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!

When you look at the actual data this just isn’t true. There are risks for both. Often the risks of an ELCS are lumped in together with the risks of an EMCS and they’re just not the same things. Also often the risks are stated without any information about how big the actual risk is - there are some increased risks with a c section but many of those risks still remain really small, below 1%.

Theres some good information here - www.nice.org.uk/guidance/ng192/evidence/a-the-benefits-and-risks-of-planned-caesarean-birth-pdf-9071941646

I don't think people commonly see one consultant consistently unfortunately. Or at least they don't where we are.

I had a vb for my first and it was awful - resulting in a huge haemorrhage and emergency surgery - despite a textbook low risk pregnancy. I had lots of problems afterwards that were initially written off as 'normal' after childbirth. For the first couple of months I was on my knees and my feelings were constantly dismissed. It took a long time to get the help I needed and I was in pain for a good 9/10 months. For my second child, I was encouraged to choose an elcs by male consultants throughout pregnancy but then my last appointment was with a female consultant who was pregnant with her first who really tried to get me to ditch the elcs despite all the problems the first time round. I went for the elcs and it was a calm, painless and enjoyable experience. My husband was brilliant afterwards so I had two good weeks of rest and could then function pretty normally.

Everyone's experiences are different, and I certainly believe emergency CS would be much harder than an elcs, but I think it helps if you think about how you respond to unknown situations versus being more 'in control' and able to plan better for recovery. With a vb, you don't know exactly what you'll be recovering from. To talk to people in real life you could contact a local bumps and babies type group and go along to hear stories about care people have received in your local area.

Agree with this.

1 VB which was straightforward- no tearing or pain relief and sent home 4 hours later. But many internal post birth complications that took years to heal and still not taken seriously by health care professionals even now (7yrs later!) despite procedures being required and ongoing prescriptions to help!

Second was an ELCS at my request. Absolutely wonderful experience! Yes I was stiff and sore for about 4 days but honestly felt like a total and utter breeze in comparison to how broken I felt after my VB! Medics, MW and HV all really keen to help make sure I was healing and concerned about me, whereas no one gave a shit after my VB and never listened to me about issues I was having.

OP - I'm not sure if your logic about it being less chaotic for ELCS is right though. At the end of the day, most births will result in you being on the post natal ward afterwards for a night and IME it's the post natal ward that can be chaotic when understaffed!

Not a silly question. Two ELCS. First one due to a big breach baby. Never saw the same doctor twice with either pregnancy. Barely saw the same midwife twice.

In your shoes my decision would rest on one simple thing - are partners allowed to stay all night 24/7 on the post natal ward? If that is not a cast iron guarantee, then there is absolutely no chance I would have an elcs. Zero.

I would make vb in birthing centre at hospital my first choice. It was for my DC1, and even though I ultimately had an emergency CS, I was really glad I had given myself the opportunity for a straightforward VB. My cs was a poor experience and I was in pain for many years after (which doctors told me was in my head / because I had a low pain threshold 😡)

Had a ELCS for DC2. This was out of necessity not preference and, despite my previous experience trying unsuccessfully for a vb, I would still have rather tried for a vbac if I could. This is mainly because being on the post natal ward with cs was awful.

ELCS seems like a more “knowable”
procedure in some ways, so I can understand the appeal. But you really have zero idea of how you’ll react to it in the room (I definitely thought the elective would be a better experience than the emergency, but actually it was pretty brutal, I thought I was going to vomit and got quite upset - it’s a lot of drugs to suddenly have rushing into your system). I also couldn’t physically hold DC2 after my elcs as my arms were numb (nothing they can do to prevent that) and I couldn’t trust myself to hold my baby safely for a couple of hours. That was really upsetting and completely unexpected. You also don’t know what the effect on your body will be over the short/medium or even long term and chronic pain isn’t much fun.

To me the worst thing about cs is having to spend time in hospital afterward. Care on the post natal ward wasn't great either time I was in (and this was before covid and the current shit show), I really couldn’t move AT ALL for at least several hours afterwards and it was almost impossible to get anyone to help. For DC1 their dad wasn’t allowed to stay overnight and it was horrendous. For DC2 dad was allowed to be there and this did make the logistics of bf easier.

Because of all this I would give myself any chance, however slim, of going home asap.

I have friends who had vb who were back in their own beds less than 8 hours later. Not everyone is this lucky of course. The point is if you have an ELCS you are definitely going to stranded on post natal for at least 24 hours or more (I was in over 48 hours both times). With a VB you might get lucky!

ELCS would be a safer option as it's more medicalised than natural birth.....

I'm really scared of having a complication through a vaginal birth which then isn't treated properly afterwards.

Do you have evidence that "more medicalised" childbirth (or anything) = safer? Why is it definitely safer?

Do you have evidence that problems caused by/during C-section are more likely to be "treated properly" afterwards? I don't know how to define "treated properly" so can't find evidence on that one.

I hope the birth goes well for you, however it happens.

I can see why some might want their partner to stay on the ward but Christ it was annoying enough having blokes hanging around during visiting hours, being mostly unhelpful and noisy, I’d have not wanted that whilst we were trying to get some bloody rest at night.

Opposite experience of @catsandkid for me -
didn’t really feel like anyone gave a shit after either of my cs’s… in the room yes - afterwards absolutely not. I don’t think the medicalised nature of the procedure is what makes the difference, it just seems very much the luck of the draw in terms of staff you have contact with.

So glad it wasn’t a thing when I had my DC. If you can have a private room on a midwifery unit, it’s great, but a ward room with several men all night would have actually finished me.

Hi OP, I had one "straightforward vaginal delivery", in the midwife led unit, only gas and air, had DC1 in the water.

A lovely experience but I did tear and I also developed a prolapse later due to his quick arrival (long contraction stage, very short pushing stage).

Basically my vagina did not respond well to having a baby pushed through it! I'm still dealing with prolapse recovery 5 years later.

I was pregnant with DC2 during Covid. I mentioned to my midwife that I wanted an elective CS, didn't want to risk further damage. She referred me to a consultant (due to Covid it was a phone call consult). The consultant OB was quite keen to test my logic, said there might be worsening to the prolapse anyway due to Relaxin hormones, weight of the pregnancy, etc. I said "at least I want to know that I've done all I can to protect my vagina" and he accepted that, and I got a surgery date through the post.

I did not see that OB on the day, it was a different team in the theatre. I had done CS hypnobirthing and had a playlist which they played for me in the operating room. It was a very different experience, obviously, but the flood of love meeting DC2 was the same for me as with DC1.

DH had to leave because Covid but the night on the ward was fine. MWs very busy but helpful, I kept explaining that I wanted to get home ASAP and I was assisted to get out of the bed before midnight so that they could write on my notes that I was mobilising well.

I had oral morphine for pain relief, as well as ibuprofen and paracetamol, and I was well supported and the recovery was straightforward.

My sister had both her kids by CS (first emergency, 2nd elective) and has no pelvic floor damage at all. I also happen to know (friends of friends) 2 female OB doctors who, as experts in the field, both chose ELCS for their own babies. If I'd known what I know now as a first time mum I'd never have attempted VB.

In your shoes I would ELCS all the way - birth injuries are no joke, and there's no real way to predict if you'll suffer.

Oh! Also when I had my ELCS I had to be there at 9am (a couple of others scheduled for earlier that day had to be there from 7) with nil by mouth from at least 12 hours earlier…
Was so hungry and thirsty.

Because all ELCS get bumped for emergencies (quite rightly), and on our day they also hadn’t got through their discharges from the ward, everyone scheduled for that day had a long wait. I think the first person who had arrived at 7 don’t get into theatre til after 12. I didn’t get in until after 3. No beds or anything for waiting, so we were all sat in a corridor for hours until we were called. Obviously totally survivable, but I remember someone walking past with a take away burger around lunchtime and literally just wanting to kill them!!

(Just to give a picture of how massively unglamorous the whole process can be!)

Oh god, I do realise this sounds like scare mongering but it speaks to your concerns:

I have a cousin up in Manchester who had her first baby right at the start of Covid. All the MWs had been seconded to the Covid wards so the labour ward was massively understaffed. She wasn't properly monitored and it turned out that the baby inhaled meconium in utero. By the time he was born he had become incredibly unwell, and she spent her postnatal weeks terrified that he wouldn't survive (thank god he is fine now but it was a very close call).

She is dealing with PTSD from that experience and doesn't feel able to have another baby, even though she always wanted 2. Her healthy baby was severely injured during the labour, directly caused by low staff ratios on the birth ward.

Compared to that, you toughing out one night on the labour ward with low staff after an ELCS, and waiting longer than you'd like for your tea and toast... I know which one I'd choose.

I have had 3 c sections (2 emergencies and 1 elective) and I recovered very well and quickly. But I will choose a Vb over an elcs.

@samqueens I was at the hospital at 7am as second on the list for my elective and didn't get into theatre until 6pm due to other emcs (of which it had been me twice previous) I was allowed to drink some 7up in the afternoon as I was so thirsty.

I've read all your posts but not all the replies.
YANBU to weigh up the options and to choose an ELCS if that is what you prefer.
I have given birth twice (2017 & 2020) and many of my friends and family have given birth in the last few years.
I agree with you about the worrying state of the NHS tbh. In particular I would worry about staff shortages in maternity wards, and would be asking how many anaesthetists they usually have on duty (in case of wanting/needing an epidural) and whether they've had to close the ward, turn people away etc and if so how often and for how long. That would inform my choice.
The thing about vaginal birth is that it's unpredictable so I would worry about not being properly monitored and about substandard care causing significant issues. An ELCS does of course have risks but it is generally more controlled and predictable.

I had a bad experience with DC1 (various reasons, mainly an unpleasant midwife) and so for DC2 I hired a doula to support me, it is definitely something I would recommend if you can afford it and if you can find a good doula. I actually ended up having a home birth which worked out really well - and (perhaps surprisingly) you end up getting more midwife input because you have one-to-one care from the midwife who comes to your home and you also get a second midwife who attends during active labour. Tbh it felt like 5* treatment especially after my first birth with a horrid midwife in a grotty ward!

Mine were both vaginal births and relatively straightforward (first birth less so but no lasting issues). However as I've said I do understand why you would choose ELCS.

Personally I would avoid induction at all costs, just because I don't think the NHS currently has enough resources to manage them safely, let alone to make it a calm experience for the mother, but I have been heavily influenced on that by the recent experience of someone I'm close to. I would certainly be asking a LOT of questions before agreeing to an induction and would want an advocate - partner and/or doula - with me at all times.

My advice to you is to ask for an appointment with the consultant midwife to discuss your birth options. Also look into a doula as mentioned.

I never got my tea and toast! I was really pissed off at the time!

I think if your worry is the NHS then you need to de-risk de-risk de-risk and adding a surgical element to your childbirth that's not medically necessary is the opposite.

The truth is even with an ECLS, baby could choose to come anyway at any point and your in it no matter what.

If you were psychologically concerned about Vb then I'd say go for ECLS but otherwise I would simply understand the decision points required for a safe birth and the complications that can arise in any procedure they might need to do.

In my experience, perfect VB, one small tear, was home in 6 hrs. My ongoing issues such as bladder weakness are due to the pregnancy not the birth itself.

My c section was an absolute dream. Baby latched on in theatre, husband cut the cord, skin to skin for as long as I wanted. Up and walking in 5hrs, discharged 9hrs from birth. No issues lifting the baby or feeding. Walking around the park on day 3 ending in a pub lunch. No painkillers by day 4 (only had paracetamol), 18m on and I can barely see a scar.

It was a magical birth, I loved every minute of it and would definitely choose this again.

Also here are some links you should find helpful

www.birthrights.org.uk/factsheets/your-right-to-choose-midwife-and-doctor/

www.aims.org.uk/information/item/making-decisions

I had a horrible vb with 3rd degree tear, an operation immediately after giving birth etc. The tear was a direct result of bad midwife care when I was in labor (short staffed, night staff probably agency). To be honest the care afterwards wasn't great and that was 17 years ago. Later on, I had elcs with twins and it was amazing! I think having the birth scheduled in the day meant I had much better care. The recovery was much more straightforward than a bad v birth too. However, nearly all my friends have had straightforward v births. I'm the only one I know with such a traumatic experience.

I have had both an Emergency and Elective CS
I didn’t have any problems lifting babies, changing or feeding them. I stayed in 48hours with the emergency and about 30 hours after my elective.

I was driving (all be it an automatic car) 12 days after my emergency CS
I left hospital after my elective and wandered around B&Q and Tesco with newborn Ds and toddler Dd and Dh and had a few people round for a barbecue later that day
I didn’t really lift anything heavier than Ds and people helped Dh out whilst I just pottered about or sat with Ds whilst Dd was playing
I had no complications

In my NCT class the ones that had a CS had no issues. Problems happened with a couple of women who should have really been given a CS but were not listened to.

I've had 2 ELCS. It was honestly the best decision. BUT I was fortunate to have them at a private hospital, purely because I wanted that level of care and one consultant throughout. My dh was able to stay with me through and I don't know how I would have managed otherwise. The pain and recover for the first week is tough but you feel pretty much the same after that. If I couldn't have done it privately here, I would have just gone back to my home country and done it there. I would find out what your hospital offers in terms of recovery, support and treatment before deciding which route to go.

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

There would have been a few more people than that. An assistant surgeon, an anaesthetic nurse, a scrub nurse, and a runner. At a minimum.

As others have said, it's not so much the labour and birth itself, but the aftercare. I've had a vaginal birth and an emergency C-section. Both of which I had to stay in for two nights after for monitoring due to pre-eclampsia. I was fortunate that I was able to get up and about (albeit painfully slowly) after the C-section. Which was great, as there sure wasn't any staff to help me. They were lovely women, but absolutely rushed off their feet and unable to provide anything more than the base level of care. The vaginal birth was also a much easier recovery. Less pain and wound infections on the whole.

Would 100% choose to attempt a vaginal birth before ever choosing an elective, unless there were pretty hefty medical reasons. But that's me.

All those complications would be dealt with as a medical complication issue. However as someone said upthread, if you have any complications thorough a VB then everything is dismissed.

Friend went through multiple miscarriages before someone actually took her seriously that something has gone very wrong during her giving birth to her first and only child. It took 14 years for her to be taken seriously. (She had to go private and NHS lost all her notes)

Why would it be harder to establish breast feeding?

Also once the anaesthetic has worn off and catheter is out wouldn’t you be able to get everything you need.
All be it very very slowly.

I agree with this.

The idea that because of concerns about availability and quality of care, you opt for a MORE medicalised, more interventionist, more guaranteed hospital stay seems counter intuitive.

Obsessing about ensuring a home birth would make more sense to me.

The NHS resource stretch extends to every element of the service - an ELCS isn't some insurance against being left unmonitored, ataff being off, underexperienced, striking or tired, or you being unresponded to in post natal care. You're not more able to get hold of antibiotics when needed for eg

It's actually really upsetting to read over and over here that women's decision-making is so influenced and so skewed by the dire state of our health service. We are so vulnerable when pregnant and we shouldn't have to be trying to mitigate the threat of poor care in this way.

Maybe, if you’re feeling anxious, as you no doubt are when nothing is certain and it’s the first time, it is better to only read /listen to what you really need to. However I’d chase up the midwife allocation, surely you have had your booking-in by now? It is fascinating, and maybe helpful, to read others’ birthing experiences (I offered my own lengthy one earlier, too, sorry if it just added worry or confusion!) but at the end of the day none of it will have/should have a bearing on how you will get through it or do it, as you’re not comparing like-for-like. None of us here are your doctor or midwife and whilst comparing birth stories might be enthralling/reassuring/frightening/helpful for awareness of potential issues, it might just add to your stress unnecessarily, as ultimately it’s going to be unique for you. So if you are overwhelmed and stressed, you might be better off not reading too much to try and minimise fretting about the inevitable (!), because as long as you’re being responsible/careful in pregnancy, learn about any birthing techniques you think might help you, etc., there’s not much more you can do. for me, all the ante-natal tips/ stuff I learnt in classes went out the window, though I would say definitely do listen to the midwife and doctor’s instruction about when to push during the labour! In answer to your query- my three pregnancies were consultant led, in two different locations. First time there was consistency and I saw a consultant with a particular speciality but then he did not see me during the entire days I was stuck on pre-labour wards during induction, or during recovery when I had an infection, soi don’t even know what the point of that was. The second two times there was a nominated consultant but you’d generally see any doctor in clinic. The last pregnancy I felt so ignored/confused I asked for the nominated consultant specifically and argued that it was important for me because I had another concurrent health issue affected by pregnancy- they did respect this request, but none of these consultants are likely to deliver your baby anyway unless by chance they are on duty, so sometimes it felt pointless. Keep on track with/chase medical appointments/be open to important information etc, but try not to fill your mind with too many worries/scary stories/‘I had it worse than you’ stories because they are irrelevant to you really and there is only so much you can control. I got so stressed about something unrelated to childbirth/pregnancy in my first pregnancy, that I got shingles, which may or may not have been related to the intense stress but it sure didn’t help it, and I regret that I got so upset about external factors rather than preserving my energy for pregnancy. All the best.