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?!

@sarah13xx
So delighted you managed to have such a successful birth!
Another few weeks to go for me. I’ll be hoping for an equally positive experience x

@FirstTimeMama848484 aww good luck 😊 I would be nowhere near as nervous second time round knowing how calm and controlled it all is. I listened to maybe baby podcast with Anna Williamson as a guest the night before it and she gave the most accurate run through of it all, that helped calm me down

How easy are people finding it to request an elective c section? I have vaginismus and severe anxiety and no one seems to be happy to let me have one at all. All the professionals I’ve spoke to seem very against it.

I’ve just had my induction date for two weeks time when I’ll be 37 weeks exactly.
I’m expecting twins so I could have opted for a section, however twin 1 is head down so VB was an option. I’d like to at least try for a VB to avoid the surgery and recovery, they’ll be reasonably small babies, and other than being twins and me being 38, my risk factors are low. I was extremely fit pre-pregnancy and have maintained as much fitness as I’ve been able, the hospital I’m giving birth in is exceptional and I feel very safe there, which is another reason I’m attempting a VB.
After a discussion with my consultant, the threshold to give up on the induction and do a CS is very low, there will be no heroics. These are my first and will be my only babies so if the induction isn’t progressing there will be a CS.
I’ll update when I’ve had them!

Hey @bollocksthemess what do you mean threshold low? As in, they'll be quick to revert to a c section in any sign of a problem? Just booked my twin induction and have gone for VB.

@ReeseWitherfork yes, exactly that. I’d love a VB for the potential of an easier, quicker recovery with two newborns to look after, but not at the expense of the safety of the twins.
I’ll be 37 weeks, they’re good weights now (5.5lbs each at 35 weeks) but there’s no guarantee my body will be ready to give birth when I’m induced.

The plan is to take a view at each stage, I’ll be able to have 3 x pessaries, one every six hours, being checked after each one. If there’s little to no progression after that then I’ll just have a section.
I don’t want a balloon catheter or a 4th pessary, which are the other options.

If the pessaries work to dilate my cervix but I’m still slow to progress I’ll just have a section. Basically the plan is to check in repeatedly and often to make sure that a VB is a viable option.

@bollocksthemess ah ok that's interesting, thank you. Tbf my midwife said something similar, she just sort of skirts around the point a lot. But this is second birth for me so theyre quite confident I'll progress just fine, they didn't even seem to think I'd make a second pessary. I do wonder how big mine will be (want to buy the right babygrow size!). 31 now and they're 4lb each, will be induced at 36 so still 5 weeks to go.

Good luck! And thanks for the info

@FirstTimeMama848484 how long to go for you now? I’ve got an appointment with the birth options clinic in 10 days and going to push for ELCS at 39 weeks.

Just to update the thread, I’ve been booked in for an ELCS at 39 weeks. I didn’t have to push too hard, I just calmly went through all the stats I’d come across from the NICE and RCOG papers and explained how I’d weighed up the risks.

I’m feeling a bit sad that I’ve written off the opportunity to have a good vaginal experience (which I do think is the best outcome where possible), but then I remember the risks of vaginal going badly and am pleased with my decision.

I asked the consultant midwife if there was any action I could take to avoid 3rd/4th degree tears, severe prolapse or incontinence issues with a vaginal, given I’m low risk, but she agreed there was nothing I could do.

Oh and the most helpful stats I found were in the NICE guidelines NG192 appendix - it contains some really clear tables on increased risks of vaginal vs increased risks of c-sections

Also updating. Section booked for tomorrow (39+2).

I must admit, I have had a few moments of doubt...
Then I'll come across a thread called things like "gaping vagina wound", "vagina repair" and "episiotomy breakdown". Not to mention all the threads about the horror of discovering rectal, vaginal and urinary tract prolapses. One poor woman, who sounded very depressed about her situation finished off her post saying "I just didn't think this would happen to me". I have had the impression that a lot of women go into this expecting a certain experience and are left with gaping infected wounds that take months to heal. The impact on mental health seems to be quite significant for people when the reality falls so much shorter than expectation.

I have pondered comments like "recovery is so much faster for a vaginal birth" and "I want to be able to life my toddler". And no doubt in the immediate term, recovery is quicker for a straightforward birth, rather than several weeks of recovering from a C section. But the vaginal birth people are still at a higher chance of pelvic floor dysfunction, incontinence etc. So for the sake of an inconvenient first few weeks, a longer term more complete recover appears to be more likely with a planned section. Maybe that is just my take on it. I am prepared to forgo the first few weeks for the long term benefit. One of my main activities is running, particularly off road, ultra distance and hills/mountains. So I am especially motivated to avoid prolapse and incontinence issues.

If I am disappointed about my choice, the reason is that I wont get to experience labour and childbirth is the "normal" way. A few friends who have had vaginal deliveries have said that's its not all that great and on balance they could have lived without it. I suppose that is easy to say afterwards though. The other thing is that I'll never know how I would have got on. But I suppose this is the nature of making a choice and something I will have to live with.

Often, when I have these moments then there's a thread from someone who has had a traumatic birth then dozens of people respond saying they had a traumatic birth followed by a much better experience with a planned C section. I know MN isnt exactly scientific data but the overwhelming feeling is recovery from a planned section is ok on the whole. Any further doubt is pushed out of my mind by reading a few stories on the birth trauma association (although I wouldn't necessarily advise reading these, these poor people are a small group and probably not representative of the over all population of people who have given birth. Some are quite terrible and I doubt it is a good thing to dwell on). However, the fact that such an organisation exists says something. The huge majority of these stories are traumatic vaginal births or vb that end in emergency sections. Another thing which I have come across are the vast amount of facebook groups for people suffering from pelvic floor prolapse (the top 10 pelvic floor fb groups have a combined total of 60,000 members). Then there are the birth tear support groups with again, thousands of members. The 4th degree tear fb groups has nearly 4,000 members. It makes me think what is going on in delivery rooms!! I doubt any of these people ever anticipated they would end up on such a facebook group.

Overall if I remind myself of my main aim- long term optimal pelvic function, then I still think a planned section is the best way. By long term I include post menopausal years. There are thousands of older ladies needing pelvic floor repairs, then you hear of things like the complications associated with transvaginal mesh repairs. Something else I would like to avoid.

I know nothing is risk free. Pregnancy its self contributes to pelvic floor dysfunction despite mode of delivery, there's a chance of poor scaring, overhang and infection etc. To a large extent it depends on which risks seem more acceptable to individuals.

I have had a few remarks about going for a planned section, but if I can laugh and run without peeing myself and I don't end up on an operating table aged 60 getting a pelvic floor repair, then I will be at peace with my choice. It goes without saying that I want my baby to be ok. The asthma/ obesity links seem very small. Transient tachypnoea of the newborn is by definition transient. I think the likelihood is the baby will be fine and I am relieved not to risk things like shoulder dystocia and oxygen deprivation issues.

There are so many factors and no one has a crystal ball. Whatever individual people decide, I hope they feel they have made the right decision for them.

@FirstTimeMama848484 thanks so much for your update. We are in pretty much identical situations a couple of weeks apart!

I have had all the same thoughts as you, both in terms of indecision/concerns and hopes.

I think you will have now had your section? I sincerely hope it was a positive experience for you and you are now cradling your lovely newborn If you get a minute in the newborn madness I’d be really grateful to hear how you got on. All the best for the first few days!

@Movingsoon21 Yes- section complete and I am sitting here with my lovely baby!

I thought I would give an update now I am the other side of the section and can reflect on my decision.

Summary: I would say a resounding thumbs up to my decision to go for a section.

Good points-
-having a date, not worrying about some horror story delivery resulting in pelvic floor issues or months long recovery from a birth injury, infected tear or episiotomy breakdown. Not having to worry about oxygen related brain damage or injury to my baby. The theatre staff were absolutely lovely. Consultant doing a section in daylight hours, not a trainee potentially struggling with some awful situation at 3am. I think my husband would have struggled with an emergency medical situation, as it was he was able to enjoy the day and has been left with only great memories. We both had a good nights sleep beforehand. Not worrying about the large range of possible outcomes.

Bad points-
Not knowing how I would have got on with delivery. Not getting to experience a vaginal birth. Left with a scar. Potential complications of surgery. Risk of "overhang".

The actual section its self was totally fine. The spinal took less than 2 minutes and I hardly felt it. Was weird not feeling your legs and I could feel wiggling about when they were getting the baby out. I knew to expect this though so it was ok. When my baby appeared the drapes were lowered so I could see and the theatre staff were lovely and all said how cute he was. He was dried and weighed and brought round to me. He latched on and I fed him in the recovery area immediately after the section.

I must admit, I found the first night really hard. The spinal wore off about 4 hours post op and I was incredibly sore. I had the long acting morphine tablet and several short acting ones. I had a weird sensation issue for 6 hours overnight where even light touch around the scar was unbelievably painful. I struggled lifting my baby to feed and him sucking made the pain much worse. Eventually one of the ward staff spent some time improving my position, got me walking around and sat in a chair for a bit, stopped the opiates and got some gabapentin and everything resolved.

The section was at 1pm and was home by 6pm the next day. Over the next 5 or 6 days I took paracetamol/ ibuprofen. It hurt a bit getting out of bed or laughing but this was manageable. No problems going to the loo (had been taking lactulose for months to reduce haemorrhoid development- worked as had none), can still stop urine mid stream. Pelvic floor feels unchanged.

I am day 9 post section now and I've not had any painkillers today. Moving around totally comfortably. Dressing is off my wound and it is neat, not opened up or infected. Thankfully no overhang (BMI 22 pre baby, BMI 26 on day of section). Abdomen a bit saggy but vastly improving each day. Have been out walking for 30 mins or so since day 2. Feel totally fine.

Overall, I am really happy with my decision. I am luckily everything went totally perfectly and I have had no complications at all. I think my scar will end up fading nicely. In all honesty, I found the first night very difficult. But it was still worth the advantages as I see them. I am glad I have avoided a traumatic birth, months of my life with an infected wound as well as having avoided lifelong pelvic floor issues.

For anyone reading this, I hope you have a positive birth no matter the means of delivery. I don't think any birth method is without pain or changes to your body. However, all births are special no matter how the baby eventually appears.

All the best to the future mothers out there x

@FirstTimeMama848484 huge congratulations! I’m so pleased for you, and so glad it all went so well!

Thanks very much for the update, it’s really helpful to hear the breakdown of what happened afterwards and thanks for being completely honest about the difficulties.

My section is booked for next Wednesday and the hospital has been a bit of a shambles to be honest, plus the stories in the news at the moment aren’t helping with the pre-birth stress! But your story has given me hope that all will go well.

I hope I have as good an experience as you - wish me luck! Hope all continues to go brilliantly for you too.

@Movingsoon21

Hope everything goes well next Wednesday!

The current stories in the news about those poor babies& mums is really sad.

While trying not to be one of those annoying people giving advice…try and enjoy the day, it’s such a special time and thinking about it now the day really wizzed by!

The overwhelmingly most likely outcome is that everything goes completely fine.

All the best for the day x

@Movingsoon21
….and thanks for the congrats, much appreciated!

Hello, wanted to update the thread as it was so helpful for me. Particularly @FirstTimeMama848484

So I had my elective section 10 days ago and I am so, so happy with my decision. It was calm, pain-free, short (baby was in my arms 3 hours after we arrived at hospital. Procedure took around 40 mins and he was born within 10 mins) and although the recovery is ongoing, it is all predictable stuff and has been completely manageable. Plus I have such positive memories of the day and the experience as a whole.

I’ve had no problems with feeding (he took around 4-5 hours after birth to get the hang of it but we just gave him some pre-harvested colostrum to kick-start things an hour post-birth), no problems with bonding (felt the bond before we even reached the recovery room) and also have been lucky enough not to have any of the “common” side effects like trapped gas or a headache.

In terms of recovery, I found it really difficult to stand up and walk for the first 24 hours, however I made sure to attempt it frequently (only walking a few steps at a time) from around 10 hours post birth, and it got easier and easier. Now at 10 days I feel mostly back to normal for day to day purposes, just can’t overdo it. (So I can easily walk 15 mins into town and back on flat roads but wouldn’t be going on a 5 mile hike up and down hills).

My scar is healing nicely. I had a waterproof dressing on for 5 days so could shower normally. I now shower twice a day and air-dry the scar area to keep it clean and avoid infection. There has been no change at all to my vagina, perineum, pelvic floor or continence from before pregnancy (I did religiously do kegels throughout pregnancy, which probably helped)

There’s the usual consequences of not being able to drive or lift anything heavier than the baby for 6 weeks but honestly I think I’ll be ready for it after 4 weeks if things continue as they are, and we were able to plan for this as we knew the date and the timeframe.

I can see why this choice wouldn’t be your preference if you had a toddler to look after as well and no help, as that would be really tricky without being able to lift them. But as long as you kept fit and healthy during pregnancy, so have the best chance of a quick recovery, and plan help for at least 4 weeks post-birth, then it should be ok.

Hope this helps anyone trying to make a similar decision. Happy to answer any questions at any time!

Oh and with regard to the actual procedure itself, I explained to the staff when I arrived in theatre that I wasn’t great with needles, injections etc and they were great at distracting me. The spinal worked within a couple of minutes and was fine. Wore off a few hours after birth and then I switched to morphine. It was odd feeling them rummage around inside me but once I had my baby on my chest I sort of forgot what else was going on. I was on strong painkiller tablets for first 4 days at home and it only hurt when I got out of bed, coughed or laughed. But all completely manageable. I am now just on a bit of paracetamol and ibuprofen but hardly feel any pain at all.

@Movingsoon21 thank you so much for taking the time to update and to @FirstTimeMama848484 for starting this thread (I know it’s old but just wanted to say thanks!) I was pretty certain I wanted elcs but your stories and the stats have sealed the deal for me.

I had a lottery win twice, x2 vaginal deliveries with no assistance. First induced, minimal tearing. Second spontaneous, no tears.

I have nothing to compare it to, but my second baby I found it much harder to bond and we had feeding issues, despite the dream birth, which led to a bit of postnatal depression. I was shocked as I wasn't really expecting it, having had the delivery I'd had and a perfect healthy baby. Which led to more guilt etc.

So I think re bonding and breastfeeding delivery doesn't always matter.

For my tuppence worth.

I've had two elective sections. Both pregnancies were high risk as I'm a type 1 diabetic. My main reason for going elective was to avoid being one of the unlucky 50% and an elective section was the only way to guarantee I would avoid tearing, shoulder dystocia, forceps. Avoiding all three was non negotiable for me.

Both sections resulted in less than 500ml blood loss. Youngest DD was born at 37w and I didn't take the steroids. Both my girls had APGAR scores of 10 by 5 minutes. With my first I was in for a few days as she had jaundice and was much smaller than expected. Second I was home within 24hrs as they knew she was on the small side and had been throughout my pregnancy.
Driving by day 13 and basically back to normal.

Eldest's birthday was 7 days after my youngest was born and I held a party with 20 children.

Wouldn't change having a section for anything. It was absolutely the right choice for me and my girls.

@snowitall
@Movingsoon21
Wow - this seems like a long time ago now. My boy is 20 months old.

I had a maternal choice elective section in the end and have no regrets. Initially I was a bit sad I didn't get to see how I would have managed with labour and delivery. A perfect vaginal birth with no short- or long-term complications could be seen as the number 1 outcome. I would say an elective section is number 2. So, I felt like I had missed my chance at the number 1 option. Then I got thinking and realised I had also missed outcomes 3-100! Things like shoulder dystocia, forceps, a 3rd/4th degree tear, episiotomy breakdown taking months to heal, significant incontinence are unacceptable to me (as for everyone I'd imagine) and I would have preferred for them never to be a possibility even if it meant missing out on the dream vaginal birth.

Another thing I would mention now, 1.5 years down the line is the number of people who say things like "I wish I had just had an elective section". So many women who haven't delivered yet have an idea of a magical moment of childbirth, but I am convinced that is not the reality for many. eg days long painful inductions followed by a midnight emergency section. Just the other day a colleague was saying if she had known now her long-term outcome (moderate incontinence and prolapse) after "uncomplicated" vaginal births, then she would rather have had sections.

The thing is, on a population basis it is easier to channel people down the vaginal birth route. The minor/ moderate incontinence or prolapse or whatever isn't a cost to the healthcare system because that existence is borne silently by the women. For free.

On an individual level, do I want my maternity leave consumed by a wound breakdown that takes months to heal, or multiple appointments for 4th degree tear complications, or give up running because of incontinence or prolapse. No thanks. Give me pelvic floor sparing any day. Having a consultant obstetrician doing an elective section in daytime hours with rested theatre staff is the best way to guarantee this.

All this is very mother focused, but a happy healthy mum is going to be good for the baby. Ok the baby might get Transient Tachypnoea of the newborn (TTN), but as the name suggests its transient. The added advantage of avoiding hypoxic brain injury for me outweighs any minor issue of TTN.

In summary, yes, I was a bit disappointed about not seeing what my outcome would have been with labour but overall, I am happy with my choice. I had no issues breastfeeding or bonding, no abdominal pouch, no complications at all. My scar is now virtually invisible. I used to be shy about saying I had had an elective section but these days I really don't mind saying. I think it is good that the option is normalised and people feel they can choose an elective section if they want to. At the end of the day, birth is one day, I have many many days to have a beautiful, caring, loving time with my child.

So, if anyone stumbles across this thread- all the best in whatever you choose. I wish you a safe and successful delivery!

Thanks for updating @FirstTimeMama848484 ! So glad to hear all is well :)

@FirstTimeMama848484 I can't believe your baby is 20 months old. Feels like only yesterday you were busy researching birth options, how time flies!