsoon21
Your numbers are interesting and seem to be along the lines of the stats I had found.
I’ve spend ages reading the postnatal section on MN and got myself even more determined to avoid a horror story birth. I’m amazed at the number of people who have had episiotomy or tear wound breakdowns with stitches becoming infected and then whole thing falls apart. There are several threads called things like “gaping episiotomy wound” and people taking months to recover, sometimes over a year.

The number of bad planned C section stories are very hard to come by.

I’ve got a section booked for 39 weeks.

@FirstTimeMama848484 good for you - pleased you have a plan you are happy with. Did you have to push for the c section and what reasons did you give for requesting one?

Hi OP, more anecdata here - I did a lot of hypnobirthing and was v enthusiastic about a vaginal (although not necessarily entirely all-natural!). Honestly it hardly crossed my mind I could end up with a section but that's the optimism of youth, energy and first-time motherhood for you I guess. I ended up with an EMCS and I've never been so grateful for anything in my life, after God knows how many days of what they charmingly call "Failure to Progress" (FTP). I had no morphine - I think I was high on pure relief by that point - and it was fine, despite being a crash section and a bit scary at times. Recovery was great but bf took a while to establish - impossible to say whether that was related really though (and my baby also had a tongue tie). A couple of years later I fought for an ELCS and it was all fine, but I'm aware I was fairly lucky with recovery and wound staying uninfected etc. I knew the moment my first baby was out that I'd have another section if I had another child, and that was before I even started the recovery process!

I do know women who've struggled in various ways with section recovery (and a couple who struggled psychologically with coming to terms with what they saw as failure, very sadly) and I'm realistic about the risks but I wouldn't hesitate to recommend a section. I haven't RTFT and I expect this has already been discussed, but so many lingering adverse effects of vaginal birth are just dismissed as par for the course so it's very hard to filter out meaningful statistics on this. I'm sure I won't be the only person who's said this, but if men gave birth then the whole way society assesses the risks of childbirth and deals with these would be very different. Very best of luck with your section and lovely new baby!

@Movingsoon21
Thanks!
It was really easy. Had a great consultation with the consultant obstetrician. I basically said given the risks of a vb and an elective section, I’d rather go down the elective section route.

She discussed if I had any exaggerated anxiety about a vb, which I don’t particularly. We discussed pain relief options. Mentioned higher likelihood of baby needing help with breathing, TTN. But overall I said I wanted the option that was more likely to leave me with the least damage and best long term outcome. She was happy to schedule a section on that basis.

@Laquila
I also wonder what the options would be if it was the men who gave birth!

First baby ELCS due to breech. Second baby VBAC.

My experience is that ELCS is fine - recovery is painful but manageable if you keep up max dose paracetamol/ibuprofen. I was lucky to have no complications but still not exactly a pleasant experience. I also found breastfeeding really tough - I know not the be all and end all but worth flagging if that's something you want to do.

I then had a textbook perfect VBAC. Some slight pelvic issues but all resolved itself within 6 months. Breastfeeding was much easier as my milk came in much quicker. It was an amazing experience.

However - friends who were induced (whether from the get go or accepted drip once in labour) have almost universally had terrible experiences.

It's a really tricky one as I think a good VB is the best outcome but as you say there's no guarantee - and a bad VB is the worst. Although as others have said there are things you can do to tilt the odds in your favour - but ultimately there is a large element of luck.

@FirstTimeMama848484 it sounds like you have a great obstetrician. Really pleased you got the plan you wanted. Wish me luck with decision-making / being listened to in 4 weeks!

Inductions at term are less likely to end in CS than natural labour.

C section is a long recovery, has risks and sometimes leaves you with pouchy skin due to having cut the muscles etc
I had a terrible labour with my son but would always choose vaginal birth. Make sure you’re in hospital and if anything looks complicated they can deal with it straight away.

@Cheekypeach is there research to back that up? I’ve been told the opposite by my midwife - induction has a higher risk of c-section.

@Chichimcgee most of us are worried about the long-term internal injuries that affect continence, sex and physical activity, which all come as a relatively high risk of vaginal births, we don’t care about a bit of saggy skin!

And our point about recovery is that everyone we know who has had a c-section has had a fast, easy recovery. Do you have stats to show longer recovery times and higher risks for Planned c-sections (as opposed to emergency c-sections)?

What an interesting thread.

@Chichimccgee - my experience is the opposite of what you have written. I think that women are told what you have written because it is cheaper for health care systems to encourage women to take the risk of vaginal birth.

My first birth was awful, absolutely awful. Although I was young and fit at the time and a scan showed that I had a small baby, small head. It wasn't a long labour, but his heart failed. Emergency use of forceps. Baby survived. They gave me morphine after the birth because of the terrible pain. Much worse than labour and it endured for days and days. They don't give you morphine to take home - they just send you home.

So I found myself in my early 30s with a tiny baby, in pain and in very bad shape. There is no prize for enduring an awful birth. You still have to get on with your life, look after the baby and at the time, I was supposed to get back to work after 12 weeks.

To give a little bit of detail, I was still bleeding at 7 weeks but dr informed me that this was from the internal forceps wound. A bit of bleeding didn't worry me.
My real problem was that I could not sit down because of the pain caused by the enduring injury from the birth. And to put that into perspective when I write that I couldn't sit down - I had to eat standing up because it was agony, I couldn't drive a car or if I was a passenger in a car I had to sit on one side so that my injury didn't touch the seat. I couldn't walk normally - I had to shuffle because of the injury. It is exhausting to be constantly in pain. In addition to that we had no family help and I had to look after a new born baby. Dh had a week's paternity leave and then had to go back in.

I didn't go back to work until after surgery (internal and external) at the 6 month point which largely fixed my incontinence. (Female) surgeon gave me a letter exempting me from any further vaginal birth. Surgeon told me that my experience was common decades ago but nowadays women have choice.

I went on to have 2 planned c-sections.

With the first c-section I was very nervous but it was a beautiful experience. Better for my baby as well. I had no problem breastfeeding her at all.

Second planned c-section they went through the same scar. Again, a wonderful experience. Recovery was even easier than the first c-section. Again no problems breastfeeding.

After my second elective section, I was told I could have one more child if we chose (you can safely have 3 sections). Our family was complete with 3 children.

Oh and I do not have floppy skin or a flap or anything as a result of the 2 c-sections. There is just a small scar.

[quote Porridgeislife]@Cheekypeach is there research to back that up? I’ve been told the opposite by my midwife - induction has a higher risk of c-section.[/quote]
www.nih.gov/news-events/news-releases/induced-labor-39-weeks-may-reduce-likelihood-c-section-nih-study-suggests

www.nih.gov/news-events/news-releases/induced-labor-39-weeks-may-reduce-likelihood-c-section-nih-study-suggests

There’s nothing in it really - you’ve got broadly a 1/5 chance of c-section either way, or as the researchers put it, 1 in every 28 births might avoid a c-section.

The RCOG stats of 1/3 instrumental delivery, 1/3 CS for first time mothers are still more compelling for me. I want to avoid an EMCS or instrumental delivery for practical reasons due to existing pelvic scarring & trauma.

@Cheekypeach thanks for sharing - I hadn’t seen this. Just makes me more confused tbh! They really need to fund some unbiased research in the UK which documents all risks of all options separately, including induction pre vs post DD, and EMCS vs ELCS, and how many attempted natural end in EMCS, and how many have ongoing injuries from natural after 3 months, 6 months, 1 year

[quote Movingsoon21]@Cheekypeach thanks for sharing - I hadn’t seen this. Just makes me more confused tbh! They really need to fund some unbiased research in the UK which documents all risks of all options separately, including induction pre vs post DD, and EMCS vs ELCS, and how many attempted natural end in EMCS, and how many have ongoing injuries from natural after 3 months, 6 months, 1 year[/quote]
The issue is there are so many independent and variable factors that it would be nearly impossible to collate such information. So many external factors affect the success of induction, some EMCS are not really ‘emergencies’ and some ELCS will be done for very complicated medical reasons etc.

My local trust posts birth stats every month, and the CS rate is around 40% every time, which is really high when you think about it.

I know plenty of people who have have uncomplicated vaginal births, some friends who have had quite bad tears with long term lasting problems, some friends who have had elective sections with no problems, some who have had emergency with some difficulties after - although they are mostly associated with a complicated labour before hand resulting in an EMCS.

My personal experience... DD went into natural labour at 41 weeks, 19 hours of labour baby went into distress I had a category 1 emergency csection but sadly she did not survive and passed away during the section. There is no doubt that had I had an elective section or my labour was managed and monitored better she would be here today - my investigating consultant told me the journey from womb to world is the most dangerous anyone will ever take... my section with DD was uncomplicated however I did need months of of physio for complications afterwards that were all related to the labour side of the delivery. This was all in all a very extreme and unlucky delivery but I do t feel I was at all informed about the risks of a vagina birth and the possible complications for mother and baby.

I've since gone on to have 2 more children - both born by ELCS not without complication - needed forceps with both during the csection... I spent hours and hours and hours researching the stats for vbac vs elcs when I fell pregnant for the second time - after losing dd I was riddled with anxiety and worried about making the wrong choice and having another worst outcome scenario - I paid to see a number of private consultants as well as various conversations with my nhs consultants and midwives the general consensus was - vaginal birth IF uncomplicated is by far the safest option and best for recovery but that isn't always the case esp if it involves induction or complications mean it results in EMCS. Csection stats were harder to be accurate about as they don't separate the stats for elcs and EMCS... but EVERY single consultant I spoke to said elcs was by far the safest option for mother and baby IF there were no other complications and baby was born at term (before 39 weeks can led to some breathing issues). They said they situation is more controlled with all necessary staff on hand and every eventuality planned for. They all told me they or their partners had elected to have cesereans too which really spoke to me. So I had both subsequent babies via section planned for 39 weeks - however life had other plans and they both made an appearance at 37 weeks via csection - category 3 so not planned on date but the most relaxed of EMCS. With DC2 my spinal started to wear off after he was born and I was being closed and it was extremely traumatic, DC3 totally uncomplicated.
I've recovered well from all csections with no lasting complications even though I had 3 in a relatively short period of time.
In short I have had an extremely difficult time and my story is of course anecdotal but I would opt for csection especially if you don't want multiple (more then 3) pregnancies

@snowday01 I’m so sorry to hear about your daughter That must have been unbelievably traumatic. Thank you for sharing your advice.

@snowday01 sorry to hear about your daughter

@FirstTimeMama848484, @Movingsoon21 congrats on your pregnancies.
I've had 3 c sections, two emergencies and one elective.

First section aged 26 and 42 weeks pregnant. I was very active onto yoga, Pilates and some running. I was running up and down the stair to bring on labour from 39 weeks, very straightforward pregnancy.
Was due to be induced that morning at 42 weeks but minor contractions started at 3am. Drove myself to hospital and due to feral heart rate dropping and suspected meconium I had an emergency section. As suspected there was meconium in the amniotic fluid. My section was so quick due to being post date. I recovered really well, milk came on day 3 and no issues breastfeeding. But I overdid it and stitches opened slightly 10 days later, back to hospital and they put on steri strips. No issues afterwards,

Second birth aged 29 same level of fitness and did reflexology as was hoping for a vbac.
My consultant offered a section at 41 weeks as she was going to be away for a few days but I declined.

Went into labour at 41+5 on Friday morning at 3am, went to hospital at 4pm and was 4cm dilated. Never progressed and I kept getting really bad pains that midwife dismissed as labour pains but to me they weren't. I begged for a section on Saturday morning only to be told I'm doing well. Sunday morning I started bleeding and transferred to theatre within minutes. I remember a midwife asking a senior midwife if she should break my waters (my birth plan signed by my consultant said no) senior midwife asked if it's specified. Then decided against due to birth plan and I'll be having a section in minutes. That I think saved my baby's life. Baby was born completely tangled, cord wrapped around neck, hands and ankles. He was stuck and the registrar delivering muttered to the midwife that there is no way that baby would have been born alive vaginally.
Due to suffering from thrombocytopenia I was under the care of a consultant anesthetist and hematologist so a few people didn't get their Sunday lie in.

Blood loss for both c sections were 500ml and agpar scores for both babies were 9/10 at 1 minute and 10/10 at 5 minutes (I requested my maternity notes). No issues breastfeeding. Lost a bit of core strength but it returned when I did reformer Pilates.

Third baby aged 34, requested maternity notes to help me decide how to birth. New hospital under consultant. With my history I would have tried for a vaginal birth but the consultant told me there's no guarantee that birth two wouldn't happen again, that is not to say it will. I opted for an elective section at 38+6 and it went very smoothly no issues breastfeeding and baby will be 9 months on Monday. Recovery wasn't as easy as previous two sections but those were 5 and 8 years previously with 0 kids and 1 toddler.

The only difference I noticed with my third compared to the other two was that she was more sleepy as older two were born awake eyes wide open all the time especially my first. It could be because first (and second child) were born about 3 weeks later than third. All three did not require stay in neonatal, first has allergies that's almost outgrown. We are an atopic family and have eczema, asthma in extended family and hayfever (me). Second and third have no allergies. Wishing you both a safe delivery whichever option you choose.

I have had 2 EMCS so totally out of it for the births after long labours and the recovery fairly awful both times due to infections first baby externally second time internally due to damage from catheter and large haematoma. I am gutted both ended in section and can see why elective may be slightly better as they aren't so rushed / yanking baby out but it's still the same major surgery it's not the easy option like it's made out

@bindud

I am keen to avoid pelvic organ prolapse and incontinence issues.

I think CS reduces the risk but do not eliminate it. Pregnancy alone does damage, my 2nd was an elective & my bladder is much weaker than after my VB. My mum only had CSs & had a prolapse.

This.

It only reduces risk. The pregnancy itself does damage.

If you are looking to reduce your risk, then only having one child is your biggest factor.

I had an EMCS following a failed induction.

I had a very straightforward recovery and started doing Couch25K at 10 weeks postpartum. My pelvic floor isn't in bad shape but I think it is a bit weaker than before pregnancy. I use a device called a Perifit which I really recommend.

Currently planning a second baby and when I (hopefully) get to the point of giving birth again I will try for a VBAC if I go into labour spontaneously but am not willing to be induced under any circumstances. If it's not straightforward I would go for another C-section sooner rather than later.

I'm also shocked at it only being 50% who have uncomplicated births. I've had 8 babies and all of them were straightforward, longest labour was 3 hours, never had stitches. Everyone I know has had natural births except where the baby was breach and I've not heard any horror stories. I know this means nothing really

I dont know much about sections butall I will say is that if this is your first baby you have no idea if you will be one of the lucky ones, you might love giving birth! (I do!) Anyway good luck with whatever you choose.

Is your little one here yet? Have I missed the announcement? Congratulations if they are!

I worried my whole life about giving birth, I’m a bit of an over thinker anyway so just couldn’t cope with the unknowns of a vaginal birth. I had it set in my head I’d die if I attempted and I just didn’t want any of it, didn’t feel like I was missing out by not doing it etc. Every person I think I’ve ever spoken to has had some version of a dramatic story to tell about their birth, even the ones with sections. I just presumed even if my section went well and I miraculously survived, it would still be traumatic and painful.

I still pinch myself 6 months on (I think because it was SUCH a big deal to me) but I had the most lovely, virtually pain-free, drama-free birth. I got my section, I didn’t go into labour before it, there was no rushing about, no one had to press the emergency buzzer, I didn’t bleed to death, I wasn’t screaming in pain, my pelvic floor is the exact same as before and I’ve actually lost more weight than pre-baby which I’m just in disbelief at. All round excellent experience from me and I will 100% be back if there’s another 😂

@FirstTimeMama848484

Thanks to the above 2 posters for their replies. Only thinking 1-2 babies max and definitely keen to avoid an induction. With my cynical hat on… I found something that says a vb costs £1500 and a section £2500. I wonder if that’s why the risks of vb are understated and section overstated

Not sure if you're quoting the PbR costs there but most trusts (1) aren't on a maternity plan so don't care how many babies they deliver and how and (2) are on block contracts nowadays so costs are irrelevant. Essentially... I'd be shocked if costs factored into anything. They'll be following NICE guidelines.