Would you / have you book(ed) ELCS? Why?

[throughthesunroof]

I'm sure just like everyone else - I'd love an uncomplicated, intervention-free, vaginal birth for DC#1, but the odds are less than even.

Very afraid of damage from episiotomy/tear and worried my wishes for an EMCS will be ignored in the moment because we give a vaginal birth-centre based delivery a go and end up needing interventions. Even if that results in EMCS, if the 'damage is done' it's too late.

1 in 3 new mums in my local trust deliver by Caesarean, 2/3 EMCS and 1/3 ELCS.

Given these odds, and my concerns, would you book ELCS and leave it at that? Or give it a go? Book a growth scan privately to see what measurements look like? Or is it irrelevant - are my dimensions (small in every direction) more important?

Especially any obstetricians / gynaecologists / friends and relatives of the same - I hear a lot of people say "my mate / SIL / DB etc is an obstetrician / surgeon / doctor etc and had all their kids by ELCS" - is this true?

I'm not ignorant of the realities of surgery vs vaginal delivery, risks to this and subsequent pregnancies / deliveries (although most of what I've read seems to overstate these risks), implications for recovery and establishment of breastfeeding etc - but my own body is high on my list of priorities. Hope that doesn't cause offence; I realise it sounds selfish and princessy.

Grateful for thoughts, thanks in advance.

I don’t think it’s selfish or princessy to want a elcs, but I didn’t know that I’d end up with a rather unattractive overhang after mine. Whether that would’ve happened had I had a vaginal birth, I don’t know - I have twins and was absolutely massive!

My elcs was a beautiful and calm experience, and I felt completely in control. Recovery was quick, I was out and about shopping 5 days afterwards, and back to driving in 2 weeks. Whilst I do feel wistful and wish I’d had a vaginal birth at times, I know it was the best choice for the 3 of us, and I would have another.

Had a failed induction last year due to big baby that resulted in semi emergency section, the experience of the section was great and recovery so much faster than I imagined, due again in June so requested an ELCS this time and they agreed

I had an EMCS with DC1, but I found recovery slow and painful. Ended up with sections of the scar weeping for months, then when that stopped (4 months after birth) I had an incredibly painful infection in one section of the scar that ruptured. After that healed, all was well.

I want a VBAC this time, but I'm terrified of the scar rupturing, so going to insist on epidural ASAP, and any sign of inducing I'll insist on CS. I want to avoid a long recovery. Perhaps I need to provide the midwife with a flowchart

I had a c section with my only child. I was delighted and relieved as I was terrified of giving birth. If I'd gone on to have another I'd have opted for a c section too.

I get that I'm an oddity but I don't understand the wanting to give birth thing. I was happy to just cut straight to the baby. Pun intended.

Yes. First birth was EMCS. My chances of a natural second birth were low and I didn’t feel confident the NHS would have the resources to keep a close enough eye on issues. Surgeon who did ELCS said it was a good job it had been done planned with s senior dr during the day so help could be called in, given the mess they found my insides were after the first birth.

Glad to see such positive responses to OP here! I can recommend contacting Birthrights if you encounter any resistance from your NHS trust. I'm in one of the most hard-line anti-ELCS trusts and Birthrights has been so supportive. My main practical tip for anyone with similar reasons for ELCS would be to get your GP to refer you to another trust, if you're willing to travel. This avoids the endless route of perinatal mental health, senior midwives etc. who just try to talk you out of it with misinformation. (Obv not for people who would want a VB and actually need the mental health support).

I had ELCS for similar reasons to welsh and gin - IVF pregnancy, precious MCs and late loss and bleeding throughout the pregnancy
I was under the care of a fetal medicine consultant throughout who pretty much waved through my request but still put ‘tokophobia’ as the reason - presumably for their statistics

I have several doctor friends who had ELCS at the same rate as my wider group of friends, which I think reflects PPs point about older women of a certain income generally erring towards a CS over natural birth

I think a lot of first time mums are really worried about the “interventions” they read about and assume that a c-section would be better.

My experience: I ended up with 2 second degree tears and foreceps (which was my “worst case” scenario before actually experiencing it) and my recovery was MILES better than friends who had c-sections. I felt totally fine after a couple of days and healed perfectly. You would never know now and no issues with incontinence etc after.

Friends with c-sections had various complications (both elective and emergency) including:

• bad reaction to the spinal meaning she was basically parlayed from the neck down for 24 hours
• scar tissue fusing to the bowel and needing corrective surgery a year later
• one who had an elective couldn’t even walk up the stairs for about 2 weeks

They all talked about needing their partners to hand them the baby for several weeks after as they couldn’t bend down etc and this is a totally bonkers thing to volunteer for in my opinion! Even with my high intervention birth I was totally self sufficient straight away!!!

I know everyone has different experiences but I would just say for my c section it was only two days I needed my partner to support with handing me the baby. When I went home after the hospital on day 4/5 I easily walked up the stairs to my flat (2 flights) and no problems bending over / sitting up at all.

My sister had a VBAC and couldn’t walk or leave the house for a month whereas I’ve been up and about since a couple days in.

So ultimately you can’t predict.... sorry that isn’t helpful at all!

. I told the consultant that I will never consent to forceps. She said of course - except in an emergency she would use them.

Loosely translates as ‘We can use them and will use them whenever we want to’

I had an emergency section on Saturday morning and was discharged lunchtime on Sunday. Honestly the recovery has been a lot better than I thought. I was up and about within six hours of surgery and my catheter was removed, and I managed alone with baby while DP went to get sleep. Took me a bit longer to get to her and I had to be cautious, but I wasn't immobilised or unable to get to her (and if I was, I had a call button for midwives). The pain hasn't been that bad - I've not needed anything other than paracetamol and ibuprofen. I'm actually pleasantly surprised by how straightforward it has been and I'm now pretty much fine, just have to not lift anything heavy. If you have a supportive partner and help, it makes a huge difference).

I had planned for a vaginal birth but it wasn't to be, however I am slightly thankful I haven't had any damage downstairs as that was a real concern for me. I can imagine if it had been a planned section, things would have been even easier, even just being mentally prepared for it.

I meant to say, it seems a bit unusual to me that someone with a section would be unable to pick up their baby for weeks. In the ward I was in, we were all C-sections and all emergencies and everyone was mobile and able to pick up and look after their baby when their partners weren't there. No one seemed immobile or struggling. Obviously purely anecdotal, but I think if you're otherwise fit and healthy and there are no complications, you'll be grand after a few days.

I didn’t even debate it for my first as major surgery scares me more than vaginal birth. I have always had pain having sex and found smears really, really painful (with nurses always telling me I had a ‘small opening’ ) but I just hoped my body would be ok with a birth as it’s different! My daughter was 10lb 2oz, born vaginally and it was a really good birth. I only had minor grazes and a small tear.

This time I will only debate asking for a ELCS if the baby is measuring large again and they want to induce me early. I won’t be induced. However, the thought of not being able to pick my daughter up or drive for 6 weeks and having seen my friends have a really slow CS recovery, when I felt like nothing had happened within hours, puts me off. We’ll see.

" but remember the majority of women have these and the majority have no long term issues."

• did you miss the recent statistics on birth injuries?

Thank you all v v much for your thoughts and research and kind wishes, has all helped a huge amount.

Had low-risk, garden-variety pregnancy throughout although journey to get here wasn't straightforward and I'm 34. I feel less moved by my experience of birth and more motivated about the end result (appreciate the pun @AfterSchoolWorry).

I take the point about recovery; just seems as though it's more of a known quantity with ELCS and less clear whether it'll be a dream or a nightmare vaginal birth and recovery.

Also not feeling worried about pain in the moment of labour and delivery - no doubt it will hurt more than anything ever - but I think I have that in its place. My major worry is long term after effects on continence, muscle tone and sex life.

Very lucky that ELCS is an option in my Trust (although have met with resistance in some quarters) and MW has said since the start that the door stays open. Her advice was to note my wish to reject forceps in favour of EMCS on birth plan, when we come to making one in a couple of weeks, but I understand a) it is not always that straightforward and b) she is on the home birth team and cannot be there so it is up to the person in the room on the day, who may not share her view on my options. I'm worried we'll be bounced into continuing with interventions I don't want because it's harder to defend yourself when things are moving in the moment, theatre/consultant may not be free etc. And indeed it may be the safest option. I just know I would prefer ELCS to that.

@Bisquick thank you so much for sharing your story, I'm so so sorry about your son.
@hipstercat I can't thank you enough - hadn't come across most of these references and I've been reading around the subject casually for a while. Very grateful to you for sharing.
@clairestandish I think that's where I'm at right now. The reg I went to see (to speak about process of ELCS) offered daily sweeps from 39 weeks, intended to make vaginal delivery more appealing; MW chuckled when she read the notes and said that's precisely the sort of minimally effective / overly intrusive medical management we talking about avoiding.
@welshweasel thank you and congratulations on your new arrival!
@Alohomora07 thank you, and congratulations - hope you are feeling OK aside from all this. Been very lucky with MW since the start and her support is the only reason I've stayed relatively calm I think.
@Celebelly ahh mate I name changed for this but followed your story on other threads for many months, huge congratulations on your new arrival, delighted for you! thanks also for sharing your story, great to read both that it went well for you in the end and you're feeling good, and your thoughts on the process.

Saw another thread mention the hierarchy of perfect birth and do realise it can go well or badly whatever your approach. I would love an intervention-free, no/minor-damage-only vaginal delivery, but since the stats plus my family history suggest that is really quite unlikely the more known quantity of ELCS feels more appealing, accepting that even that may not be straightforward or free from long-term after effects.

Another maybe shallow question - has anybody had any after effects on sex and continence from ELCS? Or EMCS for that matter?

A better scientist would have framed the question more neutrally but I think I have given the - probably correct - impression I am looking to be talked into ELCS. I think on balance we're still likely to call it and book in in the next month but will keep an open mind for the time being. Apart from needing to finish the nursery furniture there's a big part of me wishing for a fast ball and vaginally delivered small bundle of joy at 37 weeks. Or a stork 🤷

Off to read these links and papers. Thanks very much again all x

Trying to decide between ELCS and normal vaginal birth myself - have vaginismus and this is an anxiety- filled IVF pregnancy. So hard!

@cannonball8726 really sorry you've had a tough time and still have a tricky decision to make, how far off EDD are you? I don't know anything about the implications of vaginismus on vaginal delivery, presumably it's a complicating factor rather than something that stands to benefit from pushing? Hope you are getting plenty of support from MW etc over the best course of action anyway, can't be easy at all. FWIW I think you're very brave; pretty certain I'd go for ELCS if I had any reason other than feeling precious about my body to steer away from vaginal delivery x

I'm not planning on having anymore dc but if I did it would be elcs. I had emcs last time and elcs the time before and I've been told that if I want to try a vba2c then I would have to have constant monitoring, tied to the bed, strict time limits etc. I know I can't labour like that so I won't be trying. I found my elcs was absolutely awful but it was a little bit better than emcs.