Please help me decide - not long left!

[tinkxo]

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!

Well I had three fairly complicated pregnancies in the last nine years and not once was I asked to sit down and discuss at length with a consultant about what kind of birth I wanted.

hope that helps.

@strawberrysea in fact with my second baby after being told by a consultant at 39 weeks I had to have a c section they then said it was no longer necessary in theatre upon a last minute scan and sent me own my way - without discussion or consideration of my wants - to the labour unit after breaking my waters. I had had to get my head around the fact I had to have a section and then whether I now wanted one or not was irrelevant since I was told I “no longer met the criteria”. That’s how much what kind of birth I wanted mattered at that point. Not as much as cost.

I think the NICE guidance changed relatively recently (maybe summer '22? not sure) enabling women to request c section without medical indication, as long as adequately informed.

That said, they don't seem to actively offer appts to discuss mode of delivery. Seems like the woman has to instigate it. Personally I'm hoping going forward that awareness will be raised that women have a choice now. I reckon we won't see a drastic rise in women choosing ELCS - going by the replies on here, seems lots of women still prefer vaginal birth. But for those of us who maybe feel differently, I think it's fantastic that we are being offered the chance to choose (as long as we are truly informed when making the decision).

Financially I think they used to think c sections were the 'expensive' option and therefore not fair to the NHS's purse. Part of the rationale in changing this was cos they realised that when you take into account the long term cost involved in physio, surgery, all the other aftercare that can be involved following vaginal births with complications, there isn't actually a massive cost difference, so 'the powers that be' seemed to decide women's choice was now financially worth factoring in and considering.

Also helps that trusts aren't being targeted on keeping their c section rates as low as possible anymore - think that had a significant bearing on them doing whatever they could to avoid sections. Now I think the NICE guidance supports trusts more to resist pressure to 'keep the rates low'.

@strawberrysea ah well then I just stand corrected since I had my last baby almost six years ago so there you go. Times change.
I’m not sure how “adequately informed” is helpful or can be accurately assessed though…….

When I had my babies my experience and those of my friends having children at that time was very much as I wrote.
I still suspect capacity and cost will dominate this agenda as it is not males going through the process. If they were I think it would be a different story 😉

I'm really sorry to hear that you didn't have a positive experience, it's all too common and it's really horrible to read stories like that.

Maternity care has definitely changed in the last few years (and while I completely agree that it's still woefully inadequate in a lot of areas) it is almost unheard of now for a request for an elective section to be denied.

I had 2 x VB ,(inc 1 episiostomy) and would do again in a heartbeat. I was very scared of a CS and tbh i would have struggled to care for DC whilst recovering from surgery. The episiostomy was fine and i couldn't feel where it was cut, it healed fine. Essentially once i was on the PN ward my body felt back to normal, i had a minor op once and managed to get an infection which was not fun at all. I also had tears with Dc1 but managed fine with salty baths, i couldn't really feel them even during delivery (i had the back injection thing)

Ah, c'mon OP.
Of course there are no routine appointments with obstetricians to discuss mode of delivery. They haven't got time!

The weird thing was I hadn’t wanted a c section at all. They spent twenty four hours preparing me to have one then bam I was sent off to get on with it the other way after being starved and all set for a major operation. it was rather surreal to say the least.
I cannot imagine how I would have felt if I had in fact wanted one!

I was explaining the fact that those appts aren't offered routinely might be why @Whiskeypowers wasn't automatically offered an appointment.

I don't think they need to be offered as standard, as I said it seems many women are fine with the default of vaginal birth and that's great.

I think if you express concerns, you should be able to be referred to a birth options clinic. Then to a consultant if it's necessary. I probably could have had the conversation I need via a birth options clinic - don't think that would've been consultant led and would've saved their time. Nice to know they feel I'm worth their time for an appt next week though.

Yes, my last child was 5 years ago and this is definitely a new thing to be asked of you'd like a c-section of vaginal birth. A few friends have chosen c-section because they're older, had previous issues etc. There are a few changes and it's really odd for me. Stopping folic acid at 12 weeks to prevent tongue tie, being asked about domestic abuse every single appointment, and introducing peanut butter before 6 months (I have nut allergy) when it was no food for 6 months. Always a surprise, but times move on.

I had an elective section due to the risks of natural with all the reasons you've said!

I had GD and was told baby could potentially get stuck, forceps, tearing and worst case still birth. They also sent me this in writing. They said he would be big.

Elective section, 38+5, 8lb 6oz! BEST decision of my life!! I took arnica tablets after and felt it really helped. Along with regular painkillers.

Was a wonderful day and I have lovely memories.. I was also driving by 3 weeks!

I had exactly the same thought process as you, OP. I opted for an ELCS. It was absolutely fine and I would do it again for a second child. ELCS recovery is much easier than EMCS. I was pretty much functional again by day 3 or 4 post-op (I could look after myself and the baby). Breast milk kicked in no problem. ELCS also carries far fewer risks than EMCS.

Oh and don’t let people write you off as just being anxious. You’re acting completely rationally - weighing up the statistics, the pros and cons, and making a value judgement that’s personal to you. There’s no right or wrong.

I'd choose to delivery vaginally. With my first i delivered feet and had an emergency csection. I then had a elective csection with my second who was also breech. My recovery was 4- 6 weeks with each. I have had terrible back problems since apparently caused by poor core strength related to csection. I had pain in the incision for about 6 months ish and it still gets itchy now and my youngest is 3.

My SIL on the other hand delivered vaginally and she had discomfort but recovered very quickly. She was sore but okay within 2 weeks.

I regret not pushing for an ELCS. I got loads of pressure to have a natural birth in the MLU, not realising I could choose to have a CS - nobody mentioned it. I had to fight just to give birth on the labour ward with access to pain relief.

Hideous experience - I had technically had a standard vaginal delivery but it took 2.5 days. High risk pregnancy and I was induced at 38 weeks. It was agony. First epidural failed to work (I had no idea this was possible), second one worked which is the only good point about the whole thing. Shoulder dystocia meant I sustained two second degree tears and an episiotomy. It was painful for weeks afterwards and took a long time to heal - I couldn't be far from a loo for several months which limited what we could do. My baby picked up an E. coli infection from my vagina on her way out.

The trauma and blood loss affected breastfeeding and my milk took weeks to come in.

An ELCS would have been far preferable.

I had an elective c section and I could have written what you wrote! All of those reasons especially fear of incontinence and the worries were the same too.

Out of my nct group there were two elective c sections and 4 unplanned c section only 3 vaginal births. Only two of us couldn't breatfeed successfully- me (tongue tie nipple trauma etc unrelated to the c section) and a vagina birth woman. But I expressed and combi fed for 6 months.

You need to stop asking family members for their opinions and start telling them either you're still deciding with your doctors and you'll decide what's best with their advice. One of my friends was very vocally anti c section and trying to get me to do a medication free birth like her when I was still deciding but didn't bother mentioning it again when I had made my mind up. It's a bit like if you tell people baby names you're considering they might criticize but once you actually announce the name you've chosen they won't.

Just be prepared that you'll need help with absolutely everything for at least a week, picking baby up, getting up and down stairs, in and out of bed etc. take your stool softener medication and instruct partner or whoever is with you that when you get farty they cannot laugh and make you laugh or you'll be in so much pain you'll cry (this happened to me)!

It's very normal anxiety no need to pathologize it

I've had a fairly difficult VB and an ELCS. The VB recovery was fine for me (I used something called an epino in the run up to birth and it really helped I think as I barely had any grazes despite tricky birth). But my dc1 had shoulder dystocia and came out not breathing etc. It was also painful and scary for me. But I popped right back to normal really quickly.

Elcs was chilled and lovely but I found the recovery painful. They almost used forceps as dc2 was really wedged in there. He was great after birth and healthy though. But yes, I am tall and heavy like you and I have a real apron tummy now 😩. It's horrible and I would really regret the cs except for the fact that I was told the risk of shoulder dystocia was higher for me with dc2 because I'd already had it. Him being safer was worth the godawful tummy.

Another pro for me of the c section was knowing the date- as my baby's father had broken up with me a few weeks before (lovely guy) I was reliant on family support so knowing the day was helpful and didn't make me worry I'd go into labour in the middle of the night on my own .

Op with the being over weight- I defo was at the start of my pregnancy and got gestational diebetes- the diebetes diet for me was great and saved me from liking on weight at the end of pregnancy I would follow it anyway if I were you. I'm also tall.

Something else is I asked the consultant doing my surgery if he could sew me up - this is an 'easy' task that they often give to someone else but I thought if there's a consultant in the room I want him to make sure my scar is ok. It's fine and my tummy is much smaller now as I still follow the gestational diebetes diet a bit

I had one of each. C section was better at the time but wouldn't wish the pain afterwards and long recovery on my worst enemy. Vaginal birth I had ventouse and episiotomy but was up and about and walking with the pram a couple of days later. C section was much slower and couldn't do basic things round the house. No one can tell you what you'll get though, I have friends who were the opposite to me.

I always planned for natural birth. I was sent to meet a consultant around 2.5 months before my due date because of my BMI/age. He said to me he is happy for me to have vaginal birth but he thought they would end up having to interfere. All changed at 36 week scan when there were complications with the baby and they decided to bring her out at 37 weeks so ended up in induction. That was short lived as I reacted badly to the medication so they had to take me to emergency C-section. The recovery was slow and with sleep starvation it was mad. I have no real recollection of the first months. It takes time to recover and my relative who had both vaginal and C-section said C was much more difficult to recover etc from. I have seen threads where those with C-section developed some health issues afterwards so there's always that risk but then again C-section might be your only options if things go wrong towards the end of the pregnancy/at the time of labour.

With the utmost respect, you need to chill. Whilst I'll be the first to agree that it's good to be informed and that as a patient it's imperative that you understand your options for treatment etc... you are over analysing to a degree that is going to send you insane and spiralling into anxiety that will make you a basket case before the baby is even here.

Take sensible steps (like keeping as active as possible during labour and making sure that you're as rested as possible before it happens) and make sure that your birth partner knows your wishes and can advocate for you. But besides that, a lot of it is your genes and the luck of the draw.

I had really good labours, no tears or grazes and pretty swift (in labour terms, anyway!) but then once baby was out I had a 4L PPH in labour number one and a 6L PPH in labour number two (despite all the things being put in place to try and stop me having a PPH of any kind that time, let alone a fucking massive one).

It's out of your hands to a degree and that's terrifying, but that's parenting too tbh so it's good practice.

And if I had to bet on what your job is, I'd go for teacher. Because I'm one too and you sound a-lot like me on certain topics (I'm calm when it comes to childbirth, less so in other areas).

Good luck whatever you decide @tinkxo

..........and if I had to bet on what your job is, I'd go for teacher.

So would I.

A third vote you’re a teacher. I was just like you with my first pregnancy.