Caesarean or vaginal birth

[SRH]

Advice Please!

We are expecting our first baby and up until now (20 weeks) I’ve very much been leaning towards having a caesarean section. I don’t have a full blown phobia about giving birth vaginally but I do have some fear. I fear it not going to plan, going past my due date, needing intervention such as forceps or worse, an emergency c section. The consultant told me that 30% of first vaginal births do require some sort of intervention.

By contrast, a planned c section feels very organised and calm. The recovery from a section doesn’t worry me as there’s no guarantee you won’t have an equally difficult recovery after a traumatic first birth.

I am 31 years old and know of at least two others my age who are refusing to have any further children due to how traumatic they found labour. I’ve also known two others who both required interventions and one who needed an emergency section.

Of course, vaginal birth is widely advocated as it’s the natural course. I would still prefer a c section but my main concerns are:

1. If it will negatively impact on future pregnancies. Could a traumatic vaginal birth also do this?
2. I read some horror stories regarding excessive bleeding and needing a hysterectomy. Of course I wouldn’t want this to happen at my first birth, we want multiple children. When I raised this with the consultant she didn’t really reply or seem to understand what I was talking about.

Has anyone here had multiple sections?

Has anyone done both and can give a direct comparison between vaginal and section?

Thank you xx

I have had 3 c sections 2 classed as an emergency due to pre eclamcia but one wasn't really an emergency as I knew the day before I was going to have it but was still in hospital at the time. 3rd was planned as I had 2 before. I would describe recovery same as having appendix removed as it is abdominal surgery. Hard to stand up straight and you can not lift any more than baby for a while or drive for 6 weeks. You have pain killers to help with the pain just make sure you take them regularly rather than wait until you need them

Repeated caesareans do carry more risks. There are the standard risks with each caesarean (excessive bleeding, infection, etc..) but also with each subsequent caesarean comes increased risks of uterine rupture, adhesions (scar tissues that builds up around the internal incision) which can make future surgeries riskier and, in some cases, impact your fertility. You're more likely to have problems with how the plancenta implants in the uterus in subsequent pregnancies as well. So the number of children you think you're likely to have is a key consideration. More than 2-3 would likely be ill-advised.

The risk of needing a hysterectomy is very very low and is only performed in life or death situations where all the usual measures to control postpartum haemorrhage have failed. Your doctor should be able to discuss those risks with you and give you some statistics, but as they have not done so, you could find that information on the RCOG website. There is some good info here for those considering a caesarean birth for non-medical reasons. https://www.rcog.org.uk/for-the-public/browse-our-patient-information/considering-a-caesarean-birth/

I am currently recovering from abdominal surgery (not a c-section). It’s no joke, has been weeks, and I’m still uncomfortable/can’t stand up straight. Comparing this to my vaginal childbirths (including episiotomy)—the vaginal births were easier to recover from than abdominal surgery, by a mile.

I had 10 natural births without any intervention... 1 emcs...
Def would opt for vaginal birth every time.

My planned c section was really rough experience & recovery was terrible. Wish I'd gone natural x

Two amazing, calm and pain free sections here. They were wonderful experiences. I made the right choice for me and am the only person I know who has a purely positive memory of birth.

I had two vaginal births without any anaesthetic and have very positive and happy memories of both.

Thanks for responses everyone. Ultimately, as with anything in life, some people will have really positive experiences and others won’t have enjoyed it - so I know I have to make my own decision. It just helps to hear from others who have recent experiences. I will take a look on the RCOG website.

I had a planned section because my baby was breech despite having turned a few times.

The section itself was fine - but the recovery wasn't easy at all. If I'd been 1p years younger (ie your age) and not breech I'd have tried for vaginal. I might even have waited a bit longer for baby to turn (lower appetite for going past 40 weeks when you're a FTM over 40)

This is such a personal decision. I’ve had three vaginal births and all three went very well and I felt absolutely fine, better than during the pregnancy, within minutes of them.

But, my babies were all engaged, head down, 41 weeks gestation, etc

If you are basing your decision purely on pain, I would go for vaginal. You can have pain relief. Once the baby is born, the pain ceases (in general). Caesareans have a much longer recovery time and have wider implications on your body (in general).

There are certain things which give you an edge in terms of the likelihood of an intervention free vaginal birth.

• being healthy weight, strong, flexible. Being able to easily swing your heavily pregnant body about to try different positions, and having the stamina to stay in them while you push is not to be underestimated. If you have managed to keep fit and strong in pregnancy you therefore have a better chance of birthing in an optimal position.
• if other women in your family have delivered without issues, you are more likely to have a pelvis shape which births more easily.
• avoid epidural so you don't run the risk of getting stuck on your back (worse for tears) or not being able to push effectively and needing forceps.
• your personality. Are you calm under pressure and whilst in pain, to the extent you'll be able to breathe calmly and deeply, and listen to your midwife when she says "stop pushing for a minute" even though you REALLY want to push?

There are other risk factors obviously which you can't mitigate, and there are plenty of women who look great on paper but for unpredictable reasons struggle with vaginal birth. But generally, if you are fit and strong, with no familial history of birth difficulties caused by narrow pelvises, and you are active in labour, avoid epidural and listen to your midwife, you have a much better chance of avoiding intervention than an overweight unfit mother who has a narrow pelvis and an epidural.

So it's difficult to say what I'd choose in your place as I don't know all your circs. Consultant/midwife is best placed to advise on your individual risks/strengths, which will arm you to make your decision.

I had a vaginal delivery including an episiotomy & the doctor having to manually free one of DDs arms due to shoulder dystocia & the recovery was still much easier than most sections I know of.

Due to have a section with my second because of risk of shoulder dystocia again & already dreading the recovery.

I’ve had 2 electives. I didn’t want to risk a traumatic vaginal birth - they are far too common. My main concern was a birth injury affecting subsequent quality of life. Other factors in my decision included that I knew I probably only wanted 2 children, maybe 3, but definitely not 4. And I was already 35 (making vaginal birth statistically harder).

My first CS went like a dream with a quick recovery. I am currently 55 hours post 2nd CS and yesterday I felt terrible and was questioning my decision! But I felt so much better this morning after a night at home and 6ish hours of (very broken up!) sleep. I am very happy with my decision.

There’s a lot to be said for going with your gut instinct. If I had a ‘bad’ CS I’d probably come to terms with it as ‘just unlucky’. If I’d allowed myself to be talked into a vaginal birth that went badly I’d have been angry and upset at myself for listening to others, and angry at them for influencing me - I’d likely have had a lot more regrets. I would inform yourself of all the statistics etc, then choose whichever option naturally feels more comfortable to you.

I was fit, healthy, worked in an active job until 35 weeks, baby was engaged and went to 39+5. Waters broke at home with a small pop and all was quite nice until I started labouring as it was like I’d been induced. Intense, painful contractions maximum 6 minutes apart from 11:30pm until around 24 hours later when after an hour of pushing I was told I needed an emergency intervention. He was super low and at all glances should have come out quickly but, once I’d finally been given the spinal, the surgeon could see his head was ever so slightly back. Not obvious at earlier exams as it was so slight. He was so low down I was bruised where he was pulled back up and out.

I did all the pre exercises. Pelvic floor, pregnancy ball, kept fit, was a healthy weight and no sections in the family ever - had the best chance of a natural but that wasn’t to be. The whole thing was not something I look back on with any fondness at all.

That said, my recovery was absolutely fine and I was back up walking short distances after a week. Off pain killers after 2 weeks. Back horse riding after 7 weeks.

I wish I’d not been so against a section as actually it wasn’t that bad. And the fact I’d have known when baby was coming would have been much better for my nerves 😂

OP, have you looked at the rating of your maternity unit? Other posters have offered some excellent advice on pros/ cons of each delivery method - I would also factor in if it's an excellent unit where you know you'll be escalated quickly if there are issues in a vaginal delivery, or if there's issues with low staffing/ poor standards of care.

Yeah me too. Three straightforward, vaginal births without any need for pain relief, one of which was at home and was very relaxing.

In contrast I know someone who had a planned ceasarian recently which was very traumatic. There are no guarantees either way.

This sounds as if I had typed it myself! I know deep down I would hugely regret going vaginal if it turned out to be traumatic whereas in theory, a planned section by its very nature is not a traumatic experience (setting aside recovery)

All of the maternity units within a 15 miles radius have similar reviews - usually requiring improvement. I choose our hospital because it was consultant led so at least I had the option of a section

My decision isn’t really based on pain to be honest. I think I am most scared of tears and needing forceps delivery

Exactly the same here!

Loved my c sections and had lovely pain free recoveries. I'm so glad to have no lasting birth or pregnancy related injuries. Even my section scar is tiny and barely visible.

I’ve heard numerous positive experiences like this which I think is pushing me towards a section. I don’t want to be left with trauma or scared to have more children. But I don’t want something to go wrong during the section that means I can’t have any future pregnancies. I guess both delivery types carry risk and I just need to come to terms with that

Two induced labours at 42 weeks, both with the syntocinon drip. Both 9lbs. First one with epidural, ventouse, shit show. In hindsight second time round I should have just said give me a bloody section.

I think if you want 2 or 3 kids max OP, then with your concerns, section is a great option.

If you think you want more than 3 children, perhaps consider trying a vaginal birth.

I’ve had both. I had an emergency section with my eldest (ended up having a 1.7L PPH and sepsis, but this was all likely due to a prolonged labour due to malposition - unfortunately although I hit all of the bullet points from an earlier poster about having a good chance of a vaginal delivery, it just didn’t happen) and my recovery was great. I had a couple of days of pain but stayed on top of painkillers and managed to move about fine.

I had a vaginal delivery with my youngest and I’m very pleased I got the experience, but my recovery was much harder in the short term at least. It was definitely more painful (although I may have just not been as good at taking painkillers as they weren’t prescribed, whereas they were after my section), and my stitches got infected.

There are pros and cons to both, but I once had a friend tell me that childbirth is like the roll of a dice. You could aim for a 1 (flawless vaginal delivery) and end up with a 6 (awful emergency section, loads of issues etc), or you could almost guarantee yourself a 2 (a straightforward planned section).

I can see arguments both ways, and I personally rolled the dice both times, but it’s a good way to think about it.