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 :/

I personally don't agree with the previous comments.

It's a major surgery, the recovery is usually more difficult, and it can delay breastfeeding or make feeding more challenging initially.

I also didn't have the experience that some people describe, where midwives don't want to give you pain relief. If you're clear about what you want when you arrive, they'll respect your wishes.

With my first baby, I wanted to experience what labour felt like. But after I was induced and reached around 6 cm, everything escalated quickly, and I realized I couldn't cope with the pain, so I asked for an epidural.

The second time, I went in and told them I wanted an epidural as soon as possible, and that's exactly what they did. For me, the idea of not feeling much during labour and "just needing to push" sounds far less scary than having major abdominal surgery and being stitched back together.

I don't think I'll ever see childbirth as an amazing experience like some other women do. I think it's terrifying. But for me, having an epidural made it manageable.

Of course, if a C-section is medically necessary, that's a different situation, but if it's simply a choice between pain relief and surgery, I'd choose the epidural every time.

I actually AM with you on this! I don't fancy a surgery either...

I much rather getting epidural ASAP, going for a nap, waking up to push and that's it, maybe a tiny tear. That would be my absolute perfection of a dream. It's just how often do dream births happen.

I just am likely to panic and make everything worse and wonder what is overall better. The emergency C-Section sounds a lot worse to me than elective one, but of course it's needed and saves lives. And the rate of c-sections in my age group is very high so I am quite likely needing one anyway...

I think the main problem is that I have tokophobia. The sheer idea of birth is really really scary to me so I am likely to panic and make everything pretty traumatic. Even if I cognitively know about techniques etc, I have no high confidence I'll be able to apply them, and I'll need to, in order to survive early labour at the very least. Induction is definitely something I don't want.

I know what you mean. I get very panicky in every situation where I feel like I'm not in control.

All the advice about breathing techniques and imagining calming things just doesn't work for me.
Even gas and air didn't help; I actually think it made me even more anxious.

Even though I've been through it twice (and I'm very lucky that I had no complications either time) and we are now planning for my third, birth still terrifies me.

I think my personality plays a big role in it. I always expect the worst-case scenario, and that makes it so much harder to stay calm.

You sound a lot like me. I would hope with second pregnancy I'd be calmer haha. Seems like might not be the case!

I think for me is less about sense of control. I would gladly give someone reigns as long as I and baby don't suffer and come out the other side in 1 piece. It's a lot about fear. But I really resonate with everything else you said!

I've managed to have two children with pretty severe tokophobia. I had them both by elective section and have zero regrets. Recovery was far easier than I thought, and what I was dreading became two of the happiest days of my life.

I knew far too many people with difficult vaginal births to risk going down that route, and I'm one of the only people I know IRL that talks about their births with a smile rather than a shudder.

It took me until over 20 weeks to get my booking bloods done with my first. I cried repeatedly at my midwife and consultant. I couldn't see a way through it, but I did and I'd do it all again just for the buzz of that first day.

I really wanted natural because I wanted to be up and about soon after, and only wanted to go through surgery if there was no alternative. There is usually a much longer recovery with CS, and you tend to stay in hospital longer, which for me would be a reason to try naturally, but if you don't mind, that's fair enough. If you might be having another baby, in our area you're advised to leave a long gap if you had a CS, but if you only want one, then that's irrelevant for you. Please check with other women in your area who've given birth recently, but there really doesn't seem to be as much emphasis as there used to be on not offering epidurals very quickly. As in decades ago, people used to say they weren't offered one immediately, but everyone I know who wanted one in the last few years got it straight away with no hassle.
And think whether this bothers you-for me, I'd hate going in and then just waiting to go down for the operation and having to wait, if there were emergencies, as in I'd prefer to go in labour at home and not be waiting about in hospital, but again, this might not bother you.

Go for the elective, 100%. I didn't want a section, otherwise open to most things. A growth scan at 37 weeks showed my baby as '93rd centile' and the consultant recommended induction. When it came to it, the only induction method was the balloon, which nobody warned me could set off immediate, painful contractions/cramps. Had that for 24 hours. Then had to wait 8 hours for a place on the delivery ward. They encouraged me to take an epidural so they could crank up the drip of pain to speed up my contractions. Epidural worked for about 1 hour then failed. I was in agony and delirious for the remaining 17 hours.

Eventually, the consultant said the baby was stuck (high up luckily) and wasnt going to come out that way. She said I could wait another couple of hours to see what happened, but it was highly unlikely and that the baby could become distressed in that time. She recommended a section right then so it could be calm and stress free. I had a massive spinal block, baby was delivered safely and I dont regret anything. My recovery went incredibly smoothly, other than my scar, it's almost as if I haven't given birth.

Nobody gets a prize for taking the slow, painful, damaging route. I don't feel I've missed out on anything.... unless you count incontinence, vaginal stitches and a fucked pelvix floor.

Elective C

Just to add, with my first I had zero incision pain. It felt weird when I first got up, like I'd been velcroed together but not painful as such. I literally ended up googling 'when do c sections start to hurt'.

With my second, I had very slight incision discomfort for a few days on an off. It wasn't painful as such, but a mild burning sensation. It reminded me of a time when I had a bag of chips from the chip ship on my lap for too long, and it felt a bit burny. No worse than that and passed quickly.

I've had far more painful periods than my c sections. I'm am absolute wimp with pain btw, so it's not about pain tolerance, it just wasn't there.

I went for the c section as I wanted to feel in control and didn’t want to risk prolapse. It is painful after but you get painkillers.

I really feel for you, it’s so tricky to make that decision. I also have tokophobia and vaginismus (so couldn’t face Epi No, well done you though!). Did hypnobirthing course and referred to specialist psychologist with my first baby and really agonized about what choice to make. Terrified of labour since childhood but wanted to maybe try and overcome it and have a lovely smooth birth and feel ready to pop out loads more! I was 40 with first baby and in the end kind of fudged it so booked in an ELCS at 41 weeks to see if baby might come naturally (but was quite scared that they might). Also have major health anxiety so frightened of c section but knew baby had to come out one way or another and didn’t fancy induction. I was petrified throughout c section literally shaking with fear but everyone was lovely and there was a very excited positive atmosphere in theatre which made it hard to fully convince myself I was going to die. Super quick, no pain just lots of weird sensations that I didn’t like. Baby was great, all good. Spent the night awake imagining I would bleed out but no pain. Home next day. Still minimal pain. No issues with recovery. Good decision all round but now pregnant with baby 2 and feel similarly torn between what to choose. ELSC was amazing and so chill but maybe I could give birth and it would be fine? And I could try for an unlikely 3rd baby sooner (I’ll be 43 when this baby born)?? And be home quicker to be with my toddler. It’s hard! I imagine I’ll go for ELCS (better the devil you know) but it’ll be sooner this time given age so less chance of natural labour starting up before. Good luck with your decision.

I had an elective CS and it was great, I have never regretted it for a second (anxiety about giving birth was my main thing too). My recovery was really easy, yes the day or two after was hard, but I was moving normally within about a week or so and my scar is invisible.

There are a lot less complications from an ELCS than vaginal births, this is born out statistically, and of course is reflected in the ongoing maternity scandals. When my surgeon put down the reasons for doing it on the form, it was 'safety of mother and child' - that's the best reason to choose any form of birth IMO.

some observations from an obs anaestbetist… MN is very polarised in favour of elective cs, but they’re not always the beautiful calm spa-days you read about on here and the complications that everyone seems to skim past do happen in real-life.

there are national standards for the time in which an anaesthetist is usually expected to be able to respond to an epidural request (but even now sometimes the rate limiting step is the MWs actually telling us there’s been a request). It isn’t always possible (or safe) to site an epidural and they don’t always work perfectly. It is worth looking at the labourpains.org website if you haven’t found it already.

there is an alternative pain relief called remifentanil that is sometimes useful in labour and I’d imagine is probably available at tommies if an epidural weren’t possible/didn’t work.

it’s important to think about how many children you’re planning to have - the incidence of pathological placentas is increasing now and that is largely due to the increased number of sections.

there isn’t really a guaranteed pain free way to have a baby and one of the big problems with giving birth is that you only know it’s going to go smoothly after it did go smoothly. Completely reasonable to request an epidural asap, but it’s important to be aware that it doesn’t always mean there’ll be no pain.

having an emergency vs elective section will make no difference to how full your bladder is because they site a catheter to make sure it’s empty and reduce the risk of damage. Some women do have ‘higher’ bladders though regardless of how full they are.