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!

You don’t know what’s going to happen. I know one woman who gave birth in 30 minutes with no damage, and another who had such a serious tear that she was anally incontinent and needed several reconstructive surgeries. Obviously the second woman would have chosen a c section if she knew what would happen.

2 planned sections here. Both were really easy, a doddle. Birth was pleasant and totally pain free. Recovery was virtually pain free and I was back to normal in just over a week.

My average period was worse than c section recovery. I'd rather a c section than a cold.

Not sure you have enough time to get hold of and read two books before your appointment next week.. but Sara Wickham's books - what is right for me and plus size pregnancy might be worth reading.

According to the WHO, caesarean rates higher than 10% are not associated with a reduction in natural and newborn mortality rates. However, this does not take into account the impact on other outcomes, long term impact on the immune system and lung health of the baby, the impact on the breastfeeding journey and the perinatal mental health of the mother and the baby due to bypassing some of the hormonal changes that happen as a result of physiological birth.

We don't like to talk about these things any more than we like to talk about the physical impact on women's bodies of physiological birth but they may be relevant in the decision making process.

Women who make fully informed decisions about their births, feel more positive about them, regardless of how the birth journey unfolds. You are right to seek as much information as you can before this decision is made.

Agree with @YokoOnosBigHat

Step away from the googling.

Ultimately op, there's no definite way to choose, either route has risks. Straightforward vaginal birth is optimal but you're not guaranteed it will be straightforward. C section is preferable to serious birth injuries. But then c section also comes with risks. There's no path that guarantees an easy time of it.

I've had a c section (after long labour and failure to progress) and a vbac, much preferred the latter despite the pain of the birth bit on gas and air alone. Felt like I'd been run over by a truck with c section, felt amazing right away with vaginal birth.

There's also the microbiome, the baby has an immunity advantage from vaginal birth.

Some of these statements are based on dubious evidence, or lumping EMCS in with ELCS. How do you weigh up claims about the micro biome from vaginal birth to a baby with an E. coli infection from vaginal birth?!

Same with mental health and breastfeeding - both went terribly for me because of vaginal birth.

Emily Oster's 'Expecting better' is worth a look and you can just dip into the chapters relevant to you. She takes the actual research evidence, assesses its quality and what it's actually saying. She doesn't make the decision for you but states the reality of what the high quality research says.

I had very similar thoughts to you. I had an elective c section and it was great. Pain was minimal afterwards, scar is neat and although a little numb there’s no pain. It did take me a while to get out and about but I fortunately had help and no other children to look after. None of my NCT class who had a vaginal birth seemed to have a great experience (although it sounds like most are still happy they experienced it).

Maternity units in the NHS are so busy because of staff shortages (at least in my area) which has stopped a lot of women I know having the birth they wanted, with a planned c section you know what you’re getting or you can have emergency one if you go into labour and there’s enough time

There are more risks of major abdominal surgery than vaginal birth, especially if you are low risk.

Having done both, I'd go C-section every time.

Completely disagree with you.

You cannot disagree with what I felt!

I would 100pc go for a C Section. I wish I had with my first - ended up with severe incontinence and prolapse (episiotomy + ventouse). Of all the women in my antenatal class, those with C Sections had the easiest recoveries.

I was Induced with an emg section. If I was a first timer again I'd have a c section if I was to be induced but if it happened spontaneously I'd try the vaginal route.

I'm pregnant and having a planned c section. Recovery was hard but at least I could sit down. So many of my friends had huge tears and couldn't x

I had a third degree tear (no instruments) and so far (9 months later) I've recovered great. Birth was incredibly peaceful and positive regardless of the tear.

There is no easy answer because both options have short and long term risks.

I was also incredibly anxious prenatally. For me it was focused on fear that I would feel FOMO / like a failure if I had a section (not that REMOTELY think other women are failures if they do) . You just have to make the best judgement you can at the time and be kind to your self when you look back on your decision in the future, whatever happens.

Completely untrue.
You can absolutely choose a c section if you wish, for any reason.

ELCS all the way.
A natural birth is great when it goes well. When it goes wrong, it’s way worse. Both at the time and potential problems afterwards.

🤮 at those who have been very belittling and trying to guess your job because you have done your research. To me, it's sensible when this will likely be one of the riskiest things you will ever go through in your life

Anyway I digress. I was like you and did a lot of research, actually over a year before we ttc. I knew I was going to opt for a c section before I got pregnant. I have zero regrets. Yes recovery was quite long, 6 weeks, and my milk supply was slow, but I got there, 5 months later me and baby are very happy and healthy and I am still breastfeeding. I have no trauma and can honestly say I look back on the day with happy, fond memories. Yesterday I was speaking to a girl in a postnatal class, both her and the baby got sepsis and she had an extremely traumatic birth. Another friends baby, had oxygen starvation during the birth, partly due to poor staffing levels, and has a baby who is now disabled. Heartbreaking. OK it may not be the majority but the risks are there. I felt happy with my decision in a controlled manner and felt very well looked after.

Thanks for posting this @tinkxo it's literally my whole thoughts and reasoning so I've found the responses really helpful.

Don't let this very personal choice be swayed by others. Go with what you are most comfortable with and the facts, which you already have. If you're anything like me it keeps swaying every so often, but I always return to my calm thoughts when I know I want a c-section and this is definitely what I'm going for.

It's your choice. Not any of your extended family, friends or anyone else!

Good luck with everything x

If you had bothered to read the ensuing conversation you would in fact be aware that the guidelines have changed since I had my last baby.
prior to this it absolutely was the case. I believe another poster added shortly afterwards that this was her experience too.

so pleased to be able to put you in the picture

I wasn’t trying to belittle you for wrong information. Just wanted OP to know it was a false comment and that it is her choice. Apologies if you thought I was being snippy.

It was comments like this (real life and online) that really affected my mental health early on in my pregnancy

Thanks for this post OP, we’re TTC and I have similar thoughts to you so it’s interesting

Most hospitals near us for maternity are requires improvement or inadequate. I’m sure a straightforward vaginal birth is the most ideal but if you don’t get that, I’m not sure the current system is best equipped to help tbh. It’s not anxiety, you’re just trying to be balanced and informed. I think this board might be biased towards vaginal birth given that the whole topic is ‘childbirth’. People will come on to discuss vaginal births rather than straight forward c sections, cos there’s arguably more to say about the former

Do what feels right for you. Either option will be fine in the end, you’ve just got to weigh it up and go with your gut. Best of luck. Please report back and let us know! X

I had a really easy recovery from my c-section. Scar healed beautifully. Up and about quickly. After I got home I barely needed painkillers, supporting the wound and moving slowly was sufficient to manage pain.

Just wanted to update that I had my consultant appointment today and it was great. She just started with the open question of why I was thinking of choosing c section, and I went into it with the mindset that this is a very experienced professional and she could always change my mind.

I told her how I was feeling and the risks I was worried about, in brief, and she immediately validated my thoughts and said she could tell I was well informed. I didn't need to debate anything or go off on a long ramble, so for anyone thinking consultants don't have time for a long winded debate - you don't need to have one, it seems they can tell if you've made an informed decision or not pretty quickly.

I told her about my thoughts on the pros and cons of both c section and vaginal birth and why overall I felt c section was the right option for me. She said not to listen to family/friends dismissing me, and that the right option is the one that sits right with me. In fact she wasn't particularly concerned about the issues I asked about, such as placenta issues in future pregnancy (said the risk was very low), impact on breast feeding (said there's no reason I shouldn't be able to go for it with the right support) etc.

She basically said some people come to her wanting a c section to avoid labour pain and she has to remind them they'll be in pain after major surgery...

Re OASI/3rd/4th degree tears, she totally agreed with me that whilst the overall risk for first time mums appears low (6%), there is no way of predicting it in real terms, as so many variables can influence it - baby's position, baby's proportions, weight (even with growth scan), progression/speed of labour, mother's pelvis, baby getting into distress and needing instrumental delivery quickly and many other things. She rounded it off saying if the risks I'd mentioned were unacceptable to me and I'm more comfortable with the risks of surgery, then she supports my choice.

There was absolutely no discussion or inference at all that I'm overly anxious or that mental health is a factor at all. I trust that she'd have said something or referred me for support, if she thought it was necessary, because it was clear from the conversation that she doesn't just approve c-sections without due diligence.

She booked my date there and then and made a point of saying that if I go into labour earlier, they will slot me in.

Hope this helps anyone feeling the same.

I'll share how it goes and recovery afterwards for anyone interested.

Oh and I'm not a teacher - just a woman trying to educate myself for the most important experience of my life so far 😊

Well done OP, I'm glad it went well!

As for it affecting BFing, you're starting off in a good place knowing that it might. It might delay your milk by a few days, which means you might need to top up with formula for a while but please don't worry about this, it doesn't meant you can't BF. A friend had an ELCS which caused milk delay and had to top up for a while until her milk came in and her supply caught up but she was able to EBF by six weeks