Cannot decide which way to give birth and would love advice.

[purplespink]

I'm still in my first trimester but my midwife has told me I'll be having a consultant appointment at about 16 weeks to discuss birth options as my birth is high risk. I have 2 DC and gave birth naturally (albeit induced for first one with drip). I haemorrhaged both times and it was horrific, particularly the first time and I tore badly. The second time, the haemorrhage wasn't as bad but I had some retained placenta and got an infection which was very unpleasant as well. So it was pretty horrible. However, I am panicky at the thought of a caesarean. I had a failed epidural the first time and worry that could happen again. Plus, I know that the recovery is harder, plus having to inject myself is something I'd be worried about. Also, I'll have 2DC to look after as well, although DH would be a massive help. I hate the idea of not being able to move to get the baby the first day of the birth. DH is very worried about me giving birth again naturally in case it takes a turn for the worst, whereas a caesarean is more controlled. He isn't trying to decide what I do but is very worried about losing me.

I was offered a blood transfusion the first time around but stupidly declined it (not JW or religious reasons, I just thought that I could manage which was a mistake). I wasn't offered it the next time as I only just met the threshold for a haemorrhage.

What would you do if you were me? I'm leaning towards natural for the recovery time and mobility reasons but DH is so worried that something bad will happen to me and it's making me think that I should pick the 'safer' option, even if that's not what I particularly want?

I had my third 8 months ago and had an EMCS under GA. My first two births were spontaneous vaginal births and largely uneventful.

This birth was induced due to GD and I chose induction over CS because I was worried about the same things as you. However, during the induction, I haemorrhaged and DS’s heart rate dropped dangerously. The recovery after was so much easier than I anticipated. I was up and walking within a day and I could look after DS fine. The most frustrating bit was not being able to drive but I had DH and my mum to take me places.

If I could go back, I would opt for a CS straight away.

Sounds like you had a rough time! I would see the doctor and ask about the options and risks with each, and also read about it, eg Royal College of Obstetrics / Gynaecology have some good topical publications.

Your H’s concern is understandable but it is solely your decision.

I don’t understand what you mean by injecting yourself? If you mean with blood thinners that seems unlikely if you previously bled a lot.

@Loopytiles thanks for your reply. I thought everyone had to inject their stomach for 10 days post CS?

It was pretty bad and DH just doesn't want to see me go through that when in his mind there's a much more controlled option. Of course will respect whatever decision I make

@BeingATwatItsABingThing thanks for replying. That is a bit reassuring with the recovery aspect, thank you

I think the c-section sounds like the safest option, but that’s just my opinion and what I would do if I were you. The recovery for me was a bit painful but worth it for the safe delivery of my baby. My friend was up and about really quickly after hers, and feeling absolutely fine.

The injections weren’t fun but I got used to them after the first couple.

I had an EMCS and didn't have to inject afterwards. I think it might be hospital dependant, I didn't do it but NCT friends who went to the hospital in the next town did have to

Talk to the consultant about risks. I had a severe PPH at the birth of my second child (surgery, transfusion) and was told I was also at risk of haemorrhage with a C-section - I suppose the difference is the medical team are all assembled. We went for hospital birth (first 2 midwife led) supposedly with cannula in place and cross matched blood on standby, managed 3rd stage. In the event my labour was 80 mins, we just about got to hospital, no cannula in and it was fine!

I had an emcs after induction due to hemorrhage and low baby heart 3 years ago.

I'm pregnant again and although I can have a natural birth I'm opting for a section.

The recovery is not as bad as most think it is. I was on my feet fairly quickly and don't recall having issues picking up baby or anything. By week 3 I am sure I mostly felt back to normal.

I found the c section so much more pleasant than what I went through during labour (which I needed counselling for eventually).

I like the idea of being able to plan it too, knowing it's going to happen and when, getting childcare for DD and someone to watch the dog. It just feels less overwhelming and stressful.

Also I think that you do get a bit more people rallying around because of the surgery side of things and you should definitely make the most of that!

I have a high bar for safety of baby and me and in your position would likely go planned C section.

Midwives are perfect for low/medium risk delivery but for high risk I’d be looking to speak to an obstetrician - that is their field - then I think you should go with what your obs recommends. Will you see a obs given your risk status? PPH can be very dangerous so I’d want to know what gave the best outcomes given the risk.

I had a c section at 9am, was able to move about by the afternoon. It was all very calm and a very positive experience! Was able to leave hospital the next day. Healed faster than others I knew with tears. I did have some pain on day 2 but only when I missed a dose of painkillers. Otherwise it was quite stingy to laugh but otherwise fine. Took it fairly easy but did go on some short walks and things.

I would honestly consider a c section in your position. Read about the experiences of people who have had planned ones, not emergency ones which have their own issues.

I had to inject, although it was thigh not stomach. I think it was for blood clots?

I have had to do the blood thinner injections after a hysterectomy and it is into the thigh. It's fine. Bit stingy but honestly, in the grand scheme of things, fine. I'd go for the caesarean, personally. Also minimises prolapse, etc.

An epidural is different to the spinal anaesthetic you would be given for a c-section. These very rarely fail and there are checks and safety measures to ensure it is working properly before the c-section starts.
Epidurals can be more temperamental, one sided, and prone to failure.

I wouldn't want a failed epidural to put you off having a c-section.

(I am an anaesthetic nurse)

Caesarean without a shadow of a doubt. You could die and leave your existing children motherless.

I've had to c-sections and recovery was absolutely fine, it's so much easier in a controlled environment I imagine that emergency one. They won't perform the C-section if the epidural doesn't work but in a controlled environment they may be better placed to give it to you.

I was up and about after a day or two although it is painful no more than tears and infections I'd imagine.

Good luck OP - wishing you a healthy pregnancy.

Regarding the blood thinners it's if you meet the criteria for having them. You'll be "scored" on certain criteria (high/low BMI, blood loss, how many times you've given birth) that make you more likely to develop blood clots post surgery. Even the type of surgery counts. If you remain under the threshold, you won't have blood thinners.

As for where to inject them, it's wherever I could get a good pinch of fat. So I rotated between LThigh, RThigh, RStomach, LStomach, so that no one area got too sore or bruised. If one area developed a humdinger of a bruise (sorry RThigh) I wasn't limited to one other area for the remaining injections. They really weren't too bad.

No advice otherwise sorry. Have the discussion with the consultant first before making any decisions. Knowing the reason(s) for the haemorrhages, and what plans would be in place for either mode of birth will help inform you.

First c section I got my husband to do the injections while i looked away.

second time i did them and found the more fat I pinched the better! It wasn’t too bad

Lots of people are saying they would go for a CS but please don't let this sway you. No-one knows your obsetric history and you are more likely to haemorrhage following a surgical birth.

Make an appointment to speak to an obstetrician for information tailored to you. Then weigh up the pros and cons and make the decision that is right for you.

I'm all for natural births where possible but in your situation I would 100% have a CS.
The recovery will probably be quicker than hemorrhaging just slightly less mobilem

I really appreciate everyone's replies, it means a lot to me. I know that this will be a question for the doctor, but does anyone know if there's anything they can give me in either birth choice that will prevent haemorrhaging?

I would definitely go for the caesarian in your position, it seems like the safest option

I know a few women who have had PPH and they were all managed postnatally with observation in subsequent pregnancy. They all received blood clotting injections after haemorrhaging but @purplespink the way I know them is they were all massive advocates of natural delivery so they pushed for that management. I definitely think speaking to your doctor and explaining what your preferred outcome is and listening to their advice is the way to go.

A few thoughts for things it’s worth discussing with your obstetrician:

• is the cause of the pph’s something that is likely to recur? (Sounds like it was different each time and it may not be particularly likely to recur).
• Is there anything they could do to reduce the chance/reduce the impact of a pph if you do try for a vaginal delivery again (eg. cannula in anticipation; active (drug) management of 3rd stage; use of drugs that help blood clotting; have blood cross-matched; low threshold for going to theatre/bailing out of the vaginal del & doing a section of its not progresssing smoothly etc.)
• Is there anything they can do to optimise you so if you do lose more blood than normal it has less impact (eg. treat iron deficiency aggressively before you deliver, etc)
• How bad were the first pph’s? (While it probably felt quite scary & looked dramatic, if you didn’t need blood transfusion it may not have been that bad).
• Is there anything else about your medical history that makes bleeding more likely (blood clotting disorder?) or means that a pph is particularly high risk (eg. being particularly petite; having heart disease; being anaemic to start with).
• For a c-section, are there any features of your medical history/current pregnancy that makes the operation higher risk (eg. obesity, diabetes). Are you planning to have more children (in which case what impact could a section now have on a future pregnancy)? What is the incidence of pph with a c-section?Are there any other particular advantages to you of having a section?

there’s probably loads more things but this might give a better feel for what you think you want this time.

OP this is a medical professional conversation not a other mum’s on Mumsnet conversation. I’m absolutely not a medical professional but I think I read somewhere that PPH is a risk in C-Sections too. I’m not sure why everyone here is assuming a C-Section would eliminate that risk. There will be things they can do to reduce the risk of PPH and minimize any risk to you if it does happen again - like by having cross-matched blood ready in the room for you. They might recommend C-Section to avoid spontaneous labour or because an induction might increase the risks. Or they might recommend you come in at the first twitch for monitoring and have a vaginal birth to potential minimize blood loss? I don’t know. Or maybe inductions actually reduce the risk? The drug they use in a drip to cause contractions is actually the same drug they inject most women with to help the placenta come away and the uterus shrink down quickly (which reduces PPH risk) Talk to an obstetrician.