Elective C-section v vaginal birth

[Hoping23]

Hi all, just wondering about perspectives on elective C-sections versus vaginal births (assuming that all goes smoothly in the latter case).

I’m giving birth in August and meeting with my midwife next week for the first time. I have heard a range of opinions on this subject but recently had a very strong opinion from a close friend that has made me want to look into things more.

My friend had three elective C-sections for her children and Is practically begging me to consider doing this myself.

There was no reason for her having the C-sections beyond maybe that she was in her 30’s rather than her 20’s. Her obstetrician strongly recommended it as a matter of course and the reason he gave is that vaginal births damage pelvic floor in a way that is often irreparable and will cause incontinence. He told her if she had a vaginal birth she would laugh at work and urinate and obviously that wasn’t a nice thought.

Instinctively I would lean towards trying to have a vaginal birth, just because it seems strange to me to bypass a natural process in favour of surgery. I’m also nervous about the idea of my stomach muscles being compromised by surgery (I know pregnancy is already going to do a number on them). I’m a professional dancer so this is foremost in my mind.

Anyway my friend was so confident and pressing with her advice that I don’t want to just go with my instincts and end up regretting it when I’m an incontinent old lady before my time! Also on reflection my sister in law chose an elective C-section for her birth and she is a doctor… I have to wonder if she knows something I don’t. We are not really close otherwise I’d ask her to weigh in.

Can I get opinions and thoughts from those who’ve faced this dilemma? Thank you!!

Your friends experience is anecdotal just like everyone else's experience. Just because something happened to one person does not mean it will happen to you. I also think it's absolutely awful that an obstetrician would say that about peeing yourself at work like it happens to everyone. It's common but not 'normal'.

Anyway I would encourage you to read the positive birth book by Milli Hill which may help you to make a more informed choice. It doesn't preach about vaginal birth but gives pros and cons of all types. However it does dispell the myth that pregnancy and birth are always traumatic and awful which just isn't true. Tv dramatises it and you're more likely to read about bad experiences here on Mumsnet because normal straightforward experiences are not interesting or don't need advice.

My c-section was amazing. No issues with recovery at all.

A very personal choice - complications can arise from both but the one thing Id try and remember is that csection is major surgery. Although it may go smoothly and there be no issues with the recovery, it will take longer to be out and about than compared to a smooth vaginal birth. Not everyone gets a prolapsed bladder/uterus and tears can even heal on their own. There are options so don't be cajoled into a making a choice. Good luck

The risk of long term incontinence following birth is higher for obese and older mothers, and is nearly three times higher after vaginal birth than Caesarian section. These figures are from a Swedish 20 year follow up of several thousand mothers. There is a reason why many female obstetricians choose a section for their own deliveries.
OP, you should discuss the risks in your own case with your obstetrician, and make a decision that is right for you, rather than your friend.

After being being left with a horrible fistula after my vaginal deliveries I'll be having a ceserean this time round.

Did your friend go private or is she abroad? I can’t imagine it being recommended as a matter of course so you don’t piss yourself at work on the NHS unless there are medical reasons she hasn’t mentioned to you. And telling you not to bother speaking to your midwife is terrible advice, unless you’re going to go private too. If you’re not under consultant care already and you did want a maternal request ELCS then you’ll need the midwife to refer you so obviously that has to be the first conversation. I’ve had 2 sections and they were fantastic- surgeries went well, no pain (although it was sore), good recovery and all muscles including stomach and pelvic floor are in good shape. However, you need to make your own informed decision. Your friend sounds weirdly invested and just plain wrong about some stuff so I’d take her out of the equation completely.

I'm angry your friend's doctor said such rubbish to her. Two vaginal births here and I can laugh and sneeze without peeing myself.

Please read the evidence around childbirth to make your decision. The positive birth book is a good source to start with.

I've had 2 sections for medical reasons. One planned and one emergency.

Both procedures were fine. But the recoveries were long (months) painful and awful.

I always wanted 3 children but won't as I couldn't put myself through it again. It's major surgery and I wouldn't recommend it.

Had a vaginal birth with my first, all went well, no tears etc. Was up probably 20 mins after the placenta was out and in the shower (though it did feel like my insides were going to drop out of me!)
However, my son had passed away before birth, and as a result there was no 'rush' to get him out and no limit on pain relief for me.
With my second I opted for an elective section (due to the loss of my son and potentially triggering trauma) and this was a wonderful experience. We walked down to theatre, all of the staff were amazing. 10 minutes after the operation began my little girl was out! There was music playing, everyone was so relaxed, and we got some fantastic photos/videos of my baby girl arriving into the world 💖

theres pros and cons to both.
not had a c section but I’ve had 3 straightforward vaginal births and had a small tear with each which required a few stitches. No incontinence problems.
found l our excruciatingly painful each time but recovery very quick each time.

Everyone’s experience will be totally
different but I’ve had three vaginal births and am definitely not incontinent!

Personally I wouldn’t be putting myself through surgery unless there was a clear medical reason for doing so.

Her obstetrician strongly recommended it as a matter of course and the reason he gave is that vaginal births damage pelvic floor in a way that is often irreparable and will cause incontinence. He told her if she had a vaginal birth she would laugh at work and urinate and obviously that wasn’t a nice thought.

The obstetrician is full of shit.

I’ve had two vaginal births in my mid 30’s- DS1 was OP and so an episiotomy and ventouse was needed after two hours of pushing.
DS2 came shooting out- second degree tear.
Neither were the hellish experiences some make them out to be- I was stitched up both times and healed fine, and after having DS2 I had a Mummy MOT where she assessed my pelvic floor and said it’s in really good nick for someone who’s had two babies. I have the occasional leak if an especially powerful sneeze catches me unawares but that’s about it. I was fit and well enough to train for and complete a half marathon within a few months of having both DC.

It’s well known that there is a divide between OBs and midwives about which is the better option- OBs either do planned sections which are usually lovely, calm, relaxed experiences, or unplanned sections which are necessary when something has gone awry with a vaginal birth. So naturally they think elective section is the way forward. Midwives deal with vaginal births and so usually believe this is the better option. The divide is also apparent in the way pregnant OBs (or wives/partners of) and midwives choose to have their own babies.

Ultimately there are risks and benefits to both vaginal births and elective sections. An elective section is by no means an easy option- it’s massive invasive surgery that can have a tough recovery which isn’t easy with a newborn.

You have plenty of time- do lots of research, see if you can get some statistics from your Trust around c sections, vaginal deliveries, birth injuries and so on, and make an informed decision on what you feel would be best for you. Don’t take secondhand advice from your friend who may just be looking for you to validate the choice she made, or her obstetrician who, if he really did say that, is an ignorant pig.

I had an elective section (medical grounds) and it was great. I was up and about as soon as I could weightbear after the anaesthetic wore off. The post-op discomfort was entirely manageable - the only time I really thought "oww" was when I naively tried jogging 4 weeks later... and promptly decided to wait a bit longer! My abdominal muscles are probably a bit weaker than they were (I do feel it when I'm out hiking) but not massively so. I've a small overhang at the scar, but everything healed really well and it's hard to say whether that would have been the case anyway post-pregnancy - I'm back in pre-pregnancy size clothing anyway.

All in all, an ELCS was the right choice for me. That does not mean it's the right choice for everyone.

I'd suggest looking at your local delivery options - what do you have available in your area, what are the local complication rates for women like you and babies like your baby? Think about things like staff experience, how easy it is to access interventions if you need them (eg if you might want an epidural), what happens if there are complications (would you need to be transferred elsewhere and how would that happen?)... You could look at CQC reports, Care Opinion, etc, and you could start a thread here asking for opinions of your area's maternity options.

I'd suggest you ask your midwife too. I found mine really professional and helpful with giving balanced information.

Older than most of you ladies but here goes! I’m very petite and was huge when pregnant 30 years ago. End result was labour of almost 30 hours, resulting in stuck baby who was 8lbs 6oz and forceps delivery. Baby had broken collar bone and I had huge tear. Have since had 2 anterior repairs and 2 posterior repairs due to the damage to my pelvic floor. Had there been evidence to suggest the position of my baby and the size I would probably have had an elective caesarean - however I think my circumstances were extreme and the difference is there is a lot more information available nowadays. Out of my group of mums - all mid late 30’s I was the only one with that level of damage.

I know a lot of doctors. The female ones all chose elective sections and the male ones all strongly encouraged their partners to do the same.

I have had 3 sections, the first an EMCS and second and third elective. I had them at 25, 28 and 42. The recovery from all was fine, walking around same day and absolutely fine within a couple of weeks. Most people I know who had vaginal births took longer than that to recover and many of them have continence issues years later.

That's my anecdotal tuppence-worth.

I’m like your friend and had an ELCS for my first, mine was more due to the severe phobia I had of giving birth though but of course bypassing some of the incontinence issues is definitely a bonus. It was great and after hearing horror stories my whole life about people’s vaginal births and everyone almost making a joke out of wetting yourself as a normal part of your daily life just because you’ve had a baby, I was really pleased with my choice and can honestly say my bladder situation is no different to pre-birth. I’ve never leaked urine when laughing etc and went back into running after having baby with no issues. A friend has just had to have her second surgery to try to correct her bladder issues following a vaginal birth as she was so miserable about the fact she kept leaking urine and had to wear tena ladies everyday. I’m sure there are people who don’t have terrible after effects of a vaginal birth though and people will say you can get the bladder issues either way but the stats do show you are way more likely to have issues going down the vaginal route.

You sound like you would like to try it though and most people do, I think that’s normal. I feel I’m more abnormal for having an ELCS for my first and I’m now having one for my second in August. I didn’t even blink when thinking about my choice for my second but it’s what you want to get out of the experience. If you feel like you’d look back and wish you’d been able to try or wish you’d got to experience some of it then give it a go. People can give you all the risks and stats but it’s down to your personal opinion

Will you be taking any antenatal classes OP? These would be a good way for you to find out the facts about both types of delivery to help you make a decision. You should also be able to take a tour of the hospital/birthing centre you’re intending to go to.

Just to add to the anecdotes for what it’s worth: I had two very straightforward vaginal births, one in hospital and one at home. They were great experiences, and I would choose vaginal birth if I was ever going to do it again (I’m not- far too old now!) I didn’t need stitches and had minimal damage. Recovery was fine and quick. My bits were sore for a couple of weeks afterwards and I had a couple of piles (delightful). Also burst a blood vessel in my eye with the effort of pushing DS out but that cleared up soon enough (just not great for the newborn photos 😂)

My pelvic floor was ok afterwards- it’s now that I’m in perimenopause that it’s weakening. Several friends who had C Sections are in the same boat so I don’t think choosing a CS will guarantee freedom from pelvic floor weakness.

I had an elective C-section because the alternative was an induction (which I was afraid would lead to an emergency C-section). My husband, a paediatrician, had a lot to do with it. I think he was more afraid of a natural birth than I was. Said he had seen so many horrible things happen to babies who were induced and he didn't think it was worth the risk. The surgery itself was fine, but the recovery time was A LOT longer than I had expected (I was still sore after 6 months), I hate the pouch I have, and I know future pregnancies will be more complicated now. If I could go back, I think I would have wanted to try for a vaginal birth.