First baby, low risk - buy an Aniball and train for a Vbac or give in to fear and ask for an elective

[Plimsongrey]

First baby
Smooth pregnancy so far, considered low risk
BMI of 20.5
Active lifestyle

Now 30 weeks at a crossroads - do I go the full hog and prepare for natural birth? Aniball hypnobirthing techniques etc or do I just request an a elective as deep down I'm shit scared of a traumatic birth and don't like the Russian roulette of a vbac.

I have an appointment to discuss an elective next week but I can't say I'm 100% adamant about it, I just want it on the table in case I bottle it. Part of me want to be courageous and try vbac, the other part things that's bonkers.

I’ve had an episiotomy OP, and it was absolutely fine. I had an epidural, so I felt nothing. Baby was in the birth canal about to be born and having some possible heart decelerations so the midwives wanted him out quick. He was over 9lb too. They did the smallest cut they could and he was born in the next two pushes. Because of the epidural I didn’t feel the stitches at all either. I had no other tearing, so the episiotomy did it’s job. It healed quickly and I have had zero issues with it. I can feel the little scar with my fingers but I’d take that over a C section scar any day.

OP, i strongly advise you to educate yourself about the basics of birth - not by reading anecdotes and birth stories (or, worse, watching OBEM) - but by signing up to an antenatal course, either in person or online (eg positive birth company). There are also some great books, I recommend The Positive Birth Book by Milli Hill. Have a read and then come back to us

(For the record, i have 2 children both born by vaginal birth, one in hospital and one at home. I think information is power so the more you have - and the more you discuss with your birth partner beforehand - the more "control" you have, although of course birth is unpredictable, you will be better equipped to deal with it if you have educated yourself.)

Have a read of the positive birth book.

Very evidenced based, talks you through the options, how birth works and how to make sense of the stats for you.

From what you've said your risk of intervention is pretty low. With some prep on your part and consideration around where to give birth you could have a really positive experience.

All birth carries risk, now is a good time to see how those risks apply to you.

This!

Decisions made from a place of fear are the ones most likely to be regretted.

Decisions made form a place of information are less likely to be regretted.

I had an elective because I didn’t want a vaginal birth. Absolutely dreamy. So calm and mellow. I, like you, was extremely active, and I recovered so well. Exercising again inside four weeks but had walked a good distance every day from week 2. It’s a very different experience to having an ‘emergency’ section, which is most people’s experiences of them.

Go with your gut, talk to the medics. Both are valid choices.

Birth is so personal and individual. I was induced as they were worried about DD, I coped just fine until put on the drip and then that accelerated the pain, I asked for an epidural and they put the needle in but I was ready to push and didn't get any drugs from it. So I ended up with a pretty much a natural birth with no pain relief (they took the gas and air off me as I had to concentrate and it made me woozy). It felt like having a massive poo and crowning really, really stung. I found the delivery of the after birth more painful than the actual birth. 12 hours I walked home admittedly it took me almost 30 minutes to walk the normal 7 minute journey home and I regretted it but seemed ridiculous to get a taxi. To be fair I was 23, I'm 36 now and not sure I wouldnt ask for all the drugs in the world now, I don't feel as resilient as I did when younger.

If a baby is v v low in the pelvis it is safer to try to do instrumentals (forceps or kiwi cup) as the head is low, over a csection - or we wouldn't do them

The risk with being fully dilated and csectioning is need to get the baby back out the pelvis, which can be tricky when the head gets impacted, else baby's face is directly in line with the csection incision

You're not "at our mercy" we do what is best to keep mum and baby safe during labour

You just need to discuss with whoever treating you, we aren't monsters we only want something that keeps you safe and have the best experience for the given settings.

An epidural is ideal, they're incredibly safe, make people pain free enough to sleep through contractions in 90% of cases, totally rational mindframe, safest pain relief for baby.

Read my post history I've explained them in great detail many times (anaesthetist)

Yes, this was exactly my experience too.

Planned c-sections seem to be very different to emergency ones.

Just from another point of view, forceps can be used in C sections too. DD was planned section due to medical reasons (me, not her) but she was very low down and they needed forceps to get her out. She was bruised from them and swollen for a few days and had the red lines down her face for about a week after.

Recovery was miserable but relatively quick. But I have had a LOT of abdo surgery due to cancer but I found the post birth contractions with the incision really painful. More painful than contractions (I only got to 4cm, started dilating the night before she was born)

The section itself was straight forward. But I wouldn't advise it to anyone unless medically needed. The recovery was miserable and because I was in so much pain and because of blood loss I didn't have it in me to push on with breastfeeding. But that's only my story and others will be different.

I have had two c sections, both classed as emergency as I went into labour before c section date (but they weren't emergency as in rushing me to theatre).

My first one was awful, could feel pain during and was very nearly put under a general. I then had a PPH in recovery (lost 1.8l) and needed a transfusion. I wasn't well enough to do anything for the baby for a good 24 hours. It took months to properly recover, (they needed to do a lot of messing to stop the bleeding).

The second one was lovely, nice and chilled, although I think the amount of blood loss was still classed as a PPH it was fine.

I wouldn't choose a c section to reduce the risk of complications though- they exist in all births.

Well best for baby and best for you is a vaginal birth, so you should really only have a C section of absolutely necessary

Epidurals often resulted in assisted deliveries

I thought epidurals were more likely to be the start of intervention which isn’t quite the same thing as causing intervention.

i think it - administration of an epidural - has been cited as a factor that might contribute to needing an assisted delivery ie the use of forceps or ventouse.

An aniball? 🤢 what is this torture device?!!! Please no. If labour your hormones/body/baby are all lined up to stretch. Randomly trying to stretch your vagina when it's not ready has got to be madness/pointless/potentially harmful!

If it's the possible interventions you're worried about I'd book for a home birth and really prepare for it (hypnobirthing and research), personally I don't like the PBC but there are other much better ones. Home birth massively reduces your chances of episiotomy/bleeding/tearing, obviously there's no forceps at home. If you need to transfer then have in your birth plan you want a c section and nothing else. Agree this advance with the head of midwifery.

I used something very similar on the recommendation of my doctor and found it helpful.

I was shiiiitttting myself before giving birth the first time and kept thinking I'd opt for a c sec.

Honestly, you get through it... pain relief is your friend.

First birth, I did hypno birthing, the breathing along with tenns machine really helped me get through the contractions at home. Every contraction is manageable, is when you're 24hrs into it and getting exhausted that it starts becoming overwhelming.

When in hospital I had gas and air then epidural when things weren't progressing quickly. Epidural was a god send, you can't feel a thing.
I didn't have any tears or grazes, possibly because I used the epino for a couple of weeks before birth.

2nd birth was much much quicker and I didn't have time for pain relief until the last few contractions once I'd got to the labour room. Again, I used the breathing , counting and tenns machine to get through the contractions. Then once I got to the labour room I used gas and air. My DD shot out, there was no pushing stage or anything, my body just expelled her. I don't really remember feeling a lot of pain or anything. Either the gas and air covered it all or the adrenalin gets you through!?? Again, no tearing. I'd used the epino again.

Particularly with my second, I would not have wanted a C sec, it would be days/weeks of pain and difficulty moving etc. Vs vaginal birth where you are up and about within the hour.

Pregnancy as a whole effects your pelvic floor though, it's wrong to insinuate that only those that give birth vaginally are affected.

I think this is bullshit tbh.

In France the epidural rate is very high (97.5% in the clinic where I gave birth) and yet the rate of emergency C-sections and assisted deliveries is not higher than it is in the UK.

I suspect the data from countries like the UK which appears to show a link between epidurals and other interventions is actually showing correlation rather than causation, due to the fact that in the UK women having uncomplicated labours don't tend to ask for or be given epidurals. The data will reflect the fact that women who have epidurals are probably already having a difficult labour.

I don’t know from personal experience just something I have read when reading around this during pregnancies . I didn’t have an epidural with any of my three mostly because there wasn’t time especially with the last one which was the time I did beg for one!

So I’m not in a position to comment but yes I can entirely see your point that things aren’t going so well when a lot of women ask for one anyway or the pain is unmanageable

Isn’t it fairly standard to administer epidurals preemptively in the US or perhaps I’m mistaken

My two births were both C sections, first emergency after exactly the sort of labour you're afraid of, the second elective.

I don't regret the elective and it was much nicer than the first one. Still, in your shoes, I would just try for a vaginal. There's no reason to think it wouldn't work out, and I wouldn't seek out C Section recovery and in my case permanent overhang with no reason to think it was needed.

I had an awful infection after my first C Section, too. It's not the easy route.

It is quite common to have an epidural pre-emptively when being induced, and a lot more women are induced in the US.

There was a fairly recent study which seemed to suggest that first time mothers actually had a reduced risk of emergency C-section when induced at 39 weeks compared to waiting for spontaneous labour up to 41 weeks, and that study is currently being repeated in France to see if it holds true there as well.

Lots of women are induced in the US because women who have little or no paid maternity leave want to have more control over when they give birth, so it is a more popular option.

I think induction probably does increase the risk of further interventions if the baby isn't ready to come out or isn't in a good position, and it can definitely increase the risk of a C-section, especially if the baby doesn't tolerate syntocinon well and gets into distress. (This is what happened to me the first time.) Given that epidurals are much more likely to be used in these situations, it stands to reason that more women who have had an epidural end up with forceps or a C-section, but it doesn't necessarily follow that the epidural has caused that intervention.

I would really like to see a big UK based study comparing the outcomes of epidural and unmedicated births in low risk women who have gone into labour spontaneously at full term with a well positioned baby and who are allowed to remain mobile during labour. I suspect it would show no real differences between the groups except lack of pain for the epidural group. But if it did, there would be much more demand for epidurals and the NHS would have to invest more money in anaesthetists for maternity units, which they probably don't want to do for funding reasons.

Theres hundreds of us in hospitals, we definitely aren't the limiting step for people getting epidurals (guidelines say ideally 30min, it's rare to not get one within an hour ie if we are in theatre).

This is the chat i give to everyone requesting epidurals

there's an association with epidurals and instrumental deliveries, so that's forceps of a csection, but we don't know if it's a true causation or something that you were destined for anyway...as the people that give birth prehospitally obviously don't have an epidural and don't have a csection so we don't know if it's a genuine cause or effect. As it may just be that baby is sat in a funny position and you would have ended up in theatre epidural or no epidural

The main rationale for baby's needing help is the lack of pain and dulled pushing sensation (can still feel pressure of a contraction just far less than without) impairs pushing abilities, so if paranoid at that can just not click the bolus topup button when at the pushing stage

I probably do about 3-5 epidurals in a 13h shift (my opposite night/day colleague doing the opposite) maybe bring a patient with an epidural to theatre every say 2 or 3 shifts, it's not common, we take far more to theatre for emergencies that don't have epidurals in and hence they get spinals in most instances.

The benefit of having an epidural means if you're already pretty comfortable it's far quicker to get you ready from an anaesthetic pov to get baby delivered than starting from scratch if the needle bit is tricky

I agree with you. I was open to having an epidural depending on how things went but both births were relatively quick and straightforward so once they got started there wasn’t time/didn’t seem much point. I used gas and air for both.

If I’d been in France where gas and air isn’t available, I probably would have opted for an epidural straight away without waiting to see if I was coping or not.

In France they don’t really offer and pain relief except epidurals.