To have an elective or not - thoughts?

[LadyRabbit]

Currently 26 weeks pregnant with first child and until recently have had my head firmly in the sand about how I am actually going to get this baby out! Early on, I was advised by my consultant that a pre-existing medical issue might require me to have an elcs. It seemed so far away at the time I didn't give it too much thought, but am aware that I might have to make a decision soonish.

Obviously, I would like a straightforward vaginal delivery with no instruments and slight grazing - wouldn't we all! But, even if I have a normal delivery (whatever that really is), there is a chance it could still put strain on the bits of me that required repeated surgery when I was younger, and I would only have to go in for repairs post delivery anyway (especially if forceps are used).

If anyone can explain/tell me the following I would be grateful (although I fully realise there is no definitive answer, I guess I'm just asking for some rough advice):

1. Is the pain of recovering from an elcs worse than the pain of labour+episiotomy+forceps and its respective recovery?

2. Has anyone had a birth plan that allowed them to labour naturally to begin with and if things don't progress move straight to cs and categorically state no use of forceps or ventouse and accompanying episiotomy?

3. Has anyone got a positive elcs story?

I really am completely undecided and don't know what to do. I'm not militant about having to have a natural delivery - but I am also of the mind that women are generally equipped by nature to figure it out naturally themselves. I wish I had a really firm opinion of my own on this one, but never having done it before I don't know either way and am in need of some experienced advice. I'd be so grateful if anyone has some pearls of wisdom they'd like to share. Thanking you!

Hi there,

1. I had an ELCS with DD. I only have DD so cannot compare to recovery from vaginal birth, but can say that I had no pain - zero- from ELCS. The worst bit was sitting on the side of the bed when they put the needle in my back.

2)N/A

3. My ELCS fab. And this is from someone who had consistently wanted a home birth, but had to change plans at the last minute. Everyone was lovely, the radio was on in theatre, very relaxed, it took six minutes from 'knife to skin' to my DD being born. Then another hour for them to stitch me up, when DH could hold DD and cuddle her. I could see her and put my hand out and touch her. She was born mid-afternoon, and by the time I got back to the ward (several hours later) I felt like I could get up and walk, but midwife said to wait until morning as it was late.

Hi
I'm having an elective on Thur, having previously had a natural delivery. This time around baby is breech.

Will try to remember to come back and find you to update you on what my experiences were for both, but might take me a few weeks from the elective to get back into swing of MN.

But trying for a natural shouldn't worry you. As long as there are no other additional complications in pregnancy, I think you should go for it. I had a ventouse which was fine, I was cut but was on epidural so didn't feel it, I healed really well from it and would have this type of delivery again, right down to the epidural! I had failure to progress because she was back to back, so in fairness, a fairly difficult labour, but I would still rather this than my planned c sect, but thats for practical reasons afterwards.

As I said, I will try to come back to you!

I have had 2 ELCS with abolutely no pain and very quick recoveries. Never been in abour so can't compare but my ELCS were fab.

I have two very positive El CS stories. I have nothing but positive feelings for my children's births.

I would (personally) choose an ELCS anyday

Had elcs for ds3, ds1 was emcs and ds2 vbac

Elcs was by far the easiest, minimal pain quick recovery and shorter bleeding time afterwards - guess they hoover everything out while you're opened up. Chose elcs as ds2 had been failed ventouse, forceps, episiotomy and a third degree tear.

If I was pregnant again I'd go for elcs without a shadow of a doubt though maybe I wouldn't get a choice, are you allowed to be cut open 3 times

Another plus is that you know which day you will be going to hospital so its easier to plan childcare for any siblings

What Chynah said.

ELCS rock.

And Harimo - I have very positive memories of both births. And some amazing pictures.

I had an em.section for dd and then an el. section for ds.

El. section for ds was great, had him at 12.30pm on 21/12/09 and was home for tea the next day. Had a few paracetamol for pain relief and had a great Xmas. No problems at all, bf great from the start.

1. No idea
2. Yes, my second child was a VBAC attempt after crash section first time. I was willing to try for VB on the strict criteria (my criteria that is, not the hospital's!) that is things were not going to plan, for any reason, I was going to have a CS only. No breaking my waters, no drip for contractions, no interfering. I had the second CS in the end, and while it was tiring/sore etc, it was much better than the first time.

If I had had surgery to bowel or pelvic floor that might be undone by VB, I would definately go for ELCS personally.

I've had both, and would definitely recommend the elcs, I found the recovery a million times easier. And you also get to start life with your new baby without already being exhausted and somewhat traumatised. I agonised over this as well, and I'm so glad I went for the elcs 2nd time around. I also wondered if it was possible to state 'no forceps' but never got to the stage of asking. I'm now 4 weeks post CS and feeling pretty much completely normal.

1 Can't give you a comparison myself as have only had c-sections, but my elcs was wonderful, absolutely no pain, and for me the pain of being in labour for a long time before I had my emergency cs was excrutiating, much much worse than the cs itself - and that's without even getting to the pushing stage.

I have heard women who have done both give conflicting opinions, some say their vaginal birth was much better, some vice versa.

2 No, unfortunately it is not straightforward about refusing forceps and ventouse, because if you get to the pushing stage and the baby has descended past a certain level it may not be possible for the doctors to perform a cs and they may have to go for forceps.

3 Like lots of others on this thread, I have a very positive elcs story. Fantastically happy experience, no pain, just calm and peaceful and a lovely way to meet our baby.

Good luck with whatever you decide.

1. Is the pain of recovering from an elcs worse than the pain of labour+episiotomy+forceps and its respective recovery?

I found the pain of labour, episiotomy, tears, bladder damage, emergency rotational forceps far, far worse than the elcs I had last week.

2. Has anyone had a birth plan that allowed them to labour naturally to begin with and if things don't progress move straight to cs and categorically state no use of forceps or ventouse and accompanying episiotomy?

Not always possible for the health of the baby if they are partly descended but stuck. I was fully dilated for hours before DD hit major distress and that apparantly worsens the odds if a cs is performed. The forceps were her best chance though very damaging for me.

3. Has anyone got a positive elcs story?

Yes - just posted a very detailed account on the 'elcs after trauma' thread on this board. I am very happy with my experience, totally positive compared to DD's birth. I had months of follow up with physio, gynae and urogynae after my damaging forceps birth and I would echo that if your health issues are at all at risk from labour/birth/tears/stretching pelvic floor etc then I would go for an elcs. Look at your longterm picture. My elcs this time was partly to prevent worsening the bladder damage and to prevent bowel incontinence as well. I am happily trading a few weeks of awkwardness and discomfort for years of function.

I went in for a vaginal birth by induction but ended up having a CS as my labour did not progress enough. I have to say i was sooooooooo relieved when they told me they were allowing me to have a CS as been through two days of labour/ contractions and just did not know how i was going to manage to give birth as so exhausted. I was also terrified of tearing/ episiotomy.

To answer your qus:

1. Only had CS so cannot compare but know many women who have had both and they all would go with CS everytime! You also have to consider the multitude of complications with a natural birth (not to mention the hours of pain!!) which i think are less likely with a CS. Esp if you have issues anyway.

2)My family history has had huge complications with natural births so i always wanted a CS. However, unless you have a reason they will not let you have one therefore my birth plan wwas just natural birth. I had heard terrible stories about using forceps/ ventouse and know women who have suffered terrible consequences of these and so i made sure my midwife put in my notes my feelings about forceps/ ventouse before the birth. I was induced and whilst i was having contractions, my cervix did not dilate enough and only got to 9cm but not any further so after two days of labour they told me they were going to try forceps. I refused the forceps straight away and my midwife and consultant could see this in my notes. The consultant then agreed to a CS.

3. To be honest i do not know of anyone who has had a negative CS story but unfortunatley know plenty of women with very negative natural births in respect of both mother and baby! Mine CS was a dream, absolutely no pain during and only a bit the day after. It is difficult to move around for a few days/ week but imagine this would be same with tearing/ episiotomy. Left hospital after only 2 nights and any uncomfortableness i had was kept at bay with codine and paracetamol they give you to take. My DS is 3 months now and i can hardly see the scar.

I would absolutely go with CS next time and recommend anyone do the same - unless of course they really wanted natural birth. I am afraid i have just heard too many natural birth stories with complications to be positive aabout them.

Good luck and hope all goes well.

I'll share my experiences - I have 3dc.

Dd1 was born via a delightful forceps delivery (not). Had had an epidural so the birth per se was fine - but the recovery was awful - very painful.

Dd2 was born by an emergency section - better recovery than first time around.

Ds1 was born by elective cs - was considering a VBAC but he went breech - so decision was made! Must say this was absolutely the best birth and recovery - won't be having anymore but if I was - unless I was guaranteed that it would pop out easily I would def have another elective.

Also (although you didn't ask) I was worried that having an elective would mean that my milk would be delayed as I didn't go in labour naturally. This wasn't the case, my milk came in earlier than my other births - all to do with just needing the placenta to be removed.

HTH

Had a VB (DS1) and and ELCS (DS2).

VB was with ventouse because of shoulder dystocia. Had a third degree tear. Took ages to recover. My fanny felt that it was down around my knees and couldn't sit down for 3 weeks.

ELCS - fantastic, felt "normal" quickly after. I did get tired quickly but because you have had surgery I felt better about letting other people do things.

Another one with a very positive ELCS - I had always wanted a home birth, preferably in a pool etc etc. Unfortunately I decided for health reasons right at the last moment that a CS was far more sensible and less likely to result in damage.

Honestly, I have absolutely no regrets - the whole experience was very calm and as pleasant as I would imagine it could be. And I say that in spite of having a very bad needle phobia which made me really panic.

I walked in to theatre, knew exactly what was going to happen and felt very in control of the whole thing. I was in surgery for less than an hour, and bubs was given to me for skin to skin. I'm 4 weeks on, able to walk several miles with little one and really feeling pretty good. My recovery has been totally uneventful!!

Personally, if you're likely to end up in a situation where you need repair work done afterwards, then I would be very tempted to go for the ELCS.

Wow - thank you all so much for your replies! This has been so helpful, I can't tell you. It is a bladder issue that I want to avoid making worse - and a few of you have mentioned this so I can see the wisdom in a few days of discomfort rather than months, maybe even years, of repeated doctor visits and possibly more surgery. I'm not a huge fan of surgery of any kind - having had a fair bit in the past - but the way you all describe it, it doesn't sound any less emotional or moving than giving birth naturally.

I am really grateful for all this feedback. This is so useful - and I should imagine not just for me but for anyone else reading who is trying to make a similar decision.

(I suppose I should have also asked if anyone has had an elective that wasn't positive to be fair. I guess I have just been conditioned to think it isn't a good thing and so wanted to hear from the other side, but if anyone has had a different experience I'd be interested to hear that too.)

Useful info re. being able to breastfeed without problem too. That was another of my concerns, so I was heartened to read that it was fine, hotmama

BTW, good luck beccas (I think) with your elcs on Thursday. Hope it all goes well.

I second the breastfeeding not being a problem with an elcs. In fact, I found it easier after the elcs than the VB. I think the stress, exhaustion and trauma of the VB meant that I had problems with supply in the early weeks which we never quite overcame (we resorted to mixed feeding very early with DC1). I've found BF much easier after the elcs, my milk came in at the usual time, and am happily exclusively BF this time around. Just thought I'd add this given than it was one of your concerns. Do ask midwives for help with positioning the baby in the first 24 hours though. I was a bit gung ho and did it all myself (having BF before), then suffered a few days later when my nipples objected to their rough treatment in the first couple of days!

Thanks for the good luck wish!
And ditto for the info on the breastfeeding as this really is a huge concern of mine as well, having had natural 1st time and successfully bf, I am very heartened to hear that its to do with the placenta, not contractions!
I'll come back and add my experience for sure! And of course to let you know what I have had! I'm reckoning on a boy as its been rather troublesome! Is that unfair to mankind?

1. Definitely NO. Recovering from DS's elCS was nothing compared to the sheer torture that followed DD's birth with episiotomy. After vaginal birth with episiotomy, I was crying in bed all day and night for three weeks. After elCS, I was FINE on third day and at no point in time was pain anywhere near as bad as episiotomy pain.

2. If it is likely that you might end up with CS, go for elCS and forget about a trial of labour, because the CS you get when something goes wrong is an emergency CS which is not the same thing as a calm elective where doctor takes his time doing things nice and slow.

3. Mine was a very positive CS story, Bonded with baby straight away, baby latched on immediately, got up that first night, minimum pain, no need for even paracetamol from third day onwards.

dc1 - elcs both fine
dc2 - vbac1 him fine, me in such a state they kept me in for a week to repair undercarriage.
dc3 - vbac2 me fine, her brain damaged.

guess which i'm going to suggest?

i do now have a letter on file informing me that i am only to have elcs in future.

bf fine for both dc1 and 2, dc3 tube fed with ebm.

the elcs was fine - delivered and skin to skin, cleaned up and brought back to feed whilst they were finishing off their needlework.

I've had 3:

1. elcs, lovely calm delivery, my ideal birth, now, looking back on it

2. emcs at 34 weeks due to haemhorrage from placenta praevia

3. crash cs under general at 33 weeks due to haemhorrage from placenta praevia, and hysterectomy & spell in intensive care due to placenta percreta

The trouble is, my chances of getting the last 2 were vastly increased by the prior cs.

But then, you're looking at the risk of nasty complications in future pg vs the risk of Bladder Hell, aren't you?

Elcs are lovely (not that I've ever been in labour)

Oh and bf - I bf'd the elcs one no problem. The prem ones didn't take to it though.

haemorrhage, sorry, knew it didn't look right!