Help deciding on birth options after traumatic first birth

[Confused789]

My first birth wasn’t straightforward, as a lot of peoples aren’t. But it could have been worse. It was more traumatic for my baby though. I’m now pregnant with my second and I can’t decide whether to try for a natural birth again or opt for elective C-Section.

For my first, my waters went during a sweep, which meant I had 24 hours to go into spontaneous labour before they would have induced me due to risk of infection. Labour started soon after but it was a long 36 hours. Baby was back to back and ended up being born via ventouse. I had an episiotomy but didn’t tear. However, baby was born with head trauma, leading to a hospital stay for 6 days, trips to NICU and an A&E trip for a CT scan to check for skull fracture at 8 days old. The pain he was in made establishing breastfeeding very difficult. He still has effects of this head trauma today at 3 years old, although it is now just cosmetic and doesn’t impact him at all/isn’t visible now that he has hair.

My physical recovery was ok. My stitches did tear but I felt fine after 6 weeks. I did however end up having PND and PNA. Whether my birth experience contributed towards this, I don’t know. I did find those first few weeks post birth more traumatic than birth itself.

I now need to decide what I want to do for my second delivery. I’ve been advised second births are quicker, less likely need interventions etc. but I’m terrified of the same head trauma happening again and I have a lot of anxiety around this. I’m worried the shape of my pelvis could have contributed to what happened but I’ll never know if that’s true.

If you were me, what would you do? Vaginal birth or ELCS?

Eeesh I can see why you're worried. I think, assuming at term everything is fine for you and baby with no additional complications, I'd go for a vaginal birth. I had an episiotomy with my first but didn't tear or need to be cut at all with my second who came out in two involuntary pushes - I couldn't have stopped her if I tried compared to my first who was determined to stay put and kept disappearing back up the birth canal.

Your little one was very unlucky to suffer that level of head trauma (assuming the ventuse was used correctly for the correct number of attempts). I think I'd go for a vaginal birth BUT if waters went first again with a slow labour or things were stalling or either of you were getting tired I'd then skip to a c section. If everything was progressing well I'd back the odds of no needed intervention.

I suspect a vaginal would be absolutely fine this time. But I would go c-section. I did for my third after two difficult vaginal deliveries and it was bloody lovely. Establishing breast feeding was a breeze and not harmed at all. The healing was much better than an episiotomy heal for me. And I was so much less knackered. I mainly wish I had just done it from the beginning, though I guess three sections might have been too many.

@Lighterandbrighter The thing that makes me wonder whether to go ELCS is if I say no ventouse/forceps and just opt for C-section at first sign of any trouble, would I be better off just going ELCS in the first place as I hear emergency C-sections are generally more difficult than ELCS? Due to the rush of it all, baby being partially in birth canal, already being exhausted from labour etc. I don’t know if I should just cut out the middle man? But also as you say, the stats do suggest generally less complicated second time around and I may have a smoother second experience like you. Gah so hard to know 😖

@Lindtnotlint What made you decide ELSC 3rd time?

I had a relatively straightforward forceps with my first child. I tried for a vaginal delivery last week with my second. We had an emergency forceps delivery (more urgent than first) which was scary. If I had a third, I would have an elective section.

However, the likelihood of having had the complication I did second time was very low so the risk felt reasonable to take.

A section in our second delivery was on the cards up to the very end but would have been higher risk for both me and her. Higher risk of skull fracture for her than with forceps, and higher risk of bleeding, and other surgical complications for me.

I think I would still have made same choice again this time however, as it was more likely than not that baby would deliver normally (got to point of pushing in birth pool in on site birth centre, if she hadn't been stuck in fairly rare way , would likely have delivered in pool).

I had to have an EMCS part way through as baby was getting distressed and it was fine. If I were you I’d try for a VB but with no instruments and can switch to EMCS if necessary.

I was determined to switch EMCS if things started to go awry with my first. But she was too far down the birth canal by that point and there were high risks for both of us. So I went with ventouse and forceps. What I am saying is that the switch to EMCS has to happen early enough, or there are risks.

My next two were ELCS.

I had a traumatic first birth (itu stay for me), when I got pregnant with dt I talked to the consultant and made a plan whereby I would try vaginally but the fresh hold for swapping to a C section was a lot lower so that it didn't become an emergency situation.
As it happened dt were born vaginally 12 hours after induction. My two birth experiences were like chalk and cheese, I think having everything planned in advance (as far as I could) helped.
I'd speak to the consultant/midwife explain your warranted fears and ask how you can best plan for a better outcome.

I had a similar first birth with the ventouse, the worst bruising I've ever seen on my poor baby but fortunately no NICU time. I had a hemmorage at birth.
There was a lot of trauma for me and it felt like a lot of what happened was forced on me, and it felt like the care from the hospital led to the outcomes I had in a way.
For my second, I didn't want anything to do with the hospital and went for a water birth at a birth centre, with agreement with my midwife that we would transfer in an ambulance the second there was any sign of issue. Fortunately a successful water birth with no issue.
Also went on to have another baby, over 10lb completely naturally and very straightforward.
Both of these I was more upright leaning over the side of the bath, and then standing up supported by my husband - laying on your back makes the space in your pelvis smaller so that can sometimes be a part of the issue
My last baby, born very prematurely and lots of NICU time- made me super greatful for hospital care (he wouldn't be here without it!) so I guess I went full circle on it really.
You should hopefully be able to talk it through with the midwife to make sure you feel comfortable and safe with your plan - the back up of we would head straight to the hospital the second there was a sign of issue was good for me so maybe for you it's you will go to c section then?

My first birth was awful. I was in labour for well over 24 hours and my daughter was back to back - so painful! Her heart rate plummeted during labour and they quickly needed to get her out. I was in shock and took a long time to forget the experience.

My second birth was a breeze. Daughter was a much bigger baby but I had an easy birth with just gas and air. If only they could all be like that. I didn’t consider having a section but can completely understand why you would.

I had a difficult, very long delivery with my first. He was back to back, required ventouse and I had a retained placenta.

I had stitches from my arse to my elbow (that’s what it felt like!). I had a vaginal birth with my second - at home - and it was much smoother, despite him being a fraction over 10lb

i suspect it was the baby’s posterior presentation that affected the labour far more than the shape of your pelvis.

Have you had a debrief to talk it through with a consultant/midwife who can help you make sense of what happened and whether any risk factors might present a second time?

It is so difficult isn't it? A friend of mine went on to have a Home birth after an emergency section with her first. I had an awful 1st birth and requested a section for my 2nd but was told by consultant to 'give natural a go'. I ended up with emergency section..it was grim. For my 3rd I requested a section and that is what I had!
Your mindset is important as you may feel understandably anxious. It is a tough decision and I wish you well.

@BertieBotts Unfortunately I’ve had no continuity of care this time with midwives and I’ve seen a different midwife for every appointment so it’s been difficult to properly discuss. They’ve all been really nice but obviously no relationship built so somewhat impersonal. But I do have an appointment with an obstetrician coming up to discuss risks/options so I’m hoping that will help. I’m just trying to figure out how I feel about it all first, in case they try to pressure me in anyway.

OP, everyone is different. My first birth was awful, and I spent the nine months I was expecting my second dreading the day I would go into labour. In the event, it was the easiest birth of all my DC. I think you can only go with what you feel comfortable with, and follow the advice of your medical team. Surely a scan would show whether this baby is back to back? If not, it should be a much easier birth in any case.

I'd discuss with the obstetrician to get some advice on the cause of the head trauma, but I do think you could likely have a quick vaginal birth. Could you get a late scan to see baby's position? (even if you go private). Do consider that breastfeeding can be harder to establish with a planned c-section, if that's in your plans.

Oh my goodness I could literally have written the same post. Exactly the same for everything except forceps delivery.
I am so up and down about what to do, I had a meeting with a consultant the other day (I’m under shared care because of my uterus shape) and she said she definitely thought I should try for a natural birth as it would be ‘quick and easy’ 🧐 when I burst into tears saying I was scared I might die she’s given me an appointment with a birth choices team in a few weeks, but basically I’ve decided I’m going to write down a list of my ‘demands’ as such about what I want. I will be asking for a ELCS if I get too far over as I’m not going down the induction route, if labour is over 12 hours I want to go for a section, I want a scan of baby late on to check the position etc. Please feel free to DM me about this - it would be good to have someone to talk to. Like you, the last thing I want is an EMCS and after what happened last time where I was in theatre seconds away from one, that actually an ELCS might be my best option but there’s a little part of me thinking oh maybe it will be quick and easy! 🤦🏻‍♀️

I also had a complicated first birth and had to make the vaginal/ELCS decision for my second. I tried to consider what was more likely to happen a second time and what was just 'one of those things', unlikely to reoccur. And then I considered what we could do about them (in discussion with HCPs) versus to what extent it was a risk I was going to have to be okay with taking.

Personal preference also comes into it. I preferred a vaginal birth, both for practical reasons and just gut feeling, and ended up feeling that we had a plan I was comfortable with, so tried for vaginal. Some things did reoccur, but were much better managed, and my second birth was much more straightforward overall, both of us home the same day.

I had a difficult and long labour with my first, he was back to back, failed ventouse and forceps with episiotomy.
My second I barely made it from the car park into the maternity ward. Few pushes and out he came.
I get why you're reluctant to do it again though.

My first birth sounds very like yours (but without injury to the baby). I was planning vaginal for the second but the decision ended up being taken away from me due to a large headed breech baby. The ELCS was so calm and everything felt much more in control. I had a very easy recovery from it and no regrets.

I had a similarly very difficult first birth, and my firstborn has some significant health issues. I knew with my second that I wouldn’t have another induction under any circumstances. I made a plan for a c-section at 39 weeks but my second came earlier naturally and it all went really well. I couldn’t believe how different it was and how much easier the recovery was or how well my baby did.

Personally I would recommend

1. Do the birth afterthoughts /debrief thing - it helps
2. Make a plan for a c section at 39/40 weeks to avoid the chaos and risks of induction
3. Try to make peace with a view that your second may come earlier and if so, it will probably be easier and they will probably do well. I remember the obstetrician saying to me she wished everyone could have a “second birth” first!

But do what feels right for you and what makes you feel safe, because that is what matters the most.

Just to add @Confused789 💐 for you. You are such a strong mama.

Also, you could ask for a referral to the specialist perinatal mental health team if you feel your anxiety is flaring again?

I had a traumatic first birth, fast induction, distressed baby, forceps no pain relief, post birth infection (baby was thankfully fine). Second baby I was in the same hospital, same bed number in same room and I was there for an induction due to reduced movements. I tried to hold off for a natural labour for a week but then became worried. Admitted for an induction but at the last min before starting I asked for a c section, the staff were very understanding. Had to wait 2 days as an inpatient due to all the emergency sections taking priority but the section itself was calm and stress free. I stayed in hospital less than 24hrs and was able to go out for the day on day 5, could drive 2 weeks later. No complications. Just a bit more pain on days 2-4. For me it was the best decision, I do feel I cheated myself out of giving birth and sometimes feel guilty as there are implications for baby such as the risk of allergies, not being exposed to vaginal bacteria etc(or something similar).
but we were both happy and healthy and it helped heal me from the first birth. Instrumental deliveries are traumatic without a doubt and sometimes you have to do what’s best for you too. Neither way is without risk but please chat to your midwife too. Whatever you decide, I wish you and baby well xx

My first pregnancy was amazing, absolutely textbook. Birth was horrific, DS got stuck after I was in labour for 36 hours then we got rushed to theatre for forceps and an episiotomy ehich ended in a 3B tear. Recovery was horrific and I suffered really bad PND because it took so long to recover. I got told I could have a vaginal birth for DD but I opted for an ELCS, it went perfectly and my recovery was great.

I’d have an elective C-section, no question about it.

My first delivery, baby was back to back, had episiotomy, ventouse and significant hemorrhage. 2nd baby I had in the midwife led unit, stood leaning over a chair, very little intervention, minor tear. I felt like my body knew what it was doing the second time and also probably helped I could get in a position I wanted to be in. I think though mindset is massive, although my first labour was more complex I felt well looked after and didn't experience it as traumatic. So I went into the 2nd labour feeling quite relaxed about a vaginal delivery (which I also suspect helped). I think being in labour and feeling anxious about it would not be a pleasant place to be and I would potentially choose an elective section over that.