oh i can't make up my mind. can you all tell me if I should go for an elective c-section this time?

[oranges]

I tore last time, badly. a 4th degree tear after a fast labour. Luck and an incredibly skilled surgeon meant I don't have ongoing problems. Now I'm pregnant again. The midwives recommend a c-section. The doctors say I will be fine with a managed vaginal birth.
I'm 35 weeks and need to decide what to do soon. Help!

c-section.

I had a third degree tear with DS1 and subsequent lesser tears with DS2 and DD. Now, I was absolutely fine but no one ever said that there was a risk of permanent damage. I do wonder what my choice would have been had someone mentioned it.

Hi Oranges, just wanted to comment as I had followed the discussion on your previous thread. I am also still struggling with the decision as well, (though my midwives and consultant are telling me they think that a VB is a better option for me). I find that the thing that is playing on my mind is that I really want to avoid having an assisted instrumental delivery and another bad tear, so I think I'll try another VB if they can assure me that if the baby is big and stuck like DS1, I can have a CS. Trouble is, I don't think that they can really give me a guarantee and so it feels risky. However, I am more stretched out this time so they say that it should be easier to push the baby out. Also, they have my previous history to go by now so they will be more aware of the possibility of complications and won't let me push for too long. Whereas, to ask for a CS, I know there will be definite recovery time involved, so I am having trouble opting for that. I'm having another consultation in a few weeks and a growth scan, so I am going to have an opportunity to ask more questions. Even though I'm sceptical, I think I will listen to the advice of my midwives. Oranges, if your midwives are recommending a CS I would tend to listen to them. But I know how hard a decision it is to say, yes, cut me open. Especially after you're already stretched out down there! I can't believe your doctor's attitude!

It really helped me get my head around the choices to read the NICE guidelines on sections, have you seen this: www.nice.org.uk/CG13
It made me feel much better to see some statistics and comparisons in the NICE guidance pdf. Good luck Oranges, looking forward to hearing how it goes for you!

Have the elective. Midwives tend to be very pro-natural birth, so if even they think you should have a cs then that is a good reason. Am surprised your docs think the opposite, get a second opinion - I would imagine most docs would advise cs. You might not be so lucky (i.e. get a brilliant surgeon) next time. Pointless risk.

I had a rotational forceps emergency delivery of DD 15 months ago. Tons of tearing and bladder problems ongoing. Months of physio and a very weak pelvic floor.

I'm choosing an elective for the baby due this June. If I could guarantee a nice waterbirth I'd love it - but an elective gives me a lot more protection longterm from tears, forceps and more incontinence.

In your position I would not risk another 4th degree tear, particularly as you have healed well. Incontinence and pelvic floor weakness is a lifelong issue, made worse by the menopause and not always fixable. Many others with tears like that have perpetual pain, nerve damage, restricted or lost sex lives and double incontinence.

Don't mean to sound negative but I think you were really lucky to recover so well last time and I personally wouldn't presume on that again. Good luck to us both!

I agree with Brahms and for the same reason. Personally I wanted (and got) two sections. It's not for everyone I know, and I would never tried to persuade anyone. But I remember my (pro-section) GP telling me not to spend too much time discussing it with the MWs as they would almost certainly try and discourage me. To be absolutely fair, once it became clear that my DC1 was a whopper (we have a family history) and also there was a problem re the placenta, the MWs I saw agreed that a section was a good idea. If they are telling you this then I would definitely go for one.

As for the 'you might die' line well, agreed, there is always a risk with any surgery. But for elective c-sections it is very small. As the Independent recently pointed out, even a survey in the Lancet which managed to quote a higher risk of maternal death for sections was based on underlying figures showing NO (that's right, zero) deaths in the group of women having elective sections. A reputable Canadian study not so long ago, that set out to discover whether there were higher risks for elective sections compared to VB showed a higher level of blood clots if I recall correctly, but again no actual deaths. Of course, anyone can quote surveys to prove anything - but basically all methods of childbirth in this country are very 'safe', statistically speaking.

Midwives are the very last people who would generally recommend a cs in my experience! If they are, then I would definitely listen.

I had a very positive elcs after a traumatic 'normal' delivery, which left me on pain meds for over a year. There was no comparison, it was brilliant.

If you have recovered so well after such a bad tear, there is no way I would inflict further trauma on that area - there are many much less pretty stories.

Recovery from elcs is not bad at all, you take the drugs, go careful for a few weeks, et voila.

In you position, I would make the decision, and move your head on to planning to make the section as 'natural' as possible. Skin to skin straight after delivery etc. I found the experience delightful and a blessed relief.

All the best.

Your doctor sounds like an arse who isn't listening to you when you tell him about your personal circumstances......he should at least be willing to entertain a discussion re. the pros and cons. I know that in some hospitals that consultants are under pressure to limit the number of elective C-sections they carry out, so it could be that he is nearing his quotient for the year, hence his insistence on trying to make you have a vaginal birth that could damage you permanently in the long run!!!

Hold your ground - demand the c-section and escalate it to another consultant if necessary. A letter outlining your concerns wouldn't go amiss....

Write a letter to your consultant outlining your clear preference for a section, and tell them that if you are forced to have this baby vaginall that will be a result of their choice and not yours. And then ask them if they are prepared to accept the responsibility if things don't go according to THEIR plan.

Fuckwits. Don't let them bully you.

hello,
just a quick update on this. I FINALLY got the results of the endo anal scan posted to me directly. It essentially says there is thinning in the low anal canal and weaker than normal squeeze pressure. No idea what this means, but will ask around before seeing the consultant on Monday.

I had a vbac second time around and ended up with 15 stitches in my labia. 7 years later it still hurts. If I had it to do all over again I would have had a elective cs with both children. Don't let your consultant bully you. I found that if I simply refused to do what they were asking, they gave me what I wanted (but not before making sure that I cried first....bastards).

I don't have personal experience of bad tear or c-section but what you have just said about the results of your endo anal scan seems to echo the state of a good friend of mine down there! She recently ruptured her anal canal pushing out her 7 1/2lb DD. She had thinning as you describe from steroids she had been taking due to Crohn's disease. Had a 24 hour dilation but at the pushing stage basically had no urge or strength to push but she did eventually get baby out with Obs hands inside her literally pulling it out. They said afterwards she probably had lower than normal squeeze pressure as you descibe as well as anal canal thinning. Her recovery was slow and painful and she narrowly escaped reconstuctive surgery and now attending physio etc. Has been told she should def have ELCS next time, but why oh why did they not realise her insides were too delicate for the task of pushing that baby out in the fist place? If I were you I wouldn't hesitate to demand a ELCS. Easy for docs to let you go into labour naturally and then try and manage it with the healthy baby as the successful outcome, but at what cost to to you? I also think you should be able to enjoy the rest of your pregnancy with peace of mind not fretting about the birth and what long term side effects it may leave you with.

With results like that I definitly wouldn't be attempting a vaginal birth. Once certain nerves are damaged there is no coming back.

Have you seen the mumsnet thread on sphincter injuries etc in General Health? It is sobering reading for those who would treat the longterm problems as insignificant/collateral damamge. not trying to scare you but I would hate you to read it later and regret not having that information!

The sonographer at my latest pregnancy scan commented on how many Obs in her hospital booked themselves in for electives when they were pregnant - they know what can happen and that's without weakness there to start with! She also said she wished she had had one to save her pelvic floor, and she had major complications!

That should read - she had NO major complications.

God I did read that thread in general health on injuries and it scared the living daylights out of me. I was amazed how composed the women on that thread seemed to be.
Right. I've written a birth plan for a c-section and clipped it to me notes, so I won't be bulldozed again when I talk to the consultant Monday.
I'm so glad I got the scan results, or I would have let them convince me I was totally back to normal down there.

I think you are being very wise - I saw my new consultant this week and gave my reasons for a c-section this time (mostly the still dodgy bladder and shot to pieces pelvic floor, and a huge fear of double incontinence if it goes pear shaped this time).

The consultant was quite happy to continue the plan for an elective given all this - I cannot see how yours could be otherwise! And the scan proof backs you up 100%.

Ultimately its your choice on which set of risks to take, not the consultants, even if they have quotas on encouraging vaginal birth etc. And to undo that great recovery from last time would be potentially devastating.

Good luck with it all!

Hi Oranges, glad you got your scan results and can chat them over with consultant at your next appointment - I hope that they're more willing to address your concerns this time round, and that you come to a decision that you're happy with. Good luck with the birth

Hi Oranges,
Followed your last thread. I have had to make a similar decision but am feeling more positive now that I have decided and booked the CS.

An still pretty anxious but now trying to focus on the positive.

Good luck with your consultant.

Can you try and find out whether your hospital are using a technique in elective section called "transversus abdominus plane blocks" (TAP blocks).

I had an elective section with my 2nd child who was born 4 months ago and the difference in recovery to my first born child was astounding. People will often say the recovery is better after an elective vs an emergency, but that is possibly largely the phsychological element. However, this new form of anaesthesia is amazing - they inject each side of your abdomen (a membrane, which obviously you dont feel because of the spinal block) and the difference in recovery is amazing. I practically leapt out of bed the next morning. I could lean over and pick my baby up to breastfeed her the day of the surgery - with my son, all I could do is lie there in wonder about how much pain I was in! You can literally pick who had TAP blocks and who didn't in the ward by how they are walking around and recovering. (They can't give tap blocks under epidural so it tends to be electives who get it).

Whilst I shouldn't extol the virtues of elective section, as a straightforward vaginal birth is nearly always better for mum and baby, this new development cannot be overlooked in your decision making process as a lot of the cons of c section, being the pain and recovery, have become so much less that it could actually sway your ultimate decision. So I'd be looking into that if I were you.

Hello, I don't want to tell you what to do as whichever way you choose to give birth has risks.

But I do want tell you that I had an EMCS and it was no where near as bad as I thought it would be. I had it at 1am and by 7am I was out of bed and shuffling around.

I followed the advice; no lifting apart from baby, no driving etc and took all the medication and I healed fine.

The only thing I didn't like about it was not being able to hold baby straight away, I was really looking forward to having him flopped on my chest as soon as he was born.

For future children I will be going for elective c-section.

Best wishes.

Thank you. Well I saw another consultant who was very certain that a c-section would be the best thing for me - his attitude was "you've been stitched up very well and had a lucky escape last time, but why push your luck and risk years of pelvic floor problems this time"
SoI'm booked for a c-section. Just having the decision made feels like a huge relef. I was in pieces the last few days and feel much calmer (though late pregnancy insomnia stil has me awake at 4am. grrr)
thank you again so much for talking me through this. Momdeguerre good luck to you too.