Elective CS - can you help me run through my decision?

[MarineIguana]

(Am a regular with new name, if you recognise me no prob, but I might stick with this for a bit)
I think I really want an elective CS, having had an EMCS last time after very painful and non-progressing labour. My lovely consultant has said he recommends it too having listened to how I feel and because of my past history. I just have to think it over, let him know and fix it up.

But, some people I have talked to about it have responded doubtfully and gone on about how I could try for a VBAC. I realise they may be trying to help but I'm finding it hard to commit myself now, even though my gut feeling is that I want the CS.

If I run through a few pros and cons as briefly can anyone say if they would have/did go for the CS in similar circumstances. And/or does anyone have tips on how to politely deflect the "But why not a VBAC!?" brigade.

For CS:

• I am worried I'll end up with CS anyway as I lack confidence for a vaginal birth after last time. I'd rather have it calm and prepared for than an EMCS.
• I have a phobia of internal exams which complicated matters last time. I feel I can't relax and let go in the vaginal region and the thought of trying to upsets me.
• Because of that (and if I had very strong/painful contractions like last time), I would probably have an epidural which again I'm worried would interfere and make CS more likely anyway.
• I'm really scared of a complex, traumatic vaginal delivery which consultant says is a fair possibility given my history, or trauma to the baby from a difficult birth.
• I found my last CS positive and recovered well.
• I don't have any special desire to "achieve" a vaginal birth.
• This is a really not very good reason I know but it would be easier to arrange care for DC1 if we had a date arranged.

For VBAC:

• I am a bit worried about the extra risks to me of a CS, though I have no reason to worry unduly but I think I'm scared it will go wrong just as some kind of "payback" for me "copping out".
• I can't help feeling like I'm "avoiding" what I "should" do and try for a VBAC, though I know the idea scares me.
• Benefits of labour to the baby (assuming it went well)
• The tempting thought of a wonderful positive VBAC, even though I'm not confident that's what I'd end up with at all.

If I was 100% sure about it, people's pro-VBAC remarks wouldn't get to me but they do. But I have the support of the consultant who is very kind and understanding, and DP's full support if I want a CS.

I know it is about what I want and feel comfortable with but would still really welcome anyone's thoughts.

I would say go for the planned CS.

You say you 'found your last one positive and recovered well' which is better than I've heard from many women who've had emergency CSs. I had a planned CS myself because of a complex medical history which meant a vaginal birth would risk doing me damage, and knew throughout my pregnancy that would be the case.

I did have moments of regret that my experience would not be the one that is built up as magical and mystical by so many, and that my friends had experienced, but my planned CS was really positive. It was actually moved forward as I wasn't well (suspected pre-eclampsia) so it was short notice in the end but still a planned CS. I recovered well and my DS is fine, healthy and thriving. I was able to breastfeed with no problems.

Most importantly for you, I had the security of knowing what would happen in my birth experience and was able to prepare myself. Given your past experience of labour and your worries about it, I think that peace of mind would be valuable for you. What's going to be best for your baby, a vaginal birth at all costs, or a planned CS that means you can feel relaxed rather than anxious in the run-up, and where you are very likely to be in good shape to care for baby afterwards, with no trauma to get in the way?

Also, you could always have a CS with this one to balance out the first birth, and then go for a VBAC with a DC3 All the best with your decision and the birth.

I should add that, as I understand it, the risks are much lower, possibly as low as an uncomplicated vaginal birth, if you have a planned CS as opposed to an emergency one. I'm open to correction on the exact comparison but I believe a planned CS is pretty safe.

Marine it sounds like you have some very good reasons to have a CS, like you I have serious issues with the vaginal examinations and plan a CS for any other DC. It's not worth worrying through a whole pregnancy about it only to feel the exact same emotions and distress like the last time.

If you don't feel any desire to have a vaginal birth then please dont feel pressured into it by the 'your to posh to push' comments (twatish in the extreme said by the thick) or other peoples positive stories might been the right choice for them, but but not necessarily for you. It doesn't make your own decision about your and DC birth any positive or special.

My first (horrific and tiring) labour ended in an EMCS, and for reasons similar to yours, I decided to have an elective section. It was so much more relaxed than the emergency one, I felt in total control, and the recovery was so much better, I was less tired, and I bonded straight away with my bab (took me months to bond with DS1). I even managed to go shopping at a busy shopping centre with my DH, toddler and baby one week later.

However, when I was pg with ds3, I felt different, and would have liked to try a VBAC, but because I'd already had two sections, I decided on an elective. Had I gone into labour naturally, I'd have tried to have a VBAC. Don't feel disappointed though with either of my decisions as all babies arrived safe and well.

Good luck with your decision, although I think your mind is pretty much made up. Doesn't make you any different to any other woman who has done different.

I went for an elective CS for DC2 after an emCS first time round. My thinking was I knew what I was letting myself in for and having nearly lost DC1 because it almost went too late, it didn't feel purely selfish. Everything was fine and again a very quick recovery compared with friends who pushed (esp as I was 42). BUT double check what pain relief they plan to give you as standard prcoedure where I was was to give you spinal block rather than epidural (cheaper I think). Because of scar tissue, it took them a long time to get the baby out so they had to top me up, which made me feel sick which meant anti-emetic which made me woozy. So I didn't get to hold her straight away. However, no regrets about the decision. Good luck.

On the 'tips for warding off the why not a VBAC?' brigade', I honestly did not find people particularly militant about this. I was open with people early on (including at my NCT classes!) and just said firmly but pleasantly that I had a complicated medical history, would be having a planned CS, and that my consultant had strongly recommended it (mine actually insisted). No-one ever argued or questioned me in any way. It's partly about putting on an act of confidence in your own decision and not sounding apologetic, which you have no reason to do.

I would say to the pro-VBAC brigade: "I already have a sunroof. Might as well use it."

I too dithered about VBAC or not for ages, but was at heart tending towards elective. The minute I made the decision to go elective with the consultant's approval (around 36 weeks), I immediately relaxed and all my worries about the birth and 'what ifs' went away. I felt lighter and happier than ever.

I knew then it was the right decision. And it was in hindsight too. A totally calm andn uneventful procedure and recovery, as it should be.

Thanks so much everyone, this is exactly the kind of experiences that are helpful to hear about. Sleighbed, it's funny, I think I do know what I want instinctively, but it's the rational/mental part of me that's obsessing over whether I should try for VBAC. But I know that I would be doing that kind of against my gut feeling.

Oops x-posted with the last two posts. Sleightieschick you're right, people probably suggest VBAC to me because I come over as apologetic or uncertain about it. If I'm firmer about it I probably won't get that response.

marineiguana, may seem like an odd reason for an elective. But after my crash cs, the scar did not heal well cosmetically and was raised and red.

For my elective, I asked the surgeon to cut away the scar tissue and sew it back carefully to minimise scarring. It was not guaranteed that I would not heal in the same way. But it turned out the scar is soooooo much better. You can barely see it now 3 years' on.

It is one of the things to come out of my elective!

blueshoes. Though I did get an infection in the scar before (which was treated and sorted out quickly), it has healed brilliantly and is almost invisible. Would just have to hope they do a great job again!

Push to have a consultant do it, not just the random house officer on duty. I was promised this and reminded the hospital of it when my CS had to be moved up from the originally booked date to 2 days' time. I couldn't have my own consultant but I did get the one working that day, who sat and read all my notes beforehand, did everything beautifully, and did a lovely neat scar which I can hardly see now.

Glad you are feeling better about this now!

Sleighties, the surgeon who stitched up my wound beautifully was actually just a doctor working under the direction of a registrar, I think. There were 2 of them huddled behind the tent. But because she was new, she was painstaking and took a lot of care. I wish I got her name because I want to write to her and thank her for her efforts.

blueshoes That makes sense, actually, because IME, the best nurses are either the most experienced ones, or the student nurses who are new and actually concerned about all the stuff that established nurses can be a bit hardened to.

You can probably send a card to the hospital and ask them to pass it on to the surgeon concerned. It will be on record somewhere who did it. No harm in trying.

The surgeon who carried out my third section was the consultant, and he was brilliant. He was also very scary, he looked like one of those psycho butcher killers you see in horror movies . He also fixed a few problems I had had with my previous section scar (it was done too tightly). You can't really see my scar at all.