Vaginal delivery or elective section - it is up to me! - What to do?

[onehitwonder]

I had my 20 week scan today and an appointment with the consultant to discuss my previous delivery and options this time.

I had a very long and painful recovery from my DDs vaginal birth 3 years ago. I had a displaced coccyx which meant I needed pain killers for 6 weeks and made breastfeeding really hard. I still have problems sitting on the floor/hard chairs for any length of time. Additionally I had faecal incontinence and needed physio for several months to resolve this.

I also had a pretty rough first stage of labour, as my induction was started, but I was sent to the ward, where my first stage of labour was dismissed as prostin pains, so I went through it all on my own, until being taken to the labour suite fully dilated and ready to push.

DD got stuck crowning and I now (following todays appointment) understand that I had a second degree tear to both sides of the vaginal wall, in addition to an episiotomy. The consultant today was surprised that I didn't get a referred back to a consultant following my faecal incontinence and that nothing was done to establish the cause of it. He did suggest an anal investigation now to see if damage to the spincter could be established (to help establish risk to the spincter of second vaginal delivery) but he seemed quite dismissive of the pain and recovery time from the displaced coccyx. I have declined the anal investigation, as if this is clear, it won't explain why I was incontinent and won't remove the fear/risk of a repeat of the coccyx issue.

The conclusion is that he really cannot recommend an option to me, as the risk factors of another vaginal delivery are not clear. He will support me in my decision whether for a vaginal delivery or an elective C-section. I am very pleased not to have to fight for an elective C-section, but had hoped to be given some help assessing the relative risks in my case. Am I right in thinking that the fact that he hasn't tried to push me towards a vaginal delivery means that an elective C-section is a reasonable choice for me?
Sorry this was long and thanks to anyone who finds the time to read and respond.

shameless bump (active threads are very active tonight)

My first delivery wasn't nearly as bad as yours, but did end in ventouse, episiotimy (sp), and being stitched up so tightly I couldn't move without wincing for weeks.

Cosequently, I fought tooth and nail with my consultant for an elective C-section, and it was a great experience, with a very quick recovery time. I was up and about within 12 hours, no wincing and would highly recommend it to you given your previous experience.

Good luck with whichever you decide

Oh lord I would have a section if I were you-honestly that sounds horrendous and just the sort of case where a c-section is best.I have had two and they were fine really,it does take a while to recover completely but I was never in really bad pain.Read michel Odent's book on c-sections though,as if at all poss an in-labour section is better than a truly elective,and I had an in labour section second time and would echo that.Perhaps you would be allowed to go into early labour naturally and have a c-section at that point.If not I would have an elective in your position.

In your situation I would have an elective section, I had an emergency section after a four day induction so not experienced an elec. Even though I didn't have the best experience I had a fast recovery with no lasting damage.

If I were you, I would have section as I wouldn't be willing to risk my vaginal area again.

Hope you get plenty of replies.

No direct experience but i had an e-c/s with DS1 and could then choose natural v elective for no. 2.

I found the NICE website has some clinical advise re c-sections incl the actual stats on risks. Found this v. helpful.

In the end i couldnt decide still so hedged my bets and booked a c/s for 40 wks (i couldnt bear to go overdue), in the end i went into labour a week early so went for it...got to fully dilated but then anohter e-c/s as ds was in distress.

FWIW i had good recoveries both times and fed both mine. The potential for the recovery of a VB to be worse than that for a c/s for you would probably sway me.

The main thing i got from the NICE stats was that it must be after 38 weeks or the baby has inc risk of breathing difficulties.

Bottom line...which will make you feel more calm about decision?
I am a big 'do it as nature intended' believer but this should never be at the expense of your mental/physical wellbeing.
I wish you luck making what seems like a difficult decision for you.

I have had 2 babies. First ventouse, second forceps.

After the second (now 18 months ago) I have experienced faecal incontinence a few times - once when I had an upset stomach and a couple of times when running. It wasn't bad, but alarming all the same and enough to make me realise I need to go and see physio. Since the second birth, if I need to poo, I have to find a toilet within a few mins or else I am in trouble. Sorry TMI

Anyway, the consultant said to me that next time (if there is one) he would probably recommend a section for me to avoid further damage. I know everyone is different. But for what its worth, having gone through this, if I do decide to have a 3rd, I will definitely be going down the section route.

Thanks for sharing your experiences and for the good luck wishes .
Should I read anything into the fact that the consultant is happy to leave me to make the decision do you think?

Oh, how horrible. Why would you want to risk going through all that again? I would definitely have a section. The recovery is not pain free, but it's better than what you have experienced.

I seem to forget that my experience wasn't 'normal' and that it really was a bad thing to go through. It is weird seeing it written down, makes it seem worse somehow. I was talking it through with DH last night and saying that I did have a lot of anxiety in the first few months of DDs life, some of which I think was down to the whole delivery and recovery. I was so focused on just getting on with things and didn't want to dwell on what happened that I almost need to remind myself now to help me come to the right decision for me this time.

Another thing to thinkk about which you no doubt did not get to experience last time is that an elective section will be scheduled for the morning and so the baby will be born in time for you to spend your first day together and you can can just cuddle and enjoy him/her rather than being so exhausted you sleep through baby's first day. I just loved hanging out with DS ~(who was a planned CS) after he was born just before noon. With DD it was along failed induction turned crash section at 3 am and we both slept all through the next day because we were both exhausted.

CS, CS, CS, CS definitely!
If you have any issues at all with your back, particularly that low down then the last thing you need is the potential of many hours lying on your back.

I had my DS 15 years ago (god, showing my age!) and at the time I had undiagnosed back problems. I had a 19 hour labour and had incredible back pain as I kept saying the epidural hadn't worked and the midwife kept saying that it had (after the delivery I was diagnosed with a prolapsed disc, pelvis and vertabrae and it was confirmed that the epidural probably wouldn't have worked and the 'normal' delivery probably made my back worse.
3 years later, I had my DD by which time my back had been diagnosed by not successfully treated. I therefore was offered an elective CS which was the best thing for me in the circumstances so as to remove the strain from my back asap.

8 years ago, I finally had a spinal fusion and now have titanium rods holding my back together. At the time I swore blind there would be no more children. I then met my wonderful DH2 and just over 2 years ago we had our DD. It was suggested by various specialists that I have a CS 3 weeks early which I did and am now having our DS in 5 days again by CS 3 weeks early.

I would never contemplate a 'normal' delivery with any sort of back problem, particularly with the other problems you've mentioned. Hope this helps and good luck to you x

If I were you, have a c-section.

It seems that a vaginal delivery might make your condtion worse....

Having had an emergency section, followed by an elective section and finally a vaginal delivery which although better in terms of physical recovery has left me with incontinence issues for which I'm having physio at the minute, I would say in your case that perhaps an elective CS would be the way to go.

I think that if you were to opt for a natural delivery you are going to spend the remainder of your pregnany worrying yourself sick about the what ifs involved in a natural delivery.

I would also say that although my recovery after my elective was harder on me physically due to a wound infection, the elective experience was a positive one and DD and I got off to a flying start in terms of bonding and feeding which wasn't there after my emCS as I was both physically and mentally exhausted from a lengthy labour.

It is a difficult decision and imo the fact that your consultant hasn't offered you any more guidance on the matter says to me that he feels the risks of each route are about the same in terms of physical delivery and potential complications.

Have a look at www.caesarean.org.uk for some more information.

Good Luck

I am a huge advocate of natural birth but I would also tend to agree with everyone else in this case - people do tend to play down the fact that the "nice easy option" of a CS does come with risks, not less an extended period of recovery, but in weighing up those risk factors, if it were me in your shoes I'd go for the CS.
I would, however, wait to go into labour (which the consultant would try to talk me out of as it messes up their planning, but hey ho) and would then insist on having a "natural" CS.
Good luck, whatever you decide.

I would like to point out that a vaginal delivery does not mean spending hours lying on your back. From that point of view, a waterbirth is great as you are supported all over which makes it possible to give birth on all 4s.

Having said that, I would say go for CS based on the episode of faecal incontinence alone.

Agree with everyone else that a cs would definitely be preferable in your circs.

Would just like to pick up on something Athene said: an elective cs might be scheduled for the morning, but that doesn't mean you'll necessarily have it in the morning! You will be bumped down the list by any emergencies, so it will just depend what sort of day the hospital is having. I was scheduled for an elective cs at 8am, and ended up having one at 7.30pm.

Having said that, I found the elective cs a fantastic experience. I'd go through it all again like a shot if I wanted more children.

I would go for the el cs with no hesitation whatsoever.
I had an em cs with my ds 4 years ago and I have to say the recovery was far better than I imagined. I was driving after 4 weeks, off painkillers in a matter of days, out walking my son in his pram within a week. My scar is faint and although does occassionally feel a bit peculiar on the whole it is fine.
In my opinion I had a better long term recovery than some people who had a vb. I appreciate maybe I was lucky. But I have never had faecal incontinence, back problems or any vaginal repair issues like some people. I am having my second baby on Thursday by el cs and i have to say i do not feel in any way bothered that I am copping out or wussing out of attempting another vb.
I would seek out someone to discuss your last birth with to get the events clear in your mind and take a long hard look, if you haven't already, at how you really were after that birth. I do think sometimes we try to make the best of things and put up with things that are really quite awful cos we don't like to make a fuss and think it is "normal" part of having babies.
Good luck whatever you decide. The main thing being though that at the end of the process you wnt to have not just a healthy baby but a healthy mum as well.

I would go for CS too. I had an emergency cs with my first and was very keen to have a vaginal delivery with my second. Had a lovely home birth but have been left with severe incontinence issues for which I have just had my second surgery - requiring even more recovery time than a c-section would have.

If I had known then what I know now I would have had an elective CS. I certainly wouldn't do another VB - my pelvic floor has shown that it is not up to it.

Go elective. I was given the choice by my Consultant and looking back, I'm glad I did!

It's a very calm atmosphere, and you still get to see baby immediately. Don't put yourself through such a huge trauma again.

second the natural c/s.

I really appreciate all the replies!
I have spoken to my (very supportive) midwife today and she is going to arrange a time for a home visit to discuss this futher, she says she is pretty pleased with the consultant giving me the choice (maybe she anticipated more pressure from him to avoid a c-section?). If I am going the elective route (which I am erring towards), then I want to get a decision made and agreed by the consultant and a date agreed if possible, so that I can start planning care for DD, help for me at home when DH goes back to work after paternity leave etc and getting my head round choosing to have surgery. I am trying to remind myself that plenty of people have to have surgery everyday for various reasons (not such happy ones often) and that it isn't such a strange thing to choose it given the alternative.

I had a dreadful first VB and a much better second VB, but if I'd any questions about future continence I would have an elective section, without a moment's hesitation.

I am very pro VB, but in your situation I would have a CS, no hesitation.

Whatever you decide, here's wishing you the very best of luck with it all, and a big Mumsnet hug