Please help me decide - not long left!

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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!

I've never had a c section so I can't comment on that. I just wanted to say that not every vaginally birth is a nightmare. I've had 4 babies no pain relief and I can honestly say it really wasn't that bad, this is what our bodies are designed for and God willing they are in the majority up to the task. No stitches, no intervention needed. ( Disclaimer: I know this isn't the case for everyone). I just think it's always useful to remember there are lots of positive vaginal birth stories out there it's just they aren't talked about as much as the nightmare scenarios. Good luck to you whatever you decide op.

my first was a planned section due to placenta failure. Recovery was awful, painful, long. I was still considerably sore after 6 weeks. Still having twinges and pains for months afterwards.

second baby I tried to go natural, no pregnancy complications that time so eventually my waters broke. Unfortunately I didn’t progress and was at risk of infection so needed an emergency c section anyway, recovery was quick, easy, completely pain free by day 5, off the painkillers and feeling normal after a week.

I am internally very sad that I will never experience a vaginal birth though. Although like you the thought of the unknown was terrifying and really made me consider electing was a c section, having that choice taken away made me realise I actually wanted it. I’ll always be a little sad about it now. But my children are here and are healthy.

I am also a researcher, and as a result choosing ELCS. Haven't gone through it yet so too early to tell if it was the right call 🤣

I don't think it's due to anxiety as some people say - I'm not an anxious person at all, and quite a risk-taker generally, but I just wanted to be informed and I don't buy into the whole narrative of vaginal births somehow "making" a woman or proving that she is up to the task of mothering (though I absolutely don't diminish the personal experiences of women whom it has empowered).

Statistics show that risks of incontinence and prolapse are halved or even 1/3rded with CS. That was a huge factor for me as a good sex life is very important and I did not want to risk it.

Risks to baby are not greater - even smaller really if you look at risks of dystocia etc from vaginal birth. Stats are harder to properly analyse though as EmCs and Elcs are usually mixed together, even though very different.

Yes - ideal is a spontaneous vaginal birth with no issues. But I don't know anyone personally yet to whom that has happened - agree though that this is not evidence and only anecdotal.

And just to respond to posters who say that giving birth vaginally is what our bodies are designed to do - perhaps, but many would say it is a very poor design (did a man design it??! Haha). In some sub-saharan countries as recently as 5 years ago, your chances of dying in childbirth over a lifetime was 1 in 8!!! Thankfully that is basically not a risk in countries with good medical care (and maternal death risk is actually slightly higher with CS).

Anyway OP, do what feels right for you! And as some say, ultimately you will never know beforehand, you may have an awesome VB/awful CS or the other way around... xo

I've had both.
First birth - natural (nothing natural about it) instrumental difficult birth with life long complications.
Second birth - took me to 36 weeks to have the confidence to say no to trying another vaginal birth. Elcs. Recovery was a doddle in comparison.
It was my last baby so may have bade the decision easier. The same as you re trying though, they can't push the baby back up so the only way to avoid instruments is not go into labour.
Feeding established quicker and easier.

Good luck

Traumatic first birth. Long induction, forceps, PPH, prolapse requiring surgery. Second birth from the outset asked for an elective c section.

Aside from further physical damage I was very concerned that I mentally wasn't confident I could deliver vaginally and wanted to avoid induction, long labour and then an emergency c section at all costs.

The c section and recovery were significantly easier than the vaginal birth. Was in and out of hospital in less than 24 hours, compared with 6 nights in birth 1 (3 nights pre birth and 3 nights post birth). never needed anything stronger than ibuprofen and paracetamol and by 2 (max 3) weeks felt very normal. It was a bit of a logistical pain not being able to Iift my toddler, but possibly more for my partner than me! I still have side effects from the vaginal birth and at the moment my only real complaint about my c section scar is that it's sometimes itchy

You're certainly well-informed. Everyone's experience is different and often it's the baby that decides the birth. I've had 2 vaginal births, first was tricky on paper (36 hour active labour, needed epidural, episiotomy and ventouse), but it was relaxed and wonderful. Despite all those things I was home next day and walked to shops 2 days after baby was born. I am quite small but have 8lbs-ish babies (size 10, 5ft5). Both babies have been born back to back/ sunny Side up ;-)

Second birth was a breeze from a physical viewpoint really, though a bit fast and so felt a bit out of control and wasn't all that well supported (they were going to discharge me as thought i wasnt in labour and I screamed at them to check me and had baby a few minutes later). Home after 4 hours (fed/cuddled baby, stitched and showered and then had to wait 2 hours as 4 hours was minimum to be discharged). Small tear stitched up that I didn't feel at all after 2 days.

I'm pregnant again and was heading for a c-section. Only then did I realise how debilitating it would be compared to my other births. Anyway, things have sorted now and so I'm on for a natural delivery probably. If you go the vaginal birth route, look up perineal massage, I'm doing this and I'm also making sure I don't recline backwards of an evening and go forwards on hands and knees to try to stop baby being back to back and speed up labour. I'm also going to wear tens machine from 37 weeks to get used to the sensation. I also always get lactulose prescribed or take califig as poos are a bit painful at the start and so this makes it much quicker/easier.

You need to stop googling and ask for help for the anxiety you're feeling.

I totally second this. You tend to hear the nightmare vaginal birth stories because the people that have easy births are too embarrassed to say when people discuss their births. It's like having a baby that sleeps through the night at 6 weeks when everyone talks about sleep deprivation... you just keep quiet and nod...

If you're 35 weeks surely you've discussed this with your midwife? Isn't it a bit late for planning an elective Caesarian?

I’ve had both. I had an easy cs with a quick recovery but did have incontinence afterwards and issues with sex for over a year. Had a VBAC second time with an episiotomy which was a few months before it was back to normal and that has healed better. Stomach is still buggered and will never be flat again.

Thanks so much for all the replies so far! Really helpful to hear people's real experiences and would love to hear more!

@CurlewKate - you're right, I asked about ELCS at my booking appt but was told 'it's your decision, but there's no point discussing it now, a lot can change, we'll book you an appt at 36 weeks to talk about it'.

Then got a call from a registrar at about 15 weeks to risk assess me due to BMI > 30. I asked her about it. She said 'you're right, we don't have a crystal ball, it sounds like you're well informed, we would have only pointed you to the RCOG choosing a c section leaflet which you've read anyway, so if you still want ELCS at 36 we'll book you in'. Think NICE guidelines do say that they should refer to things like perinatal mental health if they think anxiety is the driver. She said she wasn't going to do that as what I'd discussed were the same risks they'd discuss in a mode of delivery conversation and she felt I was trying to weigh up the actual risks and make a decision rather than 'just being anxious'.

Saw a different MW later in pregnancy and talked to her, asked if there were any birth options clinics etc, was told 'not that I'm aware of, but you can discuss at 36 weeks. At the end of the day it's up to you'.

I'm grateful to be having a baby at a time when I'm treated as an active participant in deciding mode of delivery and not just having a decision made for me. However, I've had no conversation about the realities of c section recovery, how it's impacted real women, if anyone has chosen the same and how they feel about it etc. I've just had a registrar say 'yep, those are the risks of c section and vaginal birth, you are entitled to choose which set of risks you prefer'.

If anything, I think 'they' (health care professionals) are the ones who have left it a bit late in offering the opportunity to properly discuss this at 36 weeks. I get the feeling it's going to be more of a 'which do you want, let's sign it off then' discussion, hence me trying to prep for that by seeing what real women have felt/experienced.

OP honestly, doctors and midwives haven't got time for a long, complex debate about the mode of delivery, with every overly anxious woman.
Honestly? Aim for an SVD and have an LSCS if it becomes necessary.

I have rtft so apologies if repeating myself!

I've had two amazing vaginal births (both at home) the first one I had a third degree tear - which was statistically very unlucky!! It was sore, but healed well and no long term issues. Walking around the same day.

Second birth, second degree tear, sewn up on the sofa and barely noticeable after 2 weeks.

In my humble opinion, there's no need to put yourself through a major surgery to avoid tearing which is a normal thing to happen in birth and unless you are very unlucky resolves quickly as its designed to do.

I agree with the 100%!
Don't have major surgery if you can avoid it!

It's really simple when you look at it in this way..

It’s a really personal decision OP, and I’m reluctant to offer advice. But, for me, my mum’s experience was an important factor in my decision to have ELCS, whereas your mum sounds like she had an easy labour. My mum and I are both petite, she was in labour for days, and frankly, nearly died. She had all of the interventions.

All the stats you’ve listed were my reasons too, but also bear in mind, a lot of bad tears get misclassified as a 1 or 2. I think there is a lot of covering up going on. Also, all those EMCS births could have also gone through forceps, episiotomies etc, but just get counted as an EMCS birth, so again, the stats don’t capture the full story.

Personally, as a small, slim lady, I found the recovery easy. I could get myself up and was on my feet day 3+, and walking comfortably about a week later. I’m now 9 months later, and the scar is completely fine, I have no side effects and I’m pregnant again.

But, I have an overweight friend who had issues with her scar not healing effectively due to it being so hidden away, and she wasn’t able to lift herself up so well and be mobile quickly.

I had done similar research to you (I don't think being aware of the stats necessarily means you have anxiety!) and although on paper I preferred the risks of an ELCS over a vaginal delivery, I decided to attempt a vaginal delivery with my first child. Ended in a EMCS (after refusing a trial of forceps), but obviously it could have been a straightforward vaginal birth. You don't have a crystal ball so I would go with your gut instinct. There are millions of positive and negative stories about both ways of giving birth and ultimately you know which risks you'll find it easier to handle. I was particularly worried about shoulder dystocia with a large baby and severe harm coming to both the baby and me (which is why I refused forceps). I had a wonderful ELCS with my second child. Good luck with whatever you choose.

@TheShellBeach I don't think a long complex debate would be helpful. I'd just have liked my MOD appt earlier on but can understand they leave it late in case anything happens in pregnancy that means the choice is made for you and you medically need a c section.

The opinions on me being overly anxious vs doing what I need to do to be well informed are interesting. I've considered both as possibilities. I took some confidence from the registrar's opinion that I didn't need to be referred for MH support and wasn't just anxious. I felt respected in that regard. I'm self aware enough to still be open to the idea it could be anxiety driven though.

I had a section. Found the recovery a breeze (my appendix out was a lot worse!!). It was planned but I went into labour a week early, so had to wait for a slot to become available. Went in at 1300, section at 1900, home by 1600 the next day. Section was amazing, had my own music, skin to skin straight away, baby was feeding whilst I was getting stitched up. Barely have a scar and it’s only been 2yrs. I was up and walking in the park on day 2, out for a pub lunch on day 3. I may have been lucky (friends have had a similar experience, even the one who had two emergency sections). I would definitely have one again.

Sorry I might have used something but are you planning on giving birth in an NHS hospital as an NHS patient?

if so unless there are medical reasons (including psychological / mental health reasons ) for an elective caesarean when it’s your first baby and there are no factors preventing safe vaginal labour or at least an attempted one (ie breech baby , placenta problems , a condition you have etc ) then you don’t generally get to go in sit down with a consultant and book in a c section.

Your anxiety and uncertainty as birth approaches is absolutely normal and doesn’t go away however many babies you have as each labour and birth is different.

Trying to plan around preventing as much of what might go wrong as possible will only exacerbate that and will not influence the outcome.

My mum had to have 3 sections as we all got a bit stuck. I've had 4 vaginal deliveries with no instruments involved.
Mum was days and days in labour all of mine have been under 8 hours including inductions. Shortest was an hour. So your mother's experience isn't necessarily what would happen anyways. Last baby was 9lb exactly. I'm 5 foot 4.

I had an epidural with my last and it was amazing I don't know why I never done it before probably because I was terrified it would lead to a c section or instruments. I had to have the drip which put the risk up anyways so I figured at least an epidural was already in place if needed.

All of my births I was up and walking after a couple of hours. Out shopping a few days after. Doing school runs ect. I had a couple of small tears needing stitches but honestly it wasn't bad at all.

It's great to be informed and either way your gonna have a baby at the end of it. Hope all goes well.

I've had a vaginal birth with forceps and stitches then for my other two pregnancies I chose c sections and found those births and recovery so much easier.
All my babies were born weighing between 9.3 and 10 .7
I'm only five foot tall 🤷‍♀️

Bless you. I find it interesting that people are interpreting your interest/ being informed as being overly anxious! It is a big decision and no-one knows really which is the right option. There's no need for others what for you is really just a wish to make an jnformed decision and canvass opinion.

I know I defo want a vaginal birth after my last two, the fact you're allowed to decide these days is great! It gives you some choice about your own body, as it should. At 35 weeks, friends who are the same as me are just making the decision now on the birth they want. I can totally understand why it's thus late, as you can feel different as birth approaches. A petite older lady expecting a 9lbs baby lying back-to-back and struggling to arrange ad-hoc childcare is likely to have different decision to if circumstances were different. What I would say, is as a former nurse, is I've seen both c-sections and vaginal births and both are absolutely awesome experiences . :-) in fact, my favourite, most emotional birth I watches was a c-section.

When we thought I'd need a c-section with a 3rd, my super-positive husband was pretty excited it would be such a different birth For us (and still could be!).

Towards the end of pregnancy, we focus a lot on birth, but it's part of the process, not the goal. You will get conflicting opinions here about which is 'best' from anecdotal experiences. You'll notice this is merely the start, from sleep routines, controlled crying, bottle/breast feeding, everyone seems to have opinions. You're obviously bright, look up evidence, make a decision and run with it. There's no wrong decision in birth or parenting if your goal is to help you or your child in the short/long-term. Enjoy your bundle of joy, however they arrive, it's magical.

3 natural home births one was twins and I'm older than you wouldn't change it. Several in family had the op and regretted it, long healing time, could hardly walk, missed out doing more baby things,had to rely more on others etc

I don’t think you sound overly anxious. I think you sound very informed about the (potential) real risks that are involved in having a baby, either vaginally or by c-section!

I had an ELCS due to a breech baby, but to be honest I had been considering asking for one earlier on in my pregnancy so I didn’t need a lot of persuading that it was the best option. Like you, it wasn’t the pain of a vaginal birth that I found concerning, it was the risk of damage and/or incontinence after birth. I had decided to attempt a vaginal birth before finding out that DD was breech, but I would have asked for a c-section over forceps.

Recovery was painful at times for the first few days. From speaking to other women it sounds like I had a worse recovery than those who had a ‘straightforward’ vaginal birth, but a much better recovery than those who had complicated vaginal births with bad tearing, etc but obviously that’s all anecdotal.

We did have some issues with breastfeeding, but DD had a tongue tie so that may well have been an issue anyway.

I don't know where you're getting your information from but this is absolutely not true.