Which mode of birth would you choose in my situation? Struggling here

[Missmonkeypenny]

Background : pregnant with DC3. DC1s birth was forceps delivery at 42 weeks,very traumatic, DC not breathing, PPH of 1.5L
2nd degree tear, needed a birth debrief. DC2s birth was wonderful, induced at 38 weeks due to a LGA baby +polyhydramnious but wonderful experience, just gas and air, active labour was 5 hours and 0 stitches for minimal grazing.

DC3 is a whole other kettle of fish. Current 32 weeks. Since 18 weeks I've had bleeding. At first it was suspected to be a hematoma but it transpired at a 26 week growth scan due to DC2s size that I had an extra placental lobe covering the cervix, a form of placenta previa ( main placenta is anterior high ). Between 18 and 32 weeks, I've had 17 bleeds. All of those after 23 weeks (11 of them) have been overnight hospital stays, all have meant having a cannula in, steroids at 27 weeks and meeting NICU team as tightenings after a bleed, nil by mouth at 30 weeks due to tightnings after a bleed. Told explicitly I'd need a section due to placental lobe location, would need a scan at 32 weeks to check to see if it had developed into Vasa Previa with the vessels running across the cervix would have meant a section between 34-36 weeks. Had a scan at 28 weeks which showed the same thing, panic stations from medical staff, told go to in for any bleeding/pain/tightenings etc, keep a very close eye on movements. 'High risk of placenta abruption and fetal demise' were the words used multiple times. I've not slept properly for 3 months, terrified I'm going to wake up in yet another puddle of blood. DC1 is an anxious wreck worried Mummy won't be there when she wakes up again ( lots of the bleeds have been in the early hours of the morning ). I had to stop working as a bleed = needing to go straight in without waiting for someone to cover me which wasn't feasible in my job.

So I went for that scan yesterday with fetal medicine, DC has turned head down and it's bloody moved. After being told it wouldn't move, it's bloody moved and now I don't know what to do. The lobe is 17mm away from the cervix, they like it to be 20mm away for a vaginal delivery but apparently 17mm is fine because it's a lobe not my main placenta. The consultant has booked me in for an elective section between 37-38 weeks and has said I can choose what I want to do but my brain is absolutely fried. Its been such an anxious, uncertain pregnancy and the only thing which was certain was the non negotiable fact I needed a section and I was counting down the weeks until then so I wouldn't have to be pregnant any more and now it's another choice I have to make. Seeing the fetal med consultant again at 35 weeks for another scan.

I'm just exhausted and don't know what to do.

The best vaginal births (not even thinking about medical complications) are when the mother can be as stress-free as possible. In your shoes I would probably go for the c-section, just so you can stop worrying about it. But it needs to be about which option would make you the most comfortable and relaxed, as in the end that's what's best for both you and the baby.

Stick to plan A. It’s not selfish, your DH already planned to have that time off, and you need the certainty for everyone in the family.

I'd have the section. They'll be prepared and ready for emergencies and it will have a measure of control.

I also had a rotational forceps first birth with permanent injuries to me. Then an elcs for my second and final birth.

Recovery from the elcs was so much easier than recovery from the forceps. The latter left me needing a catheter for months and lots of follow up.

The priority here is to keep your life safe. You have two children who need you. Then your new baby's life.

Given the huge bleeds and massive issues you're managing day in and out now, it seems highly likely the managed theatre based birth with a team of staff has the best chance of getting both of you through the birth safely and well.

I was in pretty much an identical situation in my first pregnancy.
Section booked for 38 weeks, scan at 34 weeks with a low lobe, scan at 36 weeks lobe had moved enough for a vaginal birth to be considered a safe option.
I chose to have the planned section, and it was definitely the right choice for me at the time. In another situation I probably wouldn't have had a section, but in that situation it felt like the best option for me and I don't regret it.

Only you can make the choice, but either choice would be valid, it just depends what would be right for you. Good luck with making your choice.

I would go for the section. This was the original plan and has more certainty and control. You’ve had such a stressful time, at least this would give you some certainty. I’ve had two sections and they were both positive calm experiences. Within a few weeks I was back to doing most things (except driving) and my husband was back at work. I do understand though it was easier in my first pregnancy when baby was breech as the c section was the obvious choice but when it’s more up to you it can be hard to decide. But trust your initial instincts x

I'm with @Megan2018 here OP. It seems like the worst bit about your situation right now is the stress and anxiety put on you by the uncertainty of things, anticipation, unknown and always changing risk factors, etc.

Give yourself something to hang onto and some reassurance with foreknowledge of what's going to happen. I'd stick to the scheduled section. Organize your hospital stay and PP recovery, relieve everybody including your older children of that fear of the unknown, take back control over your circumstances. You need some peace of mind through all that ordeal !

I had a traumatic first pregnancy - hyperemesis gravidarum, severe pre-eclampsia and pre term delivery at 32 weeks.

I am going for elective c section this time because i feel after being so out of control last time, at least it's something i can have some certainty over.

I understand your concerns about having the csection when it's technically no longer required. But, your mental health and wellbeing for the remainder are important too and if going with the planned c section helps those things, it's worth doing

@Missmonkeypenny

Thank you all, lots to read over and consider although I'm surprised by the apparent landslide answer.

I'm aware a C section is a valid birth choice but I am also aware of the implications of one (not driving, having two other children at home, husband having to take more time off etc ) and feel selfish for considering it when it isn't ' necessary' any more

Protecting and promoting your mental health is so important when you’re having a baby, and in your case even more so after everything you and your family have been through. If an ELCS does that for you, then I would say it is necessary. Good luck OP.

@Missmonkeypenny

Thank you all, lots to read over and consider although I'm surprised by the apparent landslide answer.

I'm aware a C section is a valid birth choice but I am also aware of the implications of one (not driving, having two other children at home, husband having to take more time off etc ) and feel selfish for considering it when it isn't ' necessary' any more

Maybe the landslide answer will help you feel less 'selfish'. This is not only about what's best for you, but what is best for the baby and the least risk. And to be reassured that the healing from elcs is pretty straightforward. I was walking the next day, albeit painfully. I had a 2 and a half year old. You can prep for meals etc. if you know when the baby is coming. If your H gets the full 2 weeks off, the healing should be well underway.

It's not really a case of it being 'necessary' or not, though.

For this birth, a section is the safest option still.

I wouldn't run the risk. You have risk; you can limit it - I would.

This is also in the context of having already had one good birth, and one quite bad one!

It's also a better idea, if a section is in the picture, to go for a planned one and not end up with an emergency

Gosh what a worrying time. I would choose the section. Have the decision made and know you you are heading towards.

Good luck

Start preparing the children for it just in case. I had trained my 20 month-old to independently climb onto the sofa and up the stairs as I knew I wouldn't be able to carry/lift her for awhile following c section. Everyone's recovery is different, mine wasn't easy but I was able to drive again after three weeks. Get as much help as you can from family and friends. My DH combined some annual leave with paternity leave which was an enormous help and meant I wasn't on my own with the kids until DS was 3 weeks old, but I appreciate not everyone would be able to do that!

Section definitely. You have nothing to prove. It's the safest way to get the baby out in many scary situations and if there was the slightest doubt that this was one of them then that is what I would do.

I'd go for the section, for all the reasons PPs have outlined above. You've had a very stressful risky pregnancy, there are still many unknowns, and actually 6 weeks of physical recovery is preferable over a traumatic and potentially dangerous labour which will also have long-lasting effects for you and affect how you are able to parent.

For what it's worth, I've had an elective C section and it was really lovely. Good luck whatever you choose, OP, and well done for getting this far through an incredibly scary experience.

In a pregnancy deemed to be at risk for risk factors that caused no complications I pushed back on talk of consultant care, inductions etc. I ensured they qualified there conversations with me with facts. My birth was totally different from how they told me it would be.

However in your situation I’d take the planned section. You have been through a rough time! You deserve some reassurance and certainty. It’s not at all selfish.

@Megan2018

Stick to plan A, have the section. Give yourself some certainty. You will go in to labour full of worry otherwise and that’s not going to make it easy.

This is what I would do too. I had an EMCS with DS and it was a really positive experience overalll. I imagine an ELCS being even moreso.

Section. I had very similar experiences as you for my first 2. First was gruesome and 2nd was over in minutes. I was half hoping number 3 would at worst case scenario be something between the 2. It wasn't, it was on a par with the first but with complications which meant I ended up in hospital for nearly a month.

Thank you again, you've had me in tears this afternoon with your lovely encouraging and supportive words. Will spend some time this evening discussing things with my husband as I'm yet to tell him how I'm really feeling about things - have been walking around going I'M FINE for months now and this feels like the straw which broke the camels back