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!

I had an emergency caesarean first time round and an elective one six years later. My experience second time round was so much better and easier. I could walk around much quicker, hold my baby and felt more positive.

Haven't really got any experience of your first two questions but wanted to give you a positive elcs story. Best of luck

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

I have experienced labour the first time (had emergency caesaren) and recovery from section was much less painful than labour.

I have had two subsequent ELCSs and found the same. I did wonder whether my luck would run out (some people describe the pain afterwards as dreadful) but it didn't.

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?

Hmm. I remember a thread a couple of years ago where a poster had tried to have this on her birth plan and had felt very let down when she had ended up with the episiotomy. I seem to recall the consensus was something like "you can't demand a CS in labour and get one because otherwise just about everyone would have one." She had the thread deleted so I can't find out what really happened. However in your case, if there were specific reasons that forceps/episiotomy are inadvisable your consultant should be able to specify that it'd be straightforward VB or section for you.

3. Has anyone got a positive elcs story?

Yes. Great. Although DD had a little breathing trouble from being elective (the mucus doesn't get squeezed out of their lungs as in a VB) she was fine. I loved my ELCS, although my favourite was the emergency section because after nine months worrying about how I was going to get the baby out (and six weeks of knowing how large he was going to be) all of a sudden I knew I wouldn't have to do it. I'd been convinced we would both die. The relief, oh the relief!

I have had 1 EMCS after a long labour although at consultant appt she had said disproportion might be a problem and I had an ELCS scheduled for 41 wks but went into labour before then so consultant allowed a trial of labour (a flipping long one all things considered...)

Then with DS2 I had an ELCS, wonderful - they played my mix CD in the operating theatre, it was a wonderful positive experience and better than an EMCS after a tiring painful labour.

I BF easily after both of them and recovered quickly.

DS1 EMCS under general due to a failed epidural - recovery was sore for a couple of days, but then OK. Just a week to feel fine.

DD1 VBAC - absolute agony due to a failed epidural. Stitches without painkillers worse than the birth. Recovery at least 6 months until I could have sex without discomfort (and from what I hear - this is GOOD !)

DC3 - they want me to have a vbac, but I have a growth scan on Thursday and I am going to press for an ELCS. They are trying to cut down on c-sections and so they are pushing me for one. I have tried thinking about a natural, but I am terrified of the pain again and having an instrumental and stitches without anaesthetic just to improve their statistics.

I would go for an ELCS. A natural birth is over-rated as far as I am concerned.

Before anyone gets uppity - it's just because I had a bad experience. I know there are great loads of great stories about natural birth out there, but if there is a chance of any problems for you, I just wouldn't risk it.

Re (2), I imagine also that whether or not you will get a CS during labour would depend where baby is at the time things go pot-shaped. If he is already crowning or near, it would not be feasible to pull him back out through a cut in your abdomen.

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

no, no, no, no, no. I had the back-to-back labour + episiotomy + failed ventouse + forceps. I was in a terrible state for weeks, nay months afterwards. ELCS was painful afterwards, but a relative doddle to recover from.

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 personally - but knowing what i know now, I think I would say that on my birth plan. The midwives stuck scrupulously to my birth plan, which was very good.

3. Has anyone got a positive elcs story?
   It was one of the best decisions I ever made.

I just had ELCS with first DC and although I have nothing to compare it to, I am absolutely sure it was the right choice for me. Everything was very calm, controlled and straightforward and I have recovered very well. BF in recovery, no problems. Some slight discomfort going from lying down to sitting up for the first couple days, but I was walking around my hospital room the morning after. Despite what I had heard, I had no problem with stairs once I got home and was going for short walks around our area less than a week after the ELCS.

My understanding from people who have laboured before a CS is that an EMCS is usually a much more difficult recovery due to being physically tired already going into it.

Good luck with whatever you decide!

Ive had 3 sections, 2 elective and one emergency after 2 days of failed labour. recover after the electives was much quicker and all round a much better experience for me.

Good luck with whatever you decide.

This is probably too late to be useful to you, Lady Rabbit, but may perhaps help inform the decision of someone else. I had planned for a natural water-birth at home and had not, perhaps foolishly, really considered that it could go any other way, having thrived on a diet of Ina May and ante-natal yoga (not saying this cynically, I'm very, very grateful for having been encouraged to approach birth with fearless enthusiasm). However, circumstances conspired against my plan. In the end I found myself in hospital halfway through and following over 40 hours of brave labouring unable to push my baby out. I had, on the advice from a friend, produced a 'just in case' hospital birthplan on which I had specified no forceps and no episiotomy, but when my partner tried to persuade the consultant that our efforts with perinneal massage and the Epi-No might be enough to avoid at least the episiotomy (it was pretty obvious that the forceps were necessary) he shook his head regretfully and snipped away. What I'm pointing at here is that you never know how circumstances will unravel. However firm your advocate, in the heat of the moment it can be hard (and perhaps not always appropriate, e.g. our baby did actually need forceps in the end) to stand one's ground. My instrumental delivery seemed to have no impact on our very bouncy and chilled out baby (confirmed after craniosacral therapy), but boy, did it mess me up! Apart from the obvious culprits, I also blame over-enthusiastic catheterisation and too many hours spent labouring sitting upright in a hospital bed, discouraged from moving or turning on account of all the monitoring equipment and drips, the powerful oxytocin induced contractions bearing straight down on the coccyx and pelvic floor. I was totally unprepared for how sore I would be afterwards and just how long it would take to recover. I feel tempted to describe a brief chronology of recovery, but feel this would make pretty bleak and discouraging reading. Suffice it to say that 8 weeks on, I am only just regaining sensation in my bladder and bowel (although must stress was never incontinent, thank goodness) and am no longer having to pee in the bath or pick poo out of my bum as too sore to push. The bottom line is, pardon the pun, that although you do recover to feel just fine again, it can take longer than you think. I really do not want to sound negative; first-time mum friends of mine have enjoyed amazing text-book natural vaginal deliveries of just a few hours from start to finish and bounced back within days. However, if like in your case, there is an underlying issue, I would think carefully. I've realised you cannot over estimate the loveliness and convenience of a smoothly functioning bladder and bowel, and I suspect that these are not infinate resources and can only take so much.

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

Not for me, I would say they were about comparable but that psychologically I felt far, far better after my ELCS and also going to the toilet was a hell of a lot easier after my ELCS.

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?

Don't think you can guarantee they won't use instruments if it comes to it.

3. Has anyone got a positive elcs story?

Yes, just had one last month two years after a horrible failed ventouse, forceps, failed epidural number. It was fabulous, absolute worst parts were unpleasant but didn't last long and the pain never really got on top of me. Felt absolutely fine after 3 weeks, driving and lifting just fine now after less than 4 weeks.

These are really helpful.

I had a forceps and third degree tear with DS. Was told that they would probably recommend c section with subsequent DCs due to the damage and muscle weekness down there.

I am pregnant with DC2 and I cannot make my mind up what to do. I am pretty keen to avoid a c section but the thought of the damage that could be done puts me off wanting a natural birth too.

I've just had an elcs for my 1st (10 days ago).

It was a wonderful experience, very emotional (in a good way) - just amazing to see my son emerge, pink and healthy and yelling! - no pain during the op (although all the rummaging does feel odd) - some 'breakthrough' pain on day 2 when MWs cocked up my pain medication, but nothing beyond stiffness/mild soreness since then.

No problems at all picking up/holding DS, climbing stairs, getting in and out of bed etc, although I am taking care, and avoiding any heavy lifting. No bowel or bladder issues at all.

I did lose a fair bit of blood during the op, as they nicked a vein - interestingly, the risk of excess blood loss is listed as being no greater with a CS than VB in the NHS 'comparative risks' table. In any case, my blood count afterwards was fine, and so there were no bad consequences.

Me and my lovely DS are doing very well, and BF-ing successfully and happily so far. He went straight on my boob and stayed there - milk came in day 2/3.

Good luck with whatever you decide.

I had an elcs 3 weeks ago, and seem to be about the only person on here that had a negative experience!

I had a 3rd degree tear with dd1 and 2nd degree tear with dd2, there have been some continence issues since, hence the decision to have a caesarian.

As far as the operation itself, I felt no pain, but my bp plummeted, I lost loads of blood, I was allergic to the pain meds, so had to rely on a combination of paracetemol, codeine and morphine. After the op I was too shaky to hold ds, I couldn't eat for a whole day afterwards, as i was throwing up all the time. I still feel like I have been sawn in half, everything aches, and I felt shaky on my legs for days afterwards. Because I had to be up and about, I developed an inflammation of the veins in my leg, which was very swollen and painful.

Ds was born with respiratory distress syndrome, because of immaturity of the lungs, he was taken to SCBU before I could hold him, and he was in for 8 days (I was transferred there after 3 days on postnatal ward). He was on cpap, tube fed and antibiotics for a possible infection. He was 8lb 9oz when born, but had lost 12% of his birth weight in the first week.

On the plus side, despite my milk taking 7 days to come in, and ds being unable to latch on for days and days we are breastfeeding, and he is nearly back to his birth weight.

I don't know how much of his problems have been due to the birth being an elcs, but there are strong links between RDS and elcs.

I wasn't going to post this here (I don't want to freak anyone out), but one of the things that I have found difficult to deal with is that pre birth I only heard positive stories about elcs, and have felt quite shocked at how rubbish I have felt. I think the good stories outweigh the bad, but I think it is important to remember that it is major surgery that could affect you and the baby, and that if you do take a long time to recover, or react badly to the operation then you must be gentle on yourself and get all the help you can.

Good luck with whatever you decide

Sorry for the long post!

I've had an entirely natural vb with no 1; epidural vb delivery with no 2 and, 2 weeks ago, an ELCS for no 3. The reason for the ELCS was the same as yours, a pre-existing med issue that meant strain through childbirth was to be avoided.

Your points 1 & 3: The pain of recovery from the ELCS was so much better than the natural delivery...in fact looking back I can't believe they gave me no pain relief during or after my vb - and I must be bloody stoic!

In the two weeks post ELCS, apart from avoiding very strenuous lifting, I feel completely recovered. Pain meds in hospital and the ones they gave me to take home has meant any discomfort has been mild. I had the OP on a Wednesday, home Friday and could change dc3 on the floor the next day. Scar is neat, stomach nearly flat, hospital care excellent, dc3 delicious.

2. My guaranteed epidural delivery for birth no 2 had exactly this stated by the consultant in my birth notes - c-section if labour failed to progress. And it needed to state it as the mws are v pro natural delivery at the hospital.

In terms of delivery the epidural worked very well - no pushing on my part except at the very end. In fact Iwas very surprised when they told me I was about to deliver as had noticed nothing! Epidural was topped up at source by the anesthetist so I was guaranteed not to feel any pain/urge to push which is unlike a lot of epidurals where you top up yourself with a milder solution as they like the pain relief to wear off for the crowning. Whole labour took 5 hours from start to finish. In terms of recovery the best of my labours. However, in hindsight I wonder if I should have had a section which was offered to me since there is no doubt muscles have weakened subsequently (just through haing the baby, not through pushing) and post-menopause is where problems really surface.