Natural birth vs elective ceasarian questions

[paniccentral]

26+1 with DC1 and conflicted about the best way to give birth.

Not worried at all about pain (famous last words I'm sure!) but very worried about risks of (long-term) injury from pushing. Read quite a bit about recent campaigns over birth injuries, and DM had a stage 3 tear requiring further repair followed by a huge epis in second delivery, 30 years ago and all bodies are different etc but not at all comfortable with that outcome.

Flip flopping between two options:

1. birthing centre as naturally as poss, reassured by wonderful midwife that she and all her colleagues are very "hands on" and chiefly concerned with physical management of perineum to prevent tears, and their stats are only 6% stage 3 tear or worse, BUT 95% stage 1 or 2, largely not needing stitches.

First question - if a tear doesn't need stitches or only needs a couple for a stage 2, does that = return to normal (sex) life, pain free?

2. Her advice has been to reject forceps if it comes to it, and at that stage ask to go for a ceasar instead. Happy to prepare for that but equally if the odds, and I know nobody can tell what the odds are, of going that way are good enough then why not sod the worry and book in for a c-section from the get go?

Have an appt to speak with the consultant obstetrician re planned ceasarian next month and want to be prepared. I guess I want to know why c-sections are considered so "bad" - I know they take longer to recover from, there are risks inherent with surgery and the baby doesn't have the same exposure to antibodies en route out (and it costs the NHS more) - but if the difference is a known quantity "routine" surgery vs nobody knows how a vaginal delivery will go on the day, and worst case is pretty awful, it feels almost like the safer bet?

Are there any other questions I should be asking him? I feel naive and don't want to be judged for asking about this (feel like it's hard IRL to ask other girlfriends etc in case it's "a bad thing", don't know why it should be but feels that way!) but really keen to get the most out of the opportunity.

Saw Kate Middleton's PA at home with her first baby +15 hours since going in with two paracetamol, gas and air on instagram yesterday (looking a bazillion dollars) and thought well if she can do it why would you inflict a six week surgical recovery on yourself... but if only I knew it would be sure to go that way!!!

Hope this isn't too muddled, thanks in advance for any thoughts x

A 1st degree tear is a thin tear or graze on the skin that doesn’t require any stitches & will just heal. A 2nd degree is when it involves some muscle as well so needs stitching. The midwife initially thought i had a first degree tear but there was a little bit of muscle tear hence why I had a few stitches. Didn’t feel anything.

WorriedMummybekind, you see, it's so awful it's unspeakable. I don't know what a third degree tear is or an episotimy or prolapse is.
Women don't talk about childbirth as if they did, it would scare the bejesus out of us all I'm guessing. So it probably ends up being traumatic for some as they have no clue what to expect.

My child's birth was not without drama (placental abruption so a massive bleed), but the birth itself (C-section) and recovery was drama free.

Do bear in mind that stats mean very little - you could always be "the one".

It's also not always possible to go for a c section once you reach the forceps stage (I speak with bitter experience), because the baby may have descended too far into the birth canal, and for a c section would have to be pushed / pulled back up into the womb, making it potentially quite dangerous.

Best of luck with your decision.

I only know about prolapse as my aunt had one. She’s only had CS’s. Prolapse sounds awful but I think they are pretty common in older women.

Worried
I am in a similar position now pregnant with second child and hoping that an elective c section will be signed off by the consultant.

The impacts are sadly long lasting and may not even be fully apparent until later life and the menopause hits.
The trauma never really leaves you does it.

I had a relatively ‘straightforward’ birth, but if I were to have a second (which we won’t be), I would request an ELCS. I realise now how flipping lucky I was to escape ‘relatively’ unscathed.

Despite it going ‘well’, I lost a lot of blood, and should’ve had a transfusion. I had an infection postnatally that was ignored, and I was very unwell. Despite being told by a nurse recently that my pelvic floor is excellent, I do struggle with stress incontinence, which affects my enjoyment of exercise.

Dc1 natural birth was amazing at home in water bath.
Dc2 birth in hospital post induction was a nightmare and terrifying.
Given a choice I know what I would choose..

User, you don't get to choose though when it comes to induction. That basically means, baby needs to come out.

I had an emergency section (put under general anaesthetic as there was no time for me to be awake) and because of my baby’s position and how they had to go in I’ll ha e to have a planned one next time. I’m quite relieved as I feel like there’s a bit more certainty in it but also I’m quite all or nothing; once it was established that I wouldn’t be able to have the natural water birth I’d envisioned (I blame NCT for that) then I didn’t want the overly monitored/attached to a machine natural birth so I preferred the section idea.
Also a year on my scar is fading in places and I imagine will be barely visible at some stage

I went natural and ended up with forceps. 3 introductions of forceps 😭😭 I can't say it was present and I was struggling to sit down for 2 weeks however since I have been super. No probs at all. In hindsight I wouldn't change it and very happy to not have a scar

@LadyGAgain yep I worked in the NHS, all the anaesthetists wives or females bad electives

But my time again now with 2 naturals births, both assisted with forceps and then vontoose wouldn't change a thing

Regardless of your choice I think it’s helpful to avoid the term ‘natural’ when discussing birth. It’s too loaded with judgement. The Royal College of Midwives now refers to ‘physiological’ birth to describe a birth which requires no intervention.

The problem is you can’t predict how your body will respond to childbirth.

I was terrified of tearing, planned everything around not tearing but ended up giving birth on my back both times with directed pushing.

However, first time had a teeny tiny 2nd degree tear that was no bother at all, and the second time no stitches at all, only a couple of grazes. Absolutely no impact on sex life.

So I would say that even if you get what’s classified as a second degree tear, it’s really not as bad as it sounds pre birth. But you just don’t know what’s going to happen!

I recovered from my ELCS much much faster than my natural, induced, forceps, third degree tear birth.

But everyone is different.

I had forceps, it wasn't that bad and I'd say the recovery was easier than a c section would have been. I was terrified of forceps beforehand and would have done anything to avoid them, but it honestly didn't end up being that bad!

I had EMCS after a long labour. Actual process wasn't so bad (although I had to have anaesthetic top up on the operating table) but first week or two were very hard and I think it's because of the c-section.
It's too easy to focus on labour rather than the start of motherhood. A c-section is a major operation, imagine if someone said you should have an appendix removed then be given a newborn to care for immediately! It's very exhausting and you have no time to rest and recover properly as you're into baby care immediately. Vaginal birth has a much quicker recovery time.
There's also the issue of further children - c-sections get more complex the more you have as they need to go through scar tissue. Any c-section has slightly higher risk for things like breathing difficulties in the baby. Also the process of natural birth has a hormonal function so breastfeeding etc can be harder with a c-section.
C-section can also apparently cause issues if you need hysterectomy or other similar surgery in later life.
I'm preparing for a VBAC and like you I think a good natural birth is better than c-section and a c-section is better than a hard/damaging birth - but that's not the choice you get, you can't really stop the clock if you need forceps mid-labour.

I had my appendix removed (not keyhole) & was in hospital for 5 days & given morphine hence why I was suprised that I was sent home so quickly after CS. The CS recovery was defo harder than the appendix I thought it may be similar.

Think about getting in contact with a doula.

Vaginal birth has a much quicker recovery time.

Best case scenario yes, but given I was perfectly capable of caring for my newborns on my own within hours of their births by emergency section, I don't think it's that straight forward. One Sil had a very quick vaginal birth and spent the next six months sitting on a rubber ring and swearing a lot. I wouldn't want to be the one to tell her that vaginal births have a quicker recovery time.

With my first, the bruising from failed forceps (no cuts/tears just bruising) hurt more than the c-section wound so I can imagine that a bad tear would be way more problematic to recover from than my experiences of two c-sections. (I also accept that other people's recovery experiences will vary widely).

Hi OP, I haven’t really got any advice but I just wanted to say I’m struggling with a similar decision. I’m not a doctor or midwife, but I feel as if I’m missing something about c-sections. ELCS seems like the best option to me because as a previous poster pointed out, there’s a hierarchy of birth outcomes, with ELCS somewhere around the middle, but ELCS is the only one you can guarantee.

The midwife has given me a long talk on the disadvantages of sections but her comparator seems to be the best possible birth outcome, which is far from guaranteed.

Longer recovery time - sure, compared against a straightforward vaginal birth with no tearing. What about a vaginal birth with an episiotomy/fourth degree tear?

Major surgery - sure, but surgery to repair tears and prolapses is pretty invasive too.

Greater risk of PPH - ok, accepted, but the risk is still present with vaginal births, it’s just slightly lower. What about a vaginal birth with a fourth degree tear and a PPH?

Plus it seems to me that with an ELCS you lower some of the risks to the baby - virtually no risk of shoulder dystocia. Lower risk of birth hypoxia.

The one consideration with CSs that does concern me is the risk of placenta complications in future pregnancies. But then there’s also a risk that you can’t get pregnant again because you can’t have sex because of a car crash vaginal birth.

I should stress that my only qualifications are from Dr Google - I’m in no way medically qualified and I’m more than happy to be told by a medical professional the crucial piece of information I’m missing. But from where I’m standing ELCS feels like the obvious choice. I can’t think of any other situations where people (let alone medical professionals) would encourage you to risk the very worst outcome in order to have a chance of getting the best outcome.

but ELCS is the only one you can guarantee.

That's not strictly true. Your risk might be small but dc2 was meant to be an elective. Instead we had a mad panicked rush to hospital at 3 in the morning with a toddler in tow when it became obvious that what I'd hoped were braxton hicks were contractions.

I did end up with an emergency section which was very elective like but only after several hours of full blown labour with no pain relief and several attempts to convince me to see if this labour ended better than my previous one.

Sorry, another consideration I should have mentioned in my previous post is that average woman has a 20-25% risk of ending up having an EMCS anyway - and EMCS tend by their nature to be riskier than ELCS.

Where did you get that from @monkeynuys18? As far as I'm aware it's closer to 15%.

I recovered from my ELCS much much faster than my natural, induced, forceps, third degree tear birth.

But everyone is different.

^ THIS! For me, I recovered from my natural, induced, forceps third degree tear with lasting permanent bowel damage MUCH FASTER and much better than my elective c section.

Both my births were horrendous (sorry) but it's pure luck imo. Although I have lasting bowel damage from the 1 st birth, I'm fine in a body kind of way, whereas the section absolutely ruining my body (and thus my confidence) and I got PTSD from it too...seriously the most traumatic thing that has ever happened to me. Took me nearly 4 months to even accept my newborn son, couldn't bond with him at all.

So for me, I'd go for natural in a heartbeat.

Yet most people you talk to about elective sections say how lovely and stress free they are. Definitely wasn't for me!

Stop reading things on the internet and honestly just go with whatever happens in the moment. The most important thing is that your baby is born safely and you are both alive at the end of it. I don't believe you can pick the 'best option' as there are so many things that could go wrong (or right) with either version.

Which end of it rips, the ass end or the front end?

Usually your perineum (between vagina and and but sometimes it's the front end, known as a cliterol tear and done times your labia tears.