What would you do? Elective or vaginal?

[SlowlyLurking]

I have had 3 vaginal births - standard, mostly without issue (tear with my first but that's it). The issue comes afterward. Second birth was a fully retained placenta that required manual removal in theatre with a spinal. Third was a delivered placenta that seemed whole but then I started bleeding heavily, had a manual in theatre under a spinal again but still had placenta inside me 13 weeks after birth where I had to go for a D&C.

Fourth and final baby due in four weeks. An elective has been booked in but at 39+5 as this is the earliest slot they could get. Consultant is confident I will go into natural labour beforehand and will need to present to hospital for a category C cesarean if I want one before this date.

I'm not really interested in a cesarean if I can help it. I'm very overweight and have Ehlers Danlos syndrome which impacts healing. I'd like to be on my feet as soon as possible as DH can only take two weeks off and we don't have any other help. However, I'm terrified of yet another surgical management option post-labour. The bleeding scared the hell out of me last time but being overweight it doesn't mean I won't bleed with a cesarean.

In my head, a cesarean is a more managed procedure if something were to happen but the consultant is saying it's six of one and half a dozen of the other. She said I can obviously have a vaginal birth if labour happens before the cesarean date and now I'm wondering what you would do? Better the devil you know or risk a slightly more painful recovery for a smoother delivery?

Thanks for any advice and personal experience.

Unfortunately there's absolutely no 'right' answer to this.

The best option will be the one you choose and are comfortable with. Sounds like your doctor is on the fence in terms of statistics and which one they think will have the best outcome.

If I were you I'd be coming up with a plan A, B, C etc so you're ready for the most likely scenarios and the choices you'll make if there are issues.

I think that's why I'm so torn. I know a vaginal birth is statistically less risky but combined with the complications post-birth the consultant seems to think they even out.

In the end, as long as the baby and I are safe I don't think it really matters.

I can tell you that c-section recovery with EDS is significantly worse than advertised. I had had four vaginal births of varying complication levels, some with difficulties and some without, and the csection with my fifth was unbearable though I suppose the delivery itself was smooth. They had told me it would probably be slightly more difficult but it was MUCH more difficult.

My sister had retained products after an elective caesarean. This is a very difficult decision for you to make. What did your consultant say when they booked the caesarean? What was their recommendation?

Do you mind elaborating on why it was so bad? Was it just wound healing or also prolonged pain and lack of mobility?

I've seen two consultants. The first was adamant a vaginal birth was preferable as I have several successful ones under my belt but was very dismissive of the retained products stating it would probably happen again and to prepare.

The second consultant who I asked to see for a second opinion is very much six of one, half a dozen of the other. Recovery will be longer but if something were to go wrong I'd be in a room full of professionals with a spinal already in kind of vibe. She's very much left the ball in my court and booked the elective but asked if I'd be willing to consider a vaginal birth should I labour naturally beforehand (previous babies have arrived between 37 and 39 weeks).

Even after all that I would still prefer a vaginal even it might not go well after, massive respect for women who have a c-section birth, amazing

Honestly OP so many consultants love doing c-sections and inductions, they love to try and control birth. Personally I wouldn't be listening to them at all.

why have they booked you for ELCS?

Because I asked whether it was an option and if it would be a better option than another vaginal birth in my circumstances. A combination of previous retained placentas, POTS and EDS complications they've put on the reason list.

My incision healed nicely though slowly (seven months later it’s still very tender) but as I have POTS and EDS I had a really difficult time with mobility, blood pooling, etc. I couldn’t walk without excruciating pain and support from DH for weeks. In my vaginal birth recoveries I sometimes struggled with syncope or pre-syncope due to hormonal changes but otherwise I basically felt fine. I had no other choice so I don’t regret it of course!

Did you have the same medical conditions when you had your previous babies? I’m just wondering why (other than the retained placentas, which doesn’t seem to me to be a really good reason to recommend an ELCS) I’m confused why they’re recommending C section this time but not on your other pregnancies

it doesn't sound like they have recommended it. They've said that it's a difficult choice and either option would be reasonable (but that both options have their pros & cons).

I think the consultant should give a stronger opinion to put your mind at ease tbh.

Since you're asking what I'd do I'd do vaginal. Better the devil you know

Yes, same medical conditions but now the POTS is a little worse. After the first retained placenta I was assured it was unlikely to happen again but then when it did along with the haemorrhage and the retained products months later, a cesarean became an option for this birth.

I've always been back on my feet after my vaginal births within hours. Up, had a shower, walking around and discharged within 24 hours even after theatre. I'm a bit hospital-phobic so anything that keeps me there longer than I absolutely need to be isn't ideal for my mental health.

I'm just so worried about regained products happening again. I was so so lucky I didn't go septic last time and the hospital took 7 weeks to tell me what I had passed was placenta which held all treatment options up and really affected my breastfeeding. I'd love a straightforward vaginal birth but it seems like it's probably not on the cards and having never had major surgery before, I'm so nervous and worried.

I'm seeing my consultant again either next week or the week after (depending on when they can fit me in) as I have my final growth scan next week so hopefully they can provide a stronger medical opinion to help me form plan A and B.

The fact that they seem willing to let you go so long before they'll give you a c-section makes it look they're planning a vaginal birth for you by stealth!

But to be honest if you're hospital phobic a vaginal birth would probably be better.

Op I’m following with interest as I had a forceps on my first retained placenta on my second and severe haemorrhage and a bad tear on my third. We will be done at four and not pregnant as of yet as I’m trying to think In my head can I face another birth and am also trying to drop some weight first. I never ever want a repeat of the placenta removal as it was awful!

I had thought about this but I'm having a scan next week and she said we could move it up if there are medical indications to do so, it's just more on the elective side at the moment. Not sure how far they'd push it up but it remains to be seen if it's necessary.

You're a trooper!

Name changed but I was SlowlyLurking 🤍

Just to update that my waters went at 37 weeks exactly as I stood up from the bath and my plan changed to an emergency cesarean when I came to triage which was very smooth like a planned cesarean but we obviously didn't have the time to plan it as we would have for 39 weeks. A few hours later he's here and healthy and I'm waiting for my next dose of painkillers 🤞

I found vaginal birth much much worse !!! I have ME and EDS, PoTS and honestly it felt like I’d been run over after and the recovery was months. With my c sections the only discomfort was in my abdomen and my recovery was much much easier !