Is my logic correct in ELCS vs. vaginal birth?

[EvelynSalt]

I'm due to give birth this year and whereas I've just always assumed I'd go for a vaginal birth, I'm leaning towards ELCS. I'd love your opinions on whether my logic is sound or flawed, as I'm really struggling to know what the right decision is.

With such chaos and backlogs in the NHS at the moment, staff shortages, increasing COVID rates etc. my thinking is that ELCS would be a safer option as it's more medicalised than natural birth.

Normally I wouldn't necessarily feel that's a positive, but I'm really scared of having a complication through a vaginal birth which then isn't treated properly afterwards. I haven't had great experience with OBGYN here in that a lot seems to be brushed under the carpet as "just one of those things women have to deal with". If you've had good experiences with after care from tearing, incontinence etc please correct me...I'm so confused at the moment!

With such chaos and backlogs in the NHS at the moment, staff shortages, increasing COVID rates etc. my thinking is that ELCS would be a safer option as it's more medicalised than natural birth

i disagree, I think it would be the opposite. you’re more likely to have serious complications with an ELCS as it’s major surgery, so if they’re short staffed it could mean skipping obs and missing things. It can be harder to establish bf, so less help there.

you’ll also struggle to lift your baby, change, feed, get yourself to the toilet. If there’s no help how will you manage?

I know after my elcs I refused a side ward as I very much felt I’d be forgotten.

if you have a straightforward VB you can be out same day. An Elcs is minimum 24 hrs, i was in 3 days. Not fun with no one answering buzzers, no one to refill water, fetch pain relief, lift your crying baby out the crib to feed.

a complication from an ELCS could be way worse than from a VB, nicking bowel or bladder, complications from the anaesthesia, infection, bleeding….

I had an emergency section and the staff after were wonderful and I asked to stay in an extra night no problem. But... Without the amazing staff I'd have struggled badly. I couldn't lift my baby, needed help getting up from bed. Was soo hard.
I would have much rather had a vaginal birth and that's with a brilliant and fast recovery from a section with no complications.

I'd go for vb, I've had a cs and two vbs

Maybe I was lucky but my ELCS was a breeze. I did push to go home after less than 24 hours though because I really wasn’t seeing much benefit of staying in. I was able to get up and go to the toilet/shower by the morning and didn’t need help with that. We weren’t getting any rest on the noisy ward and it was unbearably hot.

Yes the staff were busy, long waits for water etc but actually I think that’s fairly normal on all wards at the mo. Luckily I had everything I needed in reach and I just held on to my baby most of the time.

I was out for a walk two days after my section, as long as I kept on top of pain relief I was functioning as normal. So yes it’s major surgery but that doesn’t always mean you’ll be stuck in bed not able to do anything for ages!

I agree with this. I've had two straightforward ELCS, but especially in the first instance, I've never felt so alone as afterwards once DH had to go home, where at all my friends who had VBs had partners with them overnight in the birthing centre.

Also, both were very delayed due to EMCS needing the theatres before me, and I know of others who had ELCS delayed due to staff shortages.

I understand your thinking, but given what you've said, I would choose VB.

The difference between complications of ELCS and vaginal birth, is the former is considered a surgical complication and likely to be dealt with properly, whereas the later us just 'childbirth' and 'how it is', hence women heing left with prolapses, incontinence etc.

2 ELCS here. Two textbook easy and virtually painless recoveries. No regrets.

if you have a straightforward VB
’If’ being the crucial point. If you don’t have a straightforward VB you can literally be in for a lifetime of pain.

There is no easy answer as both options can be straightforward and perfect or go terribly wrong.

Hi, I ended up in labour on an induction ward at a very good hospital. Even though it is a good and well known hospital if the labour ward is full it's full. I was stuck in the induction ward for 16 hours and exhausted all forms of pain relief before there was a space on the labour ward. Ended up about 12 hours just on tablets (wasn't allowed any more pethidine and no gas and air or epidural on induction ward) and then an EMCS any way. If I have a next time it will be elective for sure but this is my experience.

I think if you're low risk, then VB is the way to go. Things can go wrong whichever route you take, obviously, but a straightforward natural birth will mean you recover quicker than from a CSection. I have seen things go very, very wrong during straightforward ELCS, unfortunately (although it's rare), it isn't a low risk operation.

I understand where you’re coming from OP but I agree with the others - I wanted to be gone ASAP following my induction. Luckily because it was my second and I didn’t need help with breastfeeding they let us leave after 6 hours. It was amazing coming home so quickly.
I don’t fancy surgery recovery or the actual procedure but to each their own.

I had a VB with my first, episiotomy, heamorrage, bad tear etc.

Had a ELCS for my second.

I would recommend a VB, i hated my C section, the experience was so cold and clinical and the recovery was horrendous. Plus I felt much more of a bond having a VB.

I had an incredible elcs a few weeks ago. It really was an amazing experience. But I'm comparing it to a very traumatic failed forceps and emcs delivery. I wouldn't necessarily go for a section for no reason.
Birth is a gamble really, you can't guarantee how it will go.

@EvelynSalt going against most of the PPs, but I'm having similar thoughts. I had to have a section last time, so this time I've been given the choice of ELCS or VBAC. I think I'm going ELCS and the current state of the NHS is playing a massive part in that decision. I feel like when you're having a section there are at least 10 people in the room and they can't leave you. Whereas with VBAC, what if they weren't able to provide safe levels of monitoring because of staffing shortages? What if something started going wrong whilst the staff were busy with other women? It's not a criticism of the staff, just all we keep hearing is how broken the NHS is...

I wouldn't ever have major surgery without really good reason. And especially as things are with rates of hospital acquired infection and lack of space and care.

I've had 3 vb and no issues. I'd have taken whatever was needed but feel lucky to have avoided surgery, scaring, adhesions. ELCS isn't no risk, it's different risk.

I feel like when you're having a section there are at least 10 people in the room and they can't leave you. Whereas with VBAC, what if they weren't able to provide safe levels of monitoring because of staffing shortages? What if something started going wrong whilst the staff were busy with other women? It's not a criticism of the staff, just all we keep hearing is how broken the NHS is...

my elcs there were me, dh, anesthetist, surgeon, m/w. That was it.

it’s not so much the surgery anyway, it’s the aftercare. Everything you say about VB also applies to ELCS, and after a CS you’re more likely to need extra monitoring and help. What if they don’t have the staff to do your obs regularly? Or help you sit up, get out of bed for the first time?

I suppose if you are having a very straightforward pregnancy with no indication of potential problems, 'good childbearing hips' rather than small frame and pelvis, VB would seem the best. Most women don't have problems afterwards. Methods of childbirth like water, or upright delivery being encouraged would give me confidence.

I'm another who would go for Vb after having one Vb, then elcs (for breach baby) then one induced vbac. I found the elcs horrendous - lots loads of blood, hated the surgery, really found recovery tough, and suspect it made it harder to bond with that DC. Neither of my Vbs were "straight-forward" but both much, much more positive than elcs. You generally need much more support for medics and midwives after a C-section.

I don't think you should be basing your decision on the current conditions within the NHS. You really don't know what things will be like on the day.

I think you should decide based on the mode of delivery that you would rather have, whatever conditions are like within the NHS.

Fwiw, I chose ELCS twice, and it was great. The postnatal care was piss poor both times, both born around a decade ago before things got really bad, but I recovered fine, I managed alright. Their dad helped a lot, so did my parents.

I think unfortunately it's hard to know ahead of time. A friend of mine recently had an ELCS and it was unfortunately completely marred by inadequate aftercare. Her trust still don't let partners in overnight but they also just didn't have any staff to take care of her. She was stuck trying to look after her baby unable to move and with no pain relief, and ultimately got an infection because they didn't monitor her urine - it was a horrible traumatic experience for her, which was particularly devastating because the section itself went very smoothly and she had chosen it because she thought she'd be more in control but was left feeling completely powerless and it was entirely due to inadequate care.

Elcs here. I was up 5 hours after the op. There were no side effects, no pain that couldn't be managed by nurofen (for 5 days only). It was very well managed and controlled environment. I had my husband with me to help getting up if needed. You are going to here a lot of scary stories about both VB and Elcs. Statistically it safer for a baby to have Elcs and safer for a woman to have VB. I chose Elcs because I was adamant I didn't want my birth to be managed by midwives, I wanted a doctor. I also wanted to make sure I don't have instrumental delivery given a high chance of side effects. I was well informed about the risks of c section given it is an abdominal operation and carries the risk of infection, bleeding etc. From my personal view the assessment of these risks vs unknown risks of VC with a significant dependancy on luck re my own labour progression + getting not under qualified and/or overtired midwife was much more favourable to Elcs.

I think the thing here is that you have no idea what your birth will be like till it's happened. You may have a easy quick VB or a complicated one ending in a section. When I had my DD the hospital was closed to new patients 2 days before because they couldn't cope with more, on the day of her birth it was empty. I really don't think you can make a decision based on what you think it will be like eg staffing levels etc. Any doctor will tell you a VB (with no known complications) is the safest and that for me is what it comes down to.

Not sure if people realise that the staffing problems in hospitals do also include theatre staffing. It’s not that unusual these days to be cobbling together teams at the last minute who may/may not be as experienced as would be ideal.

Oh I should say that I didn't get the help from their dad/family until I was home- overnights were absolutely awful and I had very little help from staff. But it was still fine- it was a couple of nights out of my life.

But then I wanted an ELCS both times so badly that I really didn't care- I was just glad to have got the births I wanted.

'Straightforward vaginal births' get mentioned a lot on these threads. Great for those that get them, and I'm not minimising that ELCS has its own risk profile, but how many women actually get 'straightforward' vaginal births?

I've had 2 sections and wouldn't wish one on my worst enemy.

Major surgery, longer stay in hospital, post op complications, wound infections, months of long and painful recovery.

I’m heavily leaning towards an ELCS. Having looked at the stats I see it as the best possible option that I can actively choose. Yes the risks are lower with a straight forward vaginal birth but I can’t pick that option - it’s basically luck of the draw. As a first time mum I have basically a 33% chance of a straightforward birth ( although that stat includes women who tear), 33% chance of an assisted birth eg forceps which can have a huge impact on your body, and 33% of emergency c section anyway after going through labour.

People will tell you all the pros and cons but often the way it’s worded can sometimes be presented to persuade you against a c section, without being totally honest about the actual data. For example, there is an increased risk of maternal death with a c section which is obviously terrifying but when you actually look at the chances of this happening, yes it’s higher for c section but for both types of birth the risk is absolutely tiny, so you’re talking about a really tiny risk Vs a tiny risk (0.004% vs 0.02% if anyone’s interested). Similarly they talk about increased risk of uterine rupture in later pregnancy but again the actual risk is tiny, below 1%. Meanwhile the risk of foecal incontinence after an assisted vaginal birth is 15% and urinary incontinence is 42%, 6% chance of a 3/4th degree tear which will have a lifelong impact for 20-40% of those women, the risk of prolapse is also much higher but they don’t tell you these bits of data because it doesn’t suit.

My concern regarding the NHS isn’t really about the actual birth - the maternity care I’ve received to date has been incredible. However, several of my friends have had to wait for YEARS to get birth injuries corrected or had to really fight to get help for urinary incontinence for example, or pain during sex. It’s just not a priority for a stretched NHS.

I think the main thing is everyone should be allowed to look at the information themselves and decide what’s best for them and their family - there shouldn’t be pressure either way and that’s what frustrates me. If you know you want a big family then c section isn’t a good option but if you know you’ll likely have 2-3 children and be done then it’s good to consider it. Ultimately though you don’t need a reason for a c section - they have to give you one if you decide after hearing the risks that it’s the best option for you.