VB vs Caesarean: what should I do?

Justine Davies
Justine Davies 

I am 6 months pregnant with my first child and I am sure that I want to have a caesarean. I've told my obstetrician and she is happy with that decision – but some of my friends aren't.

Frankly I've been gobsmacked by the level of criticism from some of the 'friends'. I’ve been accused of everything from endangering my baby’s health, to not being a real woman, to setting up future bonding problems between my baby and me. I wouldn't care if the comments were coming from people I don’t care about, but these are comments from otherwise-rational women.

The reason that I'm determined to have a caesarean is so that I don’t damage my pelvic floor. My sister damaged her pelvic floor muscles so badly after just one kid that she had to go into hospital for an operation to stop herself from weeing every time she sneezed. No thanks!

Am I really condemning my child to a bondless life of ill health by having a Caesar??? I'd love to hear from some women who have been down that path. Thanks.

Not Posh.

Don't let their comments sour your friendship though because I'm sure that they are genuinely trying to help you.

Hi Not Posh.

Ah, to be sure, it sounds like you have a 'wee' problem. Such are the dilemmas of the affluent western world, where a “natural” drug-free childbirth is a luxury.

Firstly, as far as your friends are concerned, you should thank them for their advice but remind them that at the end of the day it’s your body and your child. Don't let their comments sour your friendship though because I'm sure that they are genuinely trying to help you.

With regards to the whole pelvic floor and wetting your pants thing, I have asked the advice of Professor Euan Wallace, who is the Clinical Director for the Monash Institute Centre for Women’s Health. http://www.monashinstitute.org He is a scientist and also a practising obstetrician and if anyone can give you the lowdown on … err … low down, he can.


"The simplistic answer is that pregnancy itself causes some damage to the pelvic floor," he says. "Labour and childbirth carry risks of extra damage."

Basically, according to Professor Wallace, there are two types of pelvic floor damage:

  1. Bladder weakness (incontinence). This is where you can find yourself spurting a little bit of wee when you cough, laugh, sneeze etc. This affects up to 20% of women who have been pregnant.
  2. Bowel control problems. Much, much less common, this is where, when you need to do a poo, you need to do it now. If you're on a car trip, there's no 'holding on' until the next town. That tree over there will be just fine. This type of problem is far more likely to hit women who have a vaginal birth, particularly if it was a long labour or assisted delivery (forceps, etc). It affects only around 2% of women though. Note: carry toilet paper in handbag at all times.
  3. "With regards to sphincter damage" (I am tensing my butt cheeks as I type this) "the main issue is probably that the damage is not always being recognised and repaired at the time of birth," says Professor Wallace. "If it is recognised at the time, a couple of stiches are all that is needed to rectify the problem".

Which just goes to prove the saying that a stitch in time saves nine!

"Overall," says Professor Wallace, "a vaginal birth is safer for the mother than a caesarean section. With regards to safety for the baby, the difference has never been studied in a clinical trail to determine if one method is safer than the other."

So, Not Posh that's the news from the street. If the only reason that you’re wanting a Caesar is worry about your pelvic floor, then it's probably not going to make much difference whether you push or not (provided the medical staff give your girlie bits a good looking over after the birth). If, on the other hand, you simply want to have a Caesar anyway and your obstetrician is happy with that, then go ahead. Honestly, whether it's your stomach or fanny that ends up being sore, provided you have a healthy baby you're probably not going to give it another thought.

EB Members: What's your advice? Comment here.