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

I can't comment on vaginal births as I had an EMCS with DS and an ELCS with DD. The ELCS was brilliant. I was shitting myself not literally walking up to the theatre but the experience was very straightforward and everything was explained to me as it was happening. Recovery was great. I was out walking 5 days post section. Of course there are lots of risks involved which are explained to you by the consultant when your ELCS is booked. But in my case the risks were better odds than having a VBAC. I really wanted a VBAC second time round but with baby breech, low Papp-A, and my history with my first birth, ELCS was the safer option. I've been told that any further pregnancies will automatically be an ELCS, which I'm completely relaxed about. I never thought I'd say that after my EMCS with DS, but an ELCS is a whole other experience.

Guys, I cannot thank you all enough - dipped in and out all day and DH has read more thoroughly than I've yet had a chance to but there's so much here that has already helped and reassured and developed our thinking, will hop online from what's likely to be about 20 hours on the M6 this weekend and catch up properly. Just wanted to say thank you for having contributed, we're both super grateful, so so pleased I asked MN!!

I think it's useful to split birth into 3 sections here.

Labour/birth
This one is easy tbh. Natural childbirth is going to hurt a lot more than an elcs. No hours and hours of contractions and pain. No possibility of testing or feing cut without anaesthetic shudder. No wanting an epidural fit the pain but being denied it because the anesthetist isn't available, or its too early or too late.
An ELCS will be pretty much pain free, save for putting in the cannula, doing the spinal, which you might have for a vaginal birth anyway.
Instead of being in agony before my elcs baby was born, I went for dinner, and had an early night. Its nice also not being knackered or in pain when the baby arrives.
But you don't seem phased by pain,so it may be a small factor for you.

Immediate recovery
Longer than a very simple vaginal birth, probably longer than a complicated one. You could still be in and out within 24 hours, though you may stay longer. I found recovery fine but there is huge variation. I wasn't up quickly, but was happily wandering round the supermarket by about day 4 with no real pain (but I was religious about painkillers). Some women don't drive for 6 weeks, others feel fine after 2. You will have to take it physically a bit easy for a few weeks.
One bonus with a section is that people often do things for you / assume you do need to take it easy. With a vaginal birth, unless you are comfortable talking to friends, maybe your dad etc, about torn labia/clitoris etc, then it can be harder to get the help.
Basically roll the dice for recovery both ways, but there is more variation with a vaginal birth.

Long term
Cs- obviously your undercarriage will remain as it is, though your pelvic floor still takes a slight beating from pregnancy. Less chance of incontinence though.

But you may end up with a c section overhang, such can be hard to get rid of. It makes my tummy look really sad. Some women have long term issues stemming from section, but I think they are more common with a vaginal birth.

I had an episiotomy 7 weeks ago. It's healed fine - took about 3 weeks but hurt for only about 10 days. I wouldn't have swapped my recovery for being unable to drive for 6 weeks. I'd have got cabin fever.

I had a fairly traumatic first birth with a complicated recovery, a C section would definitely have been easier. For DC2 after talking to the consultant midwife I decided in the end to try for a vaginal birth, but to refuse the induction drip (I'd have agreed to the pessaries). Despite what someone said above, you can refuse an induction and insist on having a C-section instead - inductions are hardly a fast way to get a baby out!

I made that decision because of the much higher risk of complications with the hormone drip, interventions like forceps are much more common. If you are thinking of going this route I'd recommend getting it all documented and agreed in advance. They were very good at respecting the plan I'd agreed with the consultant midwife and she'd written up (that I'd stapled to the front of my maternity notes so they couldn't miss it) - I would be worried about being pressurised into following the 'normal' pathway otherwise.

The other thing to consider is whether you want a 2nd. If you've had a previous vaginal birth, the 2nd is likely to be a lot easier, whereas a 2nd C section isn't.

hammeringinmyhead I couldn't drive for 6 weeks with my vaginal birth, but I didn't want to leave the house anyway for fear if wetting myself all the time.

Birth is so unpredictable. And recovery from any method is not guaranteed.