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!

I had an ELCS 11 weeks ago. Theatre wise great, the aftercare in the ward was shocking as they just did not have enough staff. It was almost impossible to get a painkiller stronger than ibuprofen/ paracetamol and there se interest was discharging me the next day with nothing stronger than paracetamol. I feel really sad when I think about it. The care with my second (first ELCS) was amazing and I loved the experience of being in hospital able to focus on my newborn.

@FishnetsNightdressCrisis ’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?’

Less than 30% of first time mums and that doesn’t include those who experience tears, urinary incontinence etc. Those things are still classed as ‘straightforward’ in the data.

Not to minimise it but tearing isnt a reason for a section. I had a tear with my first that did get infected but I'd still choose that over the 2 sections I've had, I think because your awake it's not seen as big surgery but it's huge.

Actually, it’s not your place to tell other women what are and aren't valid reasons for why they might opt for an ELCS.

I had three babies all three years apart, latest one six months ago. The first one went like this: waters broke suddenly a week before due date, then failed inductions, back to back position of baby was agony but no epidural available as no anaesthetist available, horrendous labour, eventually failure to progress, then panic stations with everyone piling in and an emergency C-section, followed by one week in hospital. Recovery from surgery was textbook and unremarkable/managed pain not even that bad, but I swear the c section has made it harder to lose any baby tummy as a minor aside. Second baby was much, much bigger but in a better position- again very painful and protracted labour, baby stressed, assisted delivery and episiotomy just in the nick of time before another emergency caesarean would have been done, but then my tear got ripped in a fall and infected: three lots of antibiotics to clear it as they can’t re-stitch and the pain/inconvenience of the episiotomy tearing open was worse than the C-section. I had a vb at 40 for that one because the consultant saw no medical reason not to, but they had ac section on due date booked in but baby came early- however they completely underestimated size of baby in their suggested plan. When I had the third (they were all exactly three years apart) I was absolutely petrified at the unknowns of the birthing choices and hardly any appointments/advice about what to do even though I was ‘high risk’ due to previous, a health condition and my age (43). I had consultant led appointments and same as with the second pregnancy, she advised no reason to avoid vb especially as I succeeded with one for a 4.5kg baby previously, but if I got to my due date then they’d do an elective. Then because of staffing they brought the elcs forward to 39 weeks and I felt uneasy about it, as I was keen for vb for longer term reasons, but just scared about the risks for baby in vb delivery, so they pushed the date back a bit to give me more time to calm down and see if things decided themselves.. I was hysterical and dazed by the weight of responsibility to make the right choice, I felt alone. Baby came spontaneously and very forcefully, in between those dates and despite being 43 and having complicated labours prior, this baby came within 6 hours of water breaking spontaneously with first contraction and though v painful due to speed/force and because they couldn’t get me epidural I wanted as no time, I managed to get through it only on gas and air as I refused diamorphine which I had during previous labour as it made me feel like a zombie. I had a bit of a big bleed after this one but they dealt with it very quickly to control it and all was fine, much quicker recovery. Couldn’t wait to leave because staff were low on post natal ward/noise in there . I’m only writing all this because I really panicked about the third birth and felt poorly advised (minimal appointments, different doctors each time) and very lonely googling scary outcomes, so I understand the dilemma (though wouldn’t want to make any assumption about what is best for you medically) but honestly all I can say is trust your instincts to an extent alongside doctors advice. I know it’s easy for me to say now but I’m glad I was able to avoid another C section. But whatever is deemed best for you is the best answer.

@AliceinSlumberland that doesn't seem to be what the NHS statistics say?

Thanks so much for all of your replies, it's so helpful to hear about your experiences and lots of interesting data too. It's so much to mull over.

Does anyone know who "in real life" would be a good person to discuss birth options with? Would it be my community midwife (haven't even been assigned yet at 4 months!), a doctor or someone private like a doula? This is my first baby (probably obvious!) and I feel a bit lost.

i don’t think either way offers the reassurance you’re looking for.

With a scheduled section you have more control over the birth I guess, as in no panic, in and out of surgery quite quickly. But as many PPs have said, the recovery is significant. No jumping out of bed to sort baby, no lifting baby, no driving or even easily pushing the pram etc.

It’s also major surgery which of course has its own risks.

I can’t imagine electing for a section unless I absolutely needed one for medical or mental health reasons.

FWIW I had one for a breach, I wasn’t prepared to try and deliver naturally and was advised to go for a planned section. But there are a myriad of reasons why a woman might go for an ELCS and I hate it when other people try and say there reasons aren’t ‘good enough’. Lots of scaremongering with long recoveries here too.

VB always simply because of the recovery times, I was up and walking within an hour

Sorry, a possibly silly question but...did those of you with consultant led births have any consistency in terms of which doctors you saw? I've seen different doctors at each appointment...just wondering if at any point during pregnancy you get one consistent medical professional?

I didn't tell Op at all. She asked for thoughts and opinions because she has questions. My reply simply gave her another angle that you sometimes don't think of when making a decision with many questions.

Yes you did, you said tearing isn’t a reason for opting for a c sec. Well perhaps for some women, it is!

No, not in my experience OP, different ones at every appointment.

You're derailing the thread with your opinions. The OP asked for advice and people are giving their experiences.

It is a discussion forum, discussions evolve. No derailing here and no need to get a bee in your bonnet.

A c section has so many more risks for you and your baby, including long terms effects so unless you need one, then don't do it

Good luck OP. Hope you have a happy healthy pregnancy and birth.

I dont think the argument is logical. I was septic after my c section and the care left a lot to be desired (I work in health care and it takes a lot for me to criticise care). After my second I was well, but things like pain relief weren't given on time and I needed a lot of pain relief to be able to function.

I had a natural birth with my first, well it was a ventouse with episiotomy so technically 'assisted', and a c section with my second.
I was induced with both, first worked, second didn't. In terms of staff, they were excellent both times, both during delivery and postnatally, but my local hospital does have a highly rated maternity unit.
I was out and about 2-3 days after my first, stitches and all. It was 3-4 weeks with my second and I had an extremely straight forward recovery.
Just bear in mind the extra support you will need after baby is born with a section. How long will your partner be off? Do you have other family/friends to help? Can you get out and where you need to be without driving?
There's obviously a chance you'll end up with a section whether you opt for one or not, but if it were me I would always try for a natural birth if possible.
It was always the community midwife we discussed delivery options with initially, then the consultant at the hospital later on as I was considered high risk.
Just so you're aware, if you do opt for an ELCS, you may have to fight for one (which is absolutely your right). Not all doctors want to book them in easily for you.
Good luck with the rest of your pregnancy x

Sorry the data I gave is for first time mums - the chance of instrumental delivery and c section is higher, eg - www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/assisted-vaginal-birth-ventouse-or-forceps/

‘In the UK, approximately 1 in 8 women have an assisted vaginal birth and this is more likely (1 in 3) for women having their first baby’

No thank god. The first consultant I saw with my second was horrible. Made me cry. Was more interested in belittling his student.

My regular midwife was lovely. I was over the moon when I was referred back to them.

The best way to make a good decision is to be educated about birth by going to good antenatal classes
My Pfb is 3 months now, I attended antenatal classes given by a very experienced doula from the community during pregnancy and that gave a lot of confidence in going through a VB, I felt able to make my own decisions at every stage of the labour and delivery.
Make sure the person you speak gives you unbiased advice, because some doulas believe very much in their way of doing things and won't always give you the full picture.

My reasons for vb were:

Mum was fine and I'd heard you tend to follow your mum's pattern.

I didn't want an operation.

I was vain and didn't want a c section pouch.

I didn't want a longer recovery time.

I'm one of the the lucky ones who didn't have any complications either time. Had a tear, but it was sorted with couple of stitches. I could feel it for about 6 months, then it smoothed out.

I had one of each.

CS itself was ok, recovery was long and hard. Felt it was too clinical, just being presented with a baby. But that was me... spent a couple of nights in a noisy ward with no rest. Hated that.

VBAC was not straightforward, had forceps delivery, cut rather than tear, but all went well and home that day , recovery was relatively easy with a baby and a toddler in tow.

So for me, if I were to go back, it would be a VB by choice.