Maternal Request ELCS or vaginal birth - confused after discussion with consultant

[Ravencrow]

I am 33 weeks pregnant and I didn't think much about how I want to give birth until about 20 weeks when I was told my placenta was low lying and may need a ELCS if it doesn't move. At this point I started doing some research and also did the PBC online Hynobirthing course. This really opened my eyes to all the potential interventions which can occur during a vaginal birth. I started to feel really anxious and that an ELCS may be better for me as I would be able to plan, prepare for recovery, and have a better idea of what's going to happen.

I found out last week that my placenta has moved up enough to allow for a vaginal birth, however I was still thinking about the ELCS so I requested a meeting with the consultant.

The consultant made it very clear that he can't say no, but ideally would want to. He signed off on it and said I would get my date, but really pushed all the risks on me and made me feel as if I was doing something wrong by asking. I didn't get much of a chance to discuss my concerns about vaginal birth but he made it clear that he thought vaginal would be best choice for me and all risks would be much lower.

I'm feeling so conflicted. I've read so many wonderful birth stories and would love a vaginal birth if it could be guaranteed that it would go as I want it to. I've also read some absolute horror stories and learned about the complications which can come along with vaginal birth.

I feel very uncomfortable with the idea of vaginal examinations, sweeps, induction, interventions such as forceps or the internal monitoring clip. I would hate to go through all this during a long, painful, tiring labour - which could still end in the interventions I want to avoid or EMCS.

I am in constant pain from Pelvic Girdle Pain and have barely slept for my whole pregnancy and I would hate to go overdue and feel like this for longer, and I'm so worried about having a painful, traumatic birth.

Does anyone have any insight or experiences that might help me make this decision?

Hi I dont have experience but I do empathise with you. I have the same fears but have made the decision to go for a vaginal birth and am being induced tomorrow. I went through the pros and cons with my midwife and consultant and both were clear the decision is entirely mine. Yes some vaginal births end up in intervention but that's not necessarily a bad thing and many people still have a positive experience even if it isn't a 'straightforward' birth. My opinion is that you often hear of the bad experiences but that's because people are more likely to talk about them. I think the key thing is having trust in the staff and knowing they do it day in day out and will know exactly what is best for you and baby at the time. I'm lucky that I have a few friends that have recently given birth at the same hospital and whilst they weren't all smooth, pleasant experiences they had nothing but praise for the doctors and midwives. It's a personal choice only you can make but dont be distracted by the horror stories the vast majority of births are straightforward.

Sorry I don’t really have any advice but have the same experience of consultants, a c section is major surgery and so they do encourage vaginal births when of course there are still risks to this. I had a traumatic first birth and so was absolutely set on an elective c section this time, i’m now 39 weeks pregnant and have had a change of heart and am going to cancel the section and try to have a more positive vaginal birth. It’s a hard decision but it’s entirely up to you so don’t feel pressured either way, for me, I was induced last time when I don’t think baby was ready and so i’m hoping things can start naturally this time and go more smoothly! I have a toddler at home too so am hoping for an easier recovery. While it’s good to educate yourself, i’d try and not read too many horror stories, people are more likely to share these.

It's entirely your choice and you should go with what your gut is telling you.

My first labour ended up going exactly not what I wanted and I ended up with an EMCS. I opted for an elective the second time around, but it wasn't without its own difficulties. This time around I've been told I'm having an elective so the decision is out of my hands anyway. In some ways I wished I'd have tried for a VBAC second time around but in many ways I had much more control.

There are many women who give birth vaginally who have zero complications or interventions. In fact, I'm the only woman in my family and close friendship circle (except one) who had a difficult birth and c sections. Everyone else I know breezed through and was absolutely fine. Personally for my first birth I wanted to at least try and do it vaginally, if it didn't work out then so be it. You never know until you're actually in the swing of it and it sounds like it's fear of the unknown for you.

Entirely your choice, they do push the risks of a c section but never highlight those of a vaginal birth.

I chose a c section after doing a pregnancy yoga and hypnobirthing course. I didn't want an induction due to the higher risk of an emergency section/intervention and an emergency section after labour was my worst outcome.

I know it's major surgery but if you read people's experiences a planned c section is very different to an emergency section and they lump all the risks together. My planned section was wonderful and my recovery quicker than a lot of friends who had a vaginal birth. I was out and about 4 days after my section and managed on paracetamol after day 3. I'll be having another with my current pregnancy and looking forward to it! Go with your gut.

I also have severe PGP and horrible tailbone pain since week 15 and my OB-GYN gave me the option of an ELCS. I will be going for ELCS. I do also have an existing hip injury which labour would definitely make a lot worse so the ELCS is in great part because of that too not just PGP.

A prolonged birth etc could injure me further and leave me in pain after birth so I figured I'd rather have the C section.

Also, a planned C section is a LOT better than an emergency one!

You CAN have a vaginal birth with PGP but you'd need good midwives who understand it, help position you and move you (not on your back etc) and I decided I don't trust them.

Note I have private healthcare (not the UK although I am from the UK, I just live abroad atm). The NHS seems hellbent on not performing C sections from what I hear from my family and friends.

Are you FTM? And did they give you the leaflet about c-section risks etc? I read in it that one in three attempted vaginal birth by FTMs turns into emergency c-sections, and half of the rest need instrumental delivery. So I went with ELCS and it was very smooth and stress free. Recovery was quick and easy too (heard it's better for ELCS than emergency ones). I went home the next day. Hope it all goes well for you!

It does seem odd that you're very focused on the risks of a vaginal birth but seem to be dismissing the risks of a C section.

I suppose a lot of this is FTM anxiety, which we all suffer from and does make it hard to decide.

Even a text book section leaves you debilitated for weeks and always scarred. It also makes it difficult to get into your routine with the baby as you're dependent on others for ages. After a textbook natural delivery, you're strolling around within hours.

Fine to choose whatever you want but do weigh up both sides equally.

Personally I had two vaginal deliveries and then a planned CS and I'd rather avoid another section if I was doing it all again tomorrow.

I’ve read this to help decide

https://www.rcog.org.uk/media/lbhdfdrf/pi_considering_caesarean_birth_updated-links2.pdf

The most interesting bit for me is these statistics…

I had an emcs and a VBAC. The emcs wasn’t a dashing down the corridor one, it was a nothings progressing one. The VBAC was so much easier, not during it obvious is was really hard work but I was back to normal so quick and I had an episiotomy.
The emcs went well but sex was agony for a year and I was doubly incontinent for a few weeks. Not all the time but too much to go out and about
If I had a third I’d go for another vbac.

Not true at all! I was in horrific pain after my vaginal birth and in hospital for a week for me and baby.
Elected C-section I was out the next morning with minimal pain!

Sorry just to add - that RCOG document also confirms 1 in 2 vaginal births for first time mothers require assistance, and 1 in 3 require an emcs

I was really torn too but I'm so glad I opted for a vaginal birth. I needed an induction. The gels didn't work for me and I had a very long labour. I ended up on the drip and it was a relief because that sped up my labour. The pushing stage was fine and I didn't need forceps or any intervention. I used gas and air.

I've heard some awful stories about c sections and how women still feel numb many months later and they end up with a shelf. There's risks if you have more c sections in the future.

Edited to add that I had PGP and sciatica during my pregnancy.

I’ve got insight and experience and my advice is to go for the Elective Caesarian.
Hands down…..
I had Placenta Previa with my first and haemorrhaged at home, leading to blood transfusion and Emergency Caesarean.
My second child I chose elective.
I have no experience of vaginal birth but my sister had 2 vaginal and 3rd elective Caesarean, she definitely would recommend Elective and I would stick to your guns with the Consultant.
Hope this helps with your decision….

Thanks everyone for your comments, it's helpful to read different perspectives. Unfortunately many women I've spoken to personally have had traumatic births, often ending with an EMCS.
Just to clarify I am a FTM and also this is very likely to be my only pregnancy!

@LiterallyOnFire no it doesn't, not for everybody I was up and about in less than 12 hours! No numbness, no scar issues - that doesn't mean no risk but you have to decide what you're most comfortable with. The risks of a c section are shoved in your face (so nobody who asks for one can ignore them!) but they don't ever highlight the risks of a vaginal birth going wrong for Mum or baby and I see them every day in my job.

Also with the statistics for a planned section this includes women with significant medical needs who have no choice but to have a c section so there will be some higher risks reflected in the statistics there.

I have friends who wouldn't consider a section and I totally respect that but people don't equally respect a decision around a c section.

I had an Elective Caesarian. It was my birth plan from day 1. The Midwives were supportive but one of the Registrar’s at the hospital laughed at me and said that ‘it doesn’t work like that - I cannot just request one’. I was 38 weeks pregnant at the time and turned She-devil on her.

She stepped out of the room, had a conversation with the Consultant in the corridor … within earshot - and was back in that room writing Caesarian on my notes within about a minute.

They don’t want to do them… stats, cost etc…This is why they try and put you off, but it’s a valid choice.

The hospital where I had mine at the time only carried out caesarians in 8% of pregnancies (electives must have been a tiny proportion).

If you want an elective then don’t be talked out of it OP!

@Ravencrow
Hello there,
I'm a FTM mom too at 34+3 weeks. I am going for an ELCS despite not having any problems with my placenta position or otherwise.
I'm curious to know what risks your consultant spoke to you about because my doctor said there aren't very many risks with a planned c section.
Just like you, the idea of sweeps and inductions scare me and my doctor tells me that people at her hospital do not opt for epidural which means I would be one of the first few if I ask for it which further sealed my choice.
I'm very comfortable with my choice. I like to know when I'm going to have my baby and I don't care to labour for long just for the experience.
So it's up to you, I understand your anxiety, I was the same way. Just know that either way, your body was made for it.

Me too, 3 of my close friends in the past 2 years and 5 out of 7 of my nct group had long drawn out births that ended in emcs.

Absolutely do what you think is right for you. There are many things at play when consultants try to persuade you not to have sections, but you have a right to one if that's what you choose. Far too much is taken out of our hands as mothers.

I only know one woman who had an emergency c section. Most had vaginal births and a few ELCS. I had a very long labour and didn't need forceps or anything like that. There are risks with vaginal births and c sections.

www.tommys.org/pregnancy-information/giving-birth/caesarean-section/c-section-benefits-and-risks