Elective CS or epidural birth for a mum with tokophobia

[Scaredmama1023]

I’m FTM, 37w and due at St. Thomas’. I’ve dealt with severe tokophobia since I was a child, which is why I’m finding this so difficult.

I requested an elective C-section, but I haven't received a date yet.

Honestly, I’m still torn. Part of me wants to try for a vaginal birth with an epidural, but my anxiety around the pain of early labor and the possibility of the epidural being delayed or unavailable is keeping me up at night.

I’ve tried seeking advice on Reddit, but I found the responses were very woo hypnobirthing. I'm down for breathing exercises. Just not vagina opening like a flower type messages.

I am a healthy 37-year-old, I exercise, and I’ve prepared as much as possible for a vaginal birth (like used Epi-No (a dialator, similar to aniball) up to 8.5cm already, eating stuff like dates that have some tiny good epro labour evidence etc.). Baby is in the right head down face to back position. However, I have a very low pain threshold and massive anxiety. My consultant has documented my request for an epidural as soon as I am in established labor, if labouring naturally. I have a tens machine and anything else that can help.

Given the choice, would you opt for the elective C-section for the relative safety, or stick with the plan for a medicated vaginal birth? I’m looking for honest experiences, especially from those who have navigated birth anxiety or already went through it. I understand everyone's experience did different. I just don't fancy a surgery... But I also don't fancy being in agony for days and denied eoidural or ending up with episiotomy and foreceps :/

Given that vaginal birth often ends in emergency C-section anyway, I'd go for the elective. You also won't end up in a situation where the staff who admit you decide to "give you an opportunity to try it without pain relief" despite your documents.

I also requested a C/S for tokophobia and it was the best decision I ever made.

I don’t know if I technically had tokophobia but I have PTSD and knew from before I got pregnant that there was no way that I would be having a vaginal birth. I just couldn’t contemplate it to the extent that I would have terminated the pregnancy if I didn’t know that I would be able to have an ELCS. My ELCS was a dream, the staff were fantastic, I was up and about within 24 hours and had a very easy recovery. Wouldn’t have done it any other way.

C section can also get delayed etc but i found it easier personally, and they can delay you for other emergencies but as Pp says they can’t decide to just let you go longer before administering it. That happened with my first when I was induced, it was too soon for an epidural and then the staff member got called away and couldn’t do it when it was time, and then it was too late for one.

The hospital you’re giving birth in might not be as understaffed as the one I was in for my first baby but I requested an epidural and by the time the anaesthetist was free it was too late, my contractions were too close together. It wasn’t something I had foreseen happening!
I have a friend who had tokophobia and she opted for an elective and I think it was the most positive experience she could have hoped for.

My sister has this and had a planned c section. She paid for it privately.

it went so well that she went on to have a second baby. She really had a wonderful experience with the c section both times.

up to and including the planned c section itself, the midwives were trying to advise her to ‘go naturally’ which there is no way she would have been able for. She did the right thing 100%.

Very best wishes to you.

I was the opposite, terrified of a section and had a breech baby was trying the hypno birthing to calm me down. I was so much calmer when the section was taken off the table (baby flipped) so I think if you can agree elective now it will save you stress and anxiety.

Elective cs. Calm and lovely. Easy recovery for me.

It is as if I never gave birth (and in a sense I did not). Some women will not like missing out but I don't feel I missed anything.

Opening like a flower made me think of a Venus flytrap! I think you need to do what suits you but have some skills if it doesn't go to plan. An elective sounds like a good fit. But maybe you go early and it's fast. Maybe the hospital is having a heat wave and struggling with capacity or a birth wave and there's a delay.

Make sure you do know how to breathe through a contraction. And if you can stand a bit of woo, if you did end up having a vaginal birth and you got to the ring of fire (this brief painful moment you want to push but shouldn't yet), the woo you need is to slow down and imagine you are walking slowly into a calm cold lake. I also had a mantra- it's only a day, I can do anything for a day.

But assume you won't need it. You'll go in well rested, have a common procedure they do everyday and come out with a baby.

I’ve had both an emcs and a VBAC with episiotomy. It basically comes down to pain during or pain after. For my first labour I had pethadene and then an epidural and then a cs. For my second pethedine (I went to sleep for a few while) and then loads of gas and air and local anaesthetic.
I did have loads of issues after my cs that I didn’t have after the VBAC. The cs was life saving for both of us and I was up within hours and out of hospital in less than 36hours. But the recovery was hard.
Just don’t go for a cs thinking it will avoid the risks of a VB.

Elective cs is a surgical experience. You go into a fully prepped theatre and everyone knows what they are doing and get on with it.

You don't have to deal with incompetent midwives on a power trip or worse, no one at all.

An emcs is different from a cs, even in terms of trauma and recovery.

One school of thought is that it is better to go straight to elective (like paying an insurance premium upfront) rather than chancing it as an older FTM with a vaginal birth that could end up with emcs.

Yes an emcs is different to a elcs but the issues I suffered would have been the same.
Im not anti Elcs as I was booked for one for my second but I do feel that the risks of cs are underplayed compared to the risks of a VB which are widely discussed.

You are too late now to to hypnobirthint effectively. I did weeks of listening to a sound tracks and voice overs. It worked very well. Home birth. 10lb baby.

your attitude to something though that could possible help you with your phobia is odd. Surely you’d do anything you could….

I have had an EMCS and an ELCS, worlds apart but then I was a Cat 2 with a baby in distress. The ELCS was planned, I had a date, I could mentally prepare and I knew what was happening.

Labour on the other hand, all bets are off, see my EMCS.

I’m glad to hear you had a positive experience, but I think we are looking for very different things.

My goal isn't just to manage my anxiety (though it is also); it is to minimize pain and suffering, which I am just not equipped for (I have an actual phobia, not just regular labour anxiety). My priority is accessing the strongest pain relief available to avoid the trauma (both physical and psychological) of an intense, prolonged labor. For me, that is the most proactive way to look after myself.

I take issue with the idea that I have a 'bad attitude' simply because I don't subscribe to the hypnobirthing philosophy. I’ve done the work of giving it a go. I went to a course and I read one book (I think Positive Birth or something?), I’ve picked the tools that work for me (like breathing to calm me and some mantras/visualisations), but I just don't like anything else and I could never make it work for me. But I also disagree that it takes months to practise it, it's rather trivial.

To me, a 'successful' birth is one where I feel safe, with medically controlled pain, whether that’s via an epidural or a C-section and I end up with a healthy baby and a very smooth easy recovery. I’m not interested in viewing birth through a lens that makes any medical intervention feel like a personal failure because I specifically choose medical interventions as my path.

I've had a vaginal birth with epidural, and 2 planned elcs. All of them went well with minimal pain, but the 2nd elcs was the only one where I had no contractions at all. My 1st elcs was planned, but baby arrived the day before so I started early labour and then had the cs in the evening (which was labelled as emcs even though it was all planned, but just not surgically booked in for that day). Just mentioning that because even if you have a planned elcs, you may end up feeling early labour pains regardless, if you go into labour ahead of the planned date (and they don't like to schedule it too early because it's safer for the baby). I had no interventions with my epidural vaginal birth, but statistically it's common so I probably wouldn't opt for it if you have anxiety around that. And they only gave me the epidural once I was in labour, so again I felt some early contractions (which I'd call uncomfortable rather than painful, but someone with a low pain threshold might call it painful!) My 2nd elcs which went exactly as planned was the only one where I felt no contractions at all. It was very easy and simple - I just turned up, they had the theatre ready and gave me anaesthetic and I felt no pain at all. Definitely the one to go for if you want a calm, planned and straightforward experience.

For me, recovery was easy in all cases, and I breastfed with no problems. What helped most was having a very present and helpful DH (we are lucky that he gets 6 months paid paternity). I would have struggled with lifting etc on my own. But you can get in other family members to help or buy it in also.

Yeah I agree with you, recovery from incision is probably roughly the same.

Though it's true that the recovery of EMCS is statistically harder and all complications are more likely.

For example cuts to bladder are less likely in ELCS as you're rested, they ask you not to drink, your bladder is small and out of the way and you and baby are stable they are not rushing. Meanwhile EMCS you've been eating and drinking the whole day, you're exhausted, uterus has been working the whole day and everybody is rushing.

However I fully agree that C-section recovery is not discussed anywhere near in as much detail as vaginal birth.

To me my order of preference for birth story would be:

1. Easy Vaginal+epidural, no complications or instruments, maybe 1st or small 2nd degree tear
2. Elective C-Section
3. Hard and painful Vaginal with delayed or no epidural, maybe some complications and instruments
4. The #3 AND ending in Emergency C-Section.

The issues is that I cannot guarantee #1 so I'm contemplating #2. But as you are right, I might suffer a good deal with post op consequences and regret it... But I might also suffer episiotomy and prolapse and incontinence so... I don't know. Wish we all had a magic ball with the power of foresight which told us which path to take :(

I had 2 vaginal unassisted births with epidurals. Both were ok, but I didn’t have tokophobia.
What is massively appealing to me about an ELCS is that you don’t have to miss loads of sleep! I was in labour all night with both of mine, and first time round I was so sleep deprived on the post natal ward that I nearly lost my mind.
If booking an ELCS will take away lots of stress and worry for you, that will benefit the baby and possibly outweigh any downsides of a cs

Thanks for your reply, yep I am aware that I might go into labour ahead of my planned C-section date. In fact I think that's likely because I don't have a date yet, it's been weeks and no one called me. I've been ringing the team who does he CS bookings and no-one answers to that. Or emails. So I think it's probable that I might go into labour purely because I have no date for my C-section. But my midwife assured me that if that happens I call MAU at the first sign of any contraction and tell them.

Yeah I wonder how I'd find the early contractions. So I would call myself low pain threshold on account that I just don't like pain, but how to people measure that really? For example I use Epi-No. Went up to 8.5cm in 2 weeks. And you have to push yourself through quite a lot of discomfort. But it is discomfort I know has a time limit and I can stop when it's too much. But then there are ladies who gave it 1 pump and say it's too much but cal themselves high pain threshold.
So I think that definition is quite a bit subjective and imprecise. Maybe I'd find early labour contractions totally fine? Maybe not? Or maybe it'll be borderline, but TENS machine will help? I think in my case panic would do a lot of damage here so I know for sure I need to manage that (I've been practising breathing, but not the same as Hypnobirthing, mostly practising from psychology portals)

I know epidural is only given from active labour (4cm) though my OB has written in my file "from established labour" which is earlier, but as other rightly have written - if I'm unlucky to meet a midwife on a power trip who just declined, then I'm powerless... I do worry about that.
To your point about instruments... I don't like the idea of them, but I shudder at the thought of no epidural at all so that is definitely my preference, even if I end up with interventions. Labouring without epidural is definitely not in my radar (other than I accept there are cases where anesthesiologist is unavailable for like 12h straight by which time it's too late)

Oops replied twice

@MichaelScottPaper I’m no doubt much older than you, but in the 90s it was made very clear to me that an anaesthetist might not be available. I did understand I might not get an epidural. I did really want one and got it - so no drama.

In this case I’d go for a CS. Probably more reliable but who knows? CS numbers are going up because women don’t trust midwives and the recent report is going to make that worse.

I had tokophobia and one baby via emergency C-section after a prolonged labour with epidural. I’d have an elective C-section in your position, no doubt whatsoever. Midwives were obsessed with VBAC when my DC was born and if elective C-section had been an option back then, I’d have had at least one more child.

I had an elective C section because I was scared of giving birth and whether I could manage the pain. No regrets, it all worked very well for me. I think that if you are scared, chances are that you’ll get tense and panic when labour starts, which might prolong it and make it more difficult. If you feel more relaxed about a c section than a vaginal birth then do it!

I was about to say the same thing- cortisol slows down or in some cases can stall labour. Oxytocin is your friend so whichever option will cause less stress is the way to go IMO