38 weeks and c section has been highly recommended

[Millennial92]

Hi, I posted here when I was very early into my pregnancy about having a planned c section. I had a 3rd degree tear with my first, an episitomy, forceps delivery and bad bleeding. Recovery was horrendous for me, took a year of physio and intimacy took maybe longer. All is well now but I went into triage this morning as I have some problems down below and felt baby wasn't moving much (all okay) but I have an ulcer and some tearing down there which I'm being referred to a specialist for. The lady was a gynaecologist who said she was really recommend a c section as she now deals with these ladies who tore more than once during vaginal birth and also considering my skin isnt in great shape down there... I need to make a decision very soon and need to hear others experiences. My main concerns over c section is the pain after, I'll admit the scarring and overhang is really a concern too. Then I have a two year old along with a newborn. Obviously with vaginal birth I'm scared of another tear, forceps and it leading to problems in the future.

Thanks for any advice.

@Craftysue this would be my ideal second birth to be honest for it to go smoothly. Your first birth sounds horrible though I'm sure you were very nervous about the second time.

@Millennial92 it sounds like you want a c-section so go for a section. There are risks but there are risks with vaginal (as you know!) and you are higher risk. You get to book the date, know when and where it’s happening and if you are getting anxious maybe that certainty will help?

Yes, I think the fact the gynaecologist is recommending it is key. They deal with the surgical side of birth injuries and complications more than midwives (who OP said have recommended vaginal I think).

Hi OP I had a planned c section and wasn't in a lot of pain at all. I was worried about pain too and was advised by the professionals that it's actually not a particularly painful operation afterwards and this advice was spot on. I have a very low pain threshold and didn't need the maximum pain relief. You can have paracetamol, ibuprofen plus oramorph which is an oral morphine. I didn't need to take the max of any of it at any point.

My recovery was quicker than friends who had forceps/scars/had to be cut.

Scar wise, mine is barely visible. A planned c section is done in such a calm fashion - I feel like they have more time to get it really neat. I used bio oil on mine. I was out on gentle walks from day 4 and felt stronger every day. I don't have an overhang and I'm half a stone heavier than I was pre pregnancy.

I would take the c section hands down - your recovery and long term health will be much better.

And good points that the consultant sees more examples of when it goes wrong. My experience is that more qualified professionals (in any profession) who see things go wrong have a more realistic view on risks. No disrespect to midwives - but they see the vast majority that go well. Your history already places you at a disadvantage for doing well with vaginal, hence the advice you've had.

I’ve had 3 c sections that I didn’t want and would always be saying go for vaginal birth if possible, but after your issues after your first birth and the fact that your skin there is ulcerated and tearing already I would be opting for a c section. I didn’t get an overhang with mine but it depends on each person’s body shape, surgery, wound healing, weight, etc. I definitely have a more rounded stomach from them but I’d take that over increasingly fragile genital skin and issues. Recovery from my C-sections was absolutely manageable, no real pain after 10 days on my first (even less on my further two but the first one your body is unprepared for it).

I've had two c sections and one natural birth. My c sections were a walk in the park compared to the natural birth. Lovely, calm and smooth. Back to normal within a few weeks. No lasting effects.

Hi there I am sorry you have been so stressed out. I think you need see a Consultant obstetrician or a Consultant midwife ASAP to go through all your options. One option might be to decline induction and go for an elective Caesarean. On the other hand, I have seen women arriving at 8 cm and still insisting on a Caesarean. At which point it's no longer an elective Caesarean, it's an emergency one and the risks are higher. In my hospital women still get it because my hospital is very risk averse. Hospitals can get sued very easily these days. I can't really comment on your pelvic floor. It's not professional to have this kind of discussion over Mumsnet chat. I suggest you go to the Maternity Assessment Unit and insist on being seen either a Consultant obstetrician or Consultant midwife within a few days. Either would be fine. You need for someone to review all your risk factors and to make a detailed plan to take into account as many scenarios as possible. I hope it helps

I’d choose a section in this case

I am 2 weeks post c section, days 2/3 are the worst recovery wise but I feel completely normal and pain free now. Yeah the c section scar/overhang is a pain but I couldn’t really care less as it ensured both of us left safe and healthy.

I had a c section at 37w2d after a failed induction. I only have one child so no experience of any other labour but after the initial first days I was fairly ok to move as long as I was careful. I met with an obstetrician due to being high risk and he said the optimal week to have c section is 38. He was happy for me to try vaginal delivery but had a feeling I would end up needing intervention, which I did. I would try to meet with an obstetrician again and go with their advice. While in my c section I remember thinking why was I so negative about it during the whole pregnancy for no reason as it was so straightforward.

I had an emergency c section, the first day was tough, but once up and walking I was fine. I had no problems lifting baby and got better much quicker than my cousins who were nursing tears!

@Millennial92 the more you post, the more I'm sensing that you want a c section. I never needed one so I don't have experience (so feel free to ignore me) but if I'd had a first birth like you describe I reckon I'd be demanding one.

That said, with my first I had an epidural and forceps, but I was lucky and healed very quickly. I tore after my second, and that was trickier to recover from than the epidural. With my third I had barely a graze. So subsequent births can be much easier.

However, it sounds like your consultant is gently steering you towards a c section, so in your shoes I think I'd take their advice. I also think you'll feel better once you've made a decision.

Aren't most of these risks with a 'bad' vaginal birth also? I'm not saying you're wrong, just that really it's a risk of giving birth full stop.

A group of 5 of us gave birth same time. 1 elective section, 2 emergency c-section, 2 vaginal births. One that had the vaginal birth lost the most blood because she haemorrhaged. She didn't even need any stitches and was an otherwise textbook birth. The other vaginal birth the placenta wouldn't detach and she ended up in theatre for manual evacuation. I was one of the EMCS and lost the least.

If OP tears badly again that would bleed and need stitches which could get infected just as easily as c section stitches. If she isn't very mobile because moving hurts because of the tear then that immobility also has a blood clot risk.

Of course a 'good' vaginal birth with no tearing or stitches is going to be better than any c section recovery, but sounds like OP is pretty much guaranteed to have some damage happen.

I had a c section due to previous pph and episiotomy etc.

I hated the entire thing, recovery etc.

However in your case i would definitely have a cs.

d'you mean your perineal tissue breaking down already? I'd probably put more weight on the advice of an obstetrician with an interest in perineal repair/pelvic floor than anyone on here or perhaps even anyone IRL who has less of an interest/experience in the longer term consequences of perineal injuries. Things I might ask them would include a) if they think there is something causing the current skin breakdown that might mean that another tear is likely and b) do they think the current skin condition might mean that affect how well another repair might heal (and I guess, if there is a skin condition causing it, could it be something that could affect healing from a c-section too, or does it look like 'just' a perineal problem) c) are there any other things in your medical/obstetric history that need factoring in (eg obesity, diabetes, infections, predicted size of the baby, etc).

Just an update.. I'm booked in for a c section hopefully early next week. I also had a growth scan and baby is measuring big predicted over 9oz by 40 weeks. I'm very nervous and feel a bit of guilt for choosing a c section in the end but after speaking to the doctor he said I can't turn back time if things don't go as expected with a vaginal delivery. Now I'm just hoping I don't go into labour beforehand! Also very nervous about the actual procedure I'm so squeamish!

I just need to do all the research about recovering from a section. Even though I felt I done so much research in recovering from a 3rd degree tear and it didn't make much difference 😅

Honestly OP, I did nothing beyond the things which were common sense and was fine. I have a barely there scar now - that my doctor couldn’t believe at my 6 week check up even. It only took a few months for it to go like a very thin trace. I also have no overhang despite putting on a lot of weight in pregnancy!

Just make sure you follow the medical advice to take it easy for six weeks eg no vacuuming! I was advised to only let soapy water run over it in the shower and I left it well alone otherwise - no lotions and potions or anti-scarring products. Even much later on. I was squeamish before it too so felt like I wanted it to dry and heal ASAP. You see lots of bad advice on the internet about covering it with pads and things like that (I don’t mean in the initial days when the stitches are covered for a v short period) but it needs air. Get huge waist-high knickers in plain black cotton so they don’t irritate it.

Wishing you the very best.

Don’t feel guilt- you really don’t need to. I get it, I somehow feel I haven’t really given birth (2 sections for medical reasons) but your baby will not care. They will be happy and healthy- and so will you! Hope everything goes to plan, you’ll be fine. Only thing to consider is driving- I spoke to my insurers and they said fine to drive when I could do an emergency stop but some are different and want 6 weeks no driving.

I had a very very similar first birth to you OP, recovery was just horrific - and i think that’s putting it lightly. I ended up having bad PND and do blame lots of that on my birth/ how bad recovery was. At the time i was so sure i would never have another baby because i couldn’t go through it all again. I’m now 29 weeks pregnant and have opted for an elective section and i couldn’t be more happy with my decision. The team at the hospital have been SO supportive of it, i have requested to meet with the consultants multiple times which they have accepted and i have already had 2 and have another 2 apts booked in to go through all my worries and answer questions. I know the thought it scary, after all it IS major surgery so it can’t be a piece of p*as really can it haha, but has to be better than what unfortunately we sound like we both went through the first time.

You do what feels right for you, ask a million questions and whatever you decide will be right for you. But also do take note of the professionals are advising section, they will have seen this so many times and know the outcome so will only be advising what they think is best for you x

At Millenial92 This sounds like a good plan for you, especially in view of a large baby. I hope you have a beautiful day. Don't worry too much about the operation or recovery. Lots of women have a Caesarean, you will find the way. Good luck

My scar is virtually invisible.
I didn’t have much pain afterwards.