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!

@TheShellBeach what does this mean?

My baby’s head is measuring on the 95th percentile and I’m wondering whether to have a C-section based on that. Do big heads = difficult births?

Not at all.
It just means that the position the baby's head adopts in the mother's pelvis is the thing that determines how labour will go.

So if the head is deeply engaged prior to the onset of labour, that's a really positive thing.

And I've delivered mothers whose babies were four or five pounds, who had protracted labours.

Thanks for explaining. Is there a way to know how it’s engaged? Or a way to make it engage well?

Hi op,
I read to the bit of your thread that mentioned baby being back to back.
During my first pregnancy my baby was also back to back, it resulted in a hell of a lot of pain during labour. I then needed an epidural, my pain threshold is usually very high. Never did I think I would have an epidural.
So following this i had a very long and slow labour I needed help with forceps, resulting in 3rd degree tear, emergency surgery and I also needed 2 blood transfusions. I wasn’t able to hold my baby until the evening when I’d had him
at 10am, I was just out of it from the surgery, and I felt so weak.
Im not trying to scare you but it took a hell of a lot of recovering from. I could barely sit for the first couple of months.
My second pregnancy was an elective, and honestly, it was a walk in the park compared to my back to back labour and third degree tear. Even the recovery Of the c section overall was much quicker than my recovery from the tear.
so if baby is back to back, I would opt for a c section all the way!
Good luck!

Sorry op, now just read up date!
Im glad you have made the right decision for you!
Exciting times! 🤗

@tinkxo I had tokophobia and almost opted for an ELCS. I also had an anterior placenta like you. I am the opposite to you - very petite and a bit underweight. I was scared my baby would be too big for me (DP is very tall). I am so so glad I didn't go for the ELCS.

I ended up having an induction at 39 weeks, laboured for 2 days and nights with the gel. On the 3rd day (afternoon) I was on the drip. I delivered that night. Childbirth wasn't as bad as I thought. My stitches ended up infected a few weeks later, but you'll have even more stitches with a c section. Imagine if those got infected. And then there's the abdominal healing. Many women lose sensation around their c section scar, even years later. Or they end up with a 'shelf.'

You can go for a pathway called something like “low threshold for C section”
In essence if your delivery complicates in anyway you can state you prefer to go straight for C sec rather than gradually stepping up intervention ladder. I was adamant that I didn’t want to be induced or have labour hastened. Water broke, baby was back to back, contractions were absolute agony for 24 hours after waters broke. I can only describe it now as like “being crushed by the thumb of god” was so I’ll that I lost a massive amount of fluid and couldn’t drink water etc so had to have 4x IV drips. I only dilated to 3cm

at some point a midwife who hadn’t read the plan said it was time to start a pitocin drip to get things moving faster and I refused and said no. That’s not the plan, please arrange for the C section that I planned for - failure to progress.

technically this was classed as an EMCS rather than ELCS but it was still a positive experience. Healed well, baby great, BF wasn’t easy but that’s because of other issues, we still got it established and EDF for 20 months. I was quite healthy and in my early 30s.

i was quite happy with my experience, but then a midwife at day 5 check wanted to counsel me about it and suddenly sewed this seed in my head that I had made a poor choice and it really made my PPD spiral very rapidly.

so do be aware of how you might respond to others reactions, and give yourself the support you need to lessen that choice no matter what you choose to do.

good luck with the delivery.

I wish I had asked for an elective last birth. I was two weeks overdue and went through 2 rounds of induction which resulted in an emergency section. If I’d been more clued up I would have known success is lower in those circumstances so it’s good you want to be informed. The induction was worse than the section. I recovered really well and was on feet moving around not long after op. I did think of trying vaginal again but refusing an induction if it came to that but I’ve chosen c-section again.

It’s hard to make a decision as there’s no guarantees unfortunately. Best of luck in whatever you choose.

Your midwife or doctor will check this at every visit towards the end of your pregnancy, and it should be recorded in your notes. They will also identify the position of the baby (anterior, lateral (sideways) or posterior).

You can't do anything to make it engage, though. If it's posterior (baby's back against your back) the head is less likely to engage prior to labour, and assistance during labour is sometimes required. Again, if your baby is in a posterior position, labour can be lengthy.

Also, if this is a second or subsequent baby, the head sometimes does not engage until labour begins. This is quite normal.

@Peakypolly do you mind me asking how old you are? I had a 3rd from a forceps delivery and I’m worried about problems from it as it get older I’m only 31 x