Resisted posting for a really long time now but getting to the point I could really use any input, advice and thoughts that I can get. It's long so click away if you don't fancy a read!
I’m 35 weeks into my first pregnancy, midwife led. I have a consultant appointment next week to discuss mode of delivery. I’ve read up on vaginal birth and c section. The potential risks of a vaginal birth really concern me. I feel like I’d rather go through a c section and possibly difficult recovery than risk an instrumental birth, 3rd/4th degree tears and the subsequent potential impact on quality of life (lasting faecal incontinence/significant urinary incontinence I.e more than just ‘can’t jump on a trampoline’), prolapse requiring surgery (have always been fearful of general anaesthetic – had two in the past, found it frightening) etc.
I know the overall risk is ‘low’ – 8-12% of forceps deliveries result in 3rd/4th degree tears (RCOG). But to me that still feels like too high of a risk. I know it might not for everyone. I also keep thinking about 1/3 first timers needing instrumental birth and 1/3 first timers ending up with a section. 1/3 chance of vaginal birth without either of those doesn’t feel like great odds.
In terms of risk factors – my booking BMI was 33, I’m 6’1” and partner is 6’4” so anticipating big baby (although no growth scans and I know fundal height isn’t the strongest predictor), my mum had a 4-hour labour from first pain to delivery and a quick second stage (I know I’m by no means guaranteed precipitous labour because of this but might have some influence(?)), placenta is anterior and they think baby might be back to back (unless she moves of course).
However, there’s no escaping a maternal request c section carries risks of its own. I feel guilty re baby being at higher risk of breathing difficulties at birth. I worry about risk of issues with the placenta in future pregnancies (although seems the risk is overall very low even with a previous section?). We think we only want 2 children max but worry that I’m introducing a factor that might influence whether we can have any more and what if we change our minds? I want to give breast feeding a try and worry I might be causing issues with establishing bf if I have a section.
Obviously this is nowhere near as important as other things but I don’t have great body confidence and can only imagine a c section will make my stomach look horrendous given I’m not that skinny to start with, however if I end up with a 3rd/4th degree tear and incontinence as a result I’d probably lose all sexual confidence and really struggle to get over it (just from knowing my own personality).
DP is hugely supportive of whatever I choose and trusts me to make the right decision for me. Is fully on board with being very hands on with baby if I have a section and I couldn’t ask to feel more supported. However, family cannot understand at all why I’d choose surgery without attempting vaginal birth. DP’s 5’1” auntie says if she can deliver a 9lb baby (albeit with episiotomy) then I’ve got nothing to worry about – I don’t think they realise that although I’m tall with big hips, without an x-ray none of us know the size of my actual pelvis...
I’ve read about physiological birth, spinning babies, birthing positions, staying active and upright in labour, how different pain relief can impact on outcomes, coached pushing vs following body’s urge to push, listening to midwife and panting when told, perineal massage, perineum guarding, positions to help if things like shoulder dystocia happen, etc. Considered birth plan of trial of vaginal birth, to move to c section rather than instrumental birth if needed, however I don’t want to risk baby being too low to convert to c section and being ‘forced’ into instrumental birth due to no other option.
Overall, I think what I want is to choose the ‘second best’ option of elective c section, if best option was spontaneous vaginal birth (hopefully without significant tearing), second best was ELCS, third was EMCS and fourth was instrumental birth possibly with significant tear.
I just don’t know if I’ve been unduly influenced by the recent focus on raising awareness of 3rd/4th degree tears – MASIC Foundation have been good at getting this into the spotlight lately, so have BBC Radio Women’s Hour, I’ve seen recently stories on BBC Breakfast, etc. I’ve tried to balance this by following positive birth story accounts, Better Births, several social media accounts about empowering women and giving them the knowledge they need to help them avoid cascades of intervention etc. But overall, I still feel like there’s so much uncertainty around ‘natural’ birth that no one is going to be able to tell me without a crystal ball that I’m not going to be one of those women.
Is choosing ELCS as crazy as family would have me believe? Will I seriously regret it when going through the recovery period? Do I sound like I’m being balanced? This doesn’t feel like it’s a decision coming from irrational fear but I’m conscious that I wouldn’t think that, would I. Any thoughts/experience gratefully appreciated!