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.

“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?

Hi Not Posh,

I had a planned c-section 8 weeks ago and experienced similar extreme reactions from both friends and work colleagues. People were either highly supportive or highly negative - I was amazed at how strongly other people felt about the issue and how quick they were to question whether I was "too posh to push".

I can only speak for myself however my c-section was a wonderful experience and I do not at all regret my choice. There have been absolutely no bonding issues with my beautiful daughter and I recovered from the op very quickly.... Bear in mind however that not everyone does recover quickly - it is major surgery and should be viewed as such!!

Ultimately, you have to be comfortable with your choice. If you go into it believing that you may have regrets in the future or that other people's views are likely to get you down then it may have a negative impact on how you feel about the birth.

It's a tough one....

Wishing you all the very best whatever you decide.

Sandee

Hello NotPosh
I had an elective CS with my first child 6 years ago. We have just discovered we are pregnant again and will be doing exactly the same thing this time round. My recovery was excellent, did not affect my bonding nor my breast milk coming in.
I went home on day 4 (tried for day 3 but doc said no) and on day 8 walked 2kms to hospital with pram to deliver thank you gifts.
My mum was extremely supportive as she also had me the same way and this made a big difference. My husband was very happy with the decision and I am pretty stubborn - I was set that this is how it would be. Cord wrapped around baby's neck at 36 week ultrasound made very sure of it.
If you do decide to go ahead with an elective caesar - make sure that you read up on all of the ins and outs and prepare yourself mentally. I had decided how it would be and how I would recover - and so it did.

Good luck with your decision. There are no medals for long and painful births - just safe and healthy babies. Do what works for you to reach that goal.

Regards
gurunakal

Hi Not Posh,

I think the other posters here have given some great advice. You have outlined why you want to have a CS - your fears around pelvic floor issues (which of course you would be frightened of with what happened with your sister). I think ultimately your decision should be an informed one - and that relates not only to information about pelvic floor problems but also CS information and any other fears you might not be expressing about a vaginal birth. In the end if your decision is based on knowledge rather than fear - you will be happy with your choice. Pregnancy and Childbirth are such wonderful experiences - whatever path you decide to take. All I would suggest is for you not to make this decision based solely on stories of other women's experiences (which sometimes can sound a little scary). Maybe to get a better idea of VB you should go to the library or book shop and look at Sheila Kitzingers book on childbirth. She has some amazing pictures and information that might help you frame this debate in another way.

Good luck with making this decision - and dont forget that the birth is only one of many steps in becoming a parent.

Take care
Alphia

I am booked for a C-section on 25/09/09 only reason is because bubs is frank breech and even then i get funny looks so dont worry its your body AND your decision.

I am starting to get sick of the comments like "what a shame you cant experience labour" well um the OB is the professional and if she says C-sect is the way to go so be it LOL

You have a legitimate reason for having the c-section, lets see who decides the same way when its their turn

Good luck

Kell

Hi there,
It's a huge thing hey. I had a planned c section 2 1/2 years ago with my daughter due to placenta pravia and at the time I was a bit disapointed cos i had to go down that road. once i'd dealt with that I didnt really care, cos the most important thing is to get a healthy baby and be healthy myself. I recovered really well compared to lots of my friends who had c sections, but it was still really painfull and full on, and made things mor difficult afterwards, especially not being able to drive. But it didnt affect my bonding with her, and I dont regret it at all (not that i had a choice!)
I'm currently pregnant again and due in 6 weeks. I have just found out that I have a big baby and am trying to decide if i try a vaginal birth and risk an emergency c section or just go in and have a planned c section. at the end of the day I dont cat how it comes out, but it would be easier to not have major surgery to recover from with a new baby and a toddler. Still trying to make up my mind on that one!
In regards to the incontinence thing, I get a little bit of that, which, like one of the others said, can be caused by just being pregnant itself, so thats something to be aware of. I have friends who have had vaginal births and some have incontinence issues and some dont.
Good luck with your decision - just remember to do what is best for you and bubs, and what makes YOU happiest - after all, it's your body

Hi Posh!

I think I am lucky that I got to experience 1 of each births. First one VB, no drugs, huge tear, took 7 months to heal properly, I have major bowel and bladder incontinence which is so much fun.
When I chose to have an elective c/s last year, I was even given a hard time from some friends for this. I was petrified of giving birth naturally again!
I look back on my decisions now and have no regrets as I have 2 gorgeous little girls. Go with your instinct and dont look back.

Ive also had a planned c/s, but not for your reasons. I have also gone on to have two VB, both of which caused no extra damage to my ladies garden I had a fantastic c/s and easy recovery, but I would still choose my VB's anyday.

Gee a lot of first tome posters in such a controversial topic

Hi there,

of course it is your body and your choice. One of the things you'll learn in becoming a mother (amongst lots of other amazing things) is that everyone has an opinion on everything you do. Particularly on EB!!! It's difficult, but you have to learn how to take people's advice and use it the way you want to. Sometimes you get advice which is great, sometimes not. There will always be someone ready to criticize the way you are giving birth to your child, raising your child......zzzzzzzz....... it gets old and extremely annoying after a while.

I have not ever had a c-section so i am not qualified to speak about them. Although i know many women who have had c-sections and are fine, although all of them prefer VB. But it is up to you - you know your body and my theory is that it is far better to have a good birth experience than a traumatic one, simply because you feel the pressure to be a "real" woman. Load of s*it.

That said, i'll put this out there - has anyone told you about pelvic floor exercises? There are tons of exercises that you can do to have your pelvic floor super strong so that it doesn't get damaged during labour. I've had two babies, both VB and my number 2 bub was 9 pounds 5lbs!! my pelvic floor is going great guns i can sneeze, do star jumps, cough, the lot!!! - i made sure i did my exercises before and after birth. It might be worth looking in to. Any physio can help you with this.

Good luck

"There are tons of exercises that you can do to have your pelvic floor super strong so that it doesn't get damaged during labour." Good comment, elliemay. Regular pv exercising before, during and after pregnancy definitely makes a difference!

.

At the end of the day it's your choice although I think why subject yourself to major surgery?

I am all for going natural. Our bodies are pretty well designed for it. There are so many horror stories about VB that the good ones are never mentioned. You go into it with so much anxiety!

Not everyone has a bad experience. After the birth of DD I wanted to do it all again!

- I had a natural, drug free birth after 4 hours labour.

- I had a small tear in my labia that healed well. It looks and feels the same and for DH it hasn't been like throwing a sausage down a hallway

- Slight bladder incontinence afterwards however friends have had the same after a CS. All good now.

- Got piles after but again that isn't just a VB thing.

- I worked with my body through each of the stages and it amazes me still what it is capable of doing. Your hormones kick in and although at times can be painful it was all over when bub was out. You are left with the most amazing feeling of relief.

- I was able to walk around, I was never drowsy.

- It was the most incredible feeling in the world when I saw my baby and I was so glad I was completely clear headed to experience it.

- My baby was alert and feeding straight away. She even had a nicely shaped head!

- I was able to pee unassisted, I didn't need help to hold my baby. A CS is major surgery and you will be restricted as a result

I'm sure you've done enough research to know all the reasons why VB is best for baby and even for your own recovery so wont go into all that.

All the best with your decision although sounds like you've already made it. There are a few good forum topics on natural labour on here that you could have a look at if you wanted to entertain the idea.

I cannot or no one can make you decision for you but I have a personal belief vaginal birth is better for the majority of baby and mothers (no major medical issues such as placenta previa etc..)

Here are the reasons why and there is some research and stats to prove why vaginal birth in a healthy pregnancy is better for the baby.

1.Statistics have shown that most caserean delivered babies are born before maturity. This is why I always say to women who choose a caserean to wait until labour starts then proceed to have your caserean.

2.Studies have also shown that catecholamine is mostly found in children from Vaginal Birth. This contains a greater part of the hormones necessary for the baby’s survival and is secreted from mother to child in larger amounts during childbirth paving way for the baby’s survival outside the womb.

3.Babies born vaginally have a lower risk of respiratory problems. It is widely accepted that the contractions of labour help prepare the baby's lungs to breathe air. Babies born by caesarean section have a higher risk of respiratory distress syndrome than babies born vaginally at the same gestational ag(.A Guide to Effective Care in Pregnancy & Childbirth, Third Edition, by M Enkin, MJNC Keirse, J Neilson et al, p362)

4. Adults with asthma are more likely to have been delivered by caesarean section compared with adults without asthma.(AIMS Occasional Paper 'Risks of Caesarean Section - research papers' p2)

5. From Dr Greene website -One of the benefits of vaginal birth is the gift of Mom’s beneficial bacteria to the baby. Normally, these quickly take up residence in the newborn’s gut. Cesarean sections can be life-saving interventions, but the sterile environment they require can change or delay beneficial bacteria making their home in the baby’s intestinal tract. Perhaps this is the reason that cesarean section delivery increases the risk of food allergy by 106 percent and the risk of infant diarrhea by 46 percent compared to vaginal birth, according to a study published in the November Archives of Diseases in Childhood. This study followed
865 healthy, term, breastfed babies to look for changes in allergies and gastrointestinal illnesses after cesarean deliveries. Despite the food allergy and diarrhea evidence, there was some good news for families who had cesarean sections -- this study found no increase in colic, crying, or eczema following cesarean delivery. Still, this study supports a growing body of evidence that beneficial bacteria play an important role in the developing immune system. Other studies suggest that breastfeeding mothers can help their babies, however they are delivered, by eating foods such as yogurt that contain beneficial bacteria or by taking probiotic supplements themselves.

6.The passage down the birth canal also gives a baby a wonderful all-over massage that wakes up various systems in the body – cranial osteopaths claim to be able to detect whether a baby was born vaginally or by caesarean.


More Benefits of vaginal birth......(off King Edward Memorial Hospital Website)
• Less blood loss.
• No complications associated with surgery.
• Less infection.
• Quicker recovery time.
• Fewer complications for future
pregnancies such as, the placenta growing
into the scar on the uterus which can lead
to severe bleeding.
• Less risk of the baby having breathing
problems.

Some statements from the aims organisation in the UK sums up exactly how I feel about it. Have put the important bits relevent to what I see in BOLD.

When the birth has gone well mothers feel stronger, both physically and emotionally. There is a wonderful sense of achievement and peace, of strength and control, of health and completeness, of being able to cope and get on with life in general. It is a very positive life-changing experience.

That women are prepared to opt for major surgery in preference to undergoing labour and birth in our hospitals is an indictment of the maternity services. Normal, healthy women carrying healthy, term babies no longer feel safe and confident about giving birth under the current model of care. Until such time when true midwifery can come to the fore and women are given the emotional support that they need, then it is likely that numbers of women needing to opt out by requesting surgery will continue to rise.
In this 21st century there are two routes of birth, one is abdominally via caesarean section and the other is vaginally through the birth canal. As long as vaginal birth remains an unacceptable option women will continue to need the only other possibility available to them.

There are many very good reasons for having a caesarean section and with a little forethought and planning the operation can indeed be a wonderful experience. There is also no denying that a positive caesarean section is infinitely preferable to a traumatic vaginal delivery.

But what too many have lost sight of, is that even the best caesarean can never hold a candle to a good experience of giving birth to your baby yourself.



I agree. I also think the benefits listed above outweighs the risk of pelvic floor damage. I also think majority of women sustain pelvic floor damage because of their vaginal birth choices ie. laying on their back, choosing an epi, directed pushing etc. If you think the caserean is the easy way out you are wrong, as most caserean mums will tell you it can take longer to recover and until what I bolded above starts happening you will also have to fight for a normal natural safe vaginal birth in our current medical system.

Read, read, read and get some good support! Good luck with your choice.

as a CS and 3 time vbac mummy I would choose a VB any day. The euphoria of a natural birth can never be matched in an operating theatre. And I had more wee issues after my CS than after any of the VB's. While I respect your decision, I really do think you may be selling yourself short choosing a CS for your first baby.

It's now well known and supported by most recent studies that much of the pelvic floor weakening and damage is done by the pregnancy itself and not the way you birth. Making it a reason to have major abdominal surgery is not a very good one. Even the most common perineal tearing (second degree) is not as deep and wide as a 10 cm cut to your belly layers and uterus. I do agree that 3rd and 4th degree tears which are not common at all are a different kettle if fish and an elective c/section after having these is probably recommended in most cases.

Also think about your future children. Make sure you are aware of secondary infertility and placental adhesion problems (placenta accreta, increta and percreta) when trying for another child. Scarring on your uterus may prevent any future pregnancies from implanting and make you more susceptible to adhesions, placental abruption, placenta praevia, severe haemorrhaging leading to emergency hysterectomy. It's not a simple decision as everyone makes it out to be.

Hi Not Posh

I'm a mother of four. My first birth was by caesar, not by choice. However at the end of 48 hr I think a bit longer labour I was definitely ready to get her out by any means possible. I mut say though that my body wasn't ready to have her as I was induced. After her my healing wasn't too bad but there is a lot I couldn't do. I found it hard to do my pelvic floor muscles which really is a must. Bonding was a breeze. Whoever said you don't bond with your baby after a caesar is honestly full of it.
I've also had three VBAC since then and plan another with the child I'm carrying now. The difference in the births is huge. Healing time took next to no time at all. You're up and about straight away. I was doing pelvic floor muscle exercises straight after birth and I found that I tightened up really fast and easy.
For myself I prefer VB's. However it really is up to you and what you can handle. Also your support after birth and your birthing support. The decision is all yours. I truly think that the key to a good birth is to have no expectations and have an excellent midwife or dr to guide you throught it. Everything else will fall into place.

I've had two caeser's and both due to medical complications. I had wanted to try for a vb but no such luck. However, from my experiences I can see why a caesar might be appealing to some.

I am an anxious person and a control freak to boot. For some reason a caesar just strikes me as a far more controlled situation than natural labour. I was frankly quite scared of natural labour no matter how much research I did. I don't tend to go with the flow very well and having a ob in charge of my delivery seemed more controlled than mother nature. Note to whoever may argue against this, this is my perception - rightly or wrongly, this is how I saw/see things.

Having said this, I did want a VBAC with DD as I anticipated a far easier recovery from a vb than from a caesar. It was about 3 weeks before I could bend or move comfortably without fear of pain after the c-sec. On the other hand, I don't have any problems with my pelvis. I had amazing bladder control and certainly no other issues. My SIL had such a traumatic labour that she had severe tearing, bladder problems and ultimately a prolapse cervix which finally led to a hysterectomy during which she nearly died. So I can definitely understand your fear.

As a PP said, motherhood comes with all sorts of opinions, both welcome and unwelcome. Ultimately you need to decide what you're most comfortable with.

I wanted a cesar with my first and begged my Ob the whole nine months - he was reluctant to agree and thought I was crazy to want a major operation when there was no need for it.

Well, in the end I was booked in for the cesar and arrived at the hospital - no excitement, felt reallly weird driving there and strange that I was just going to get my baby out the next day! So... I changed my mind, went back home and did it the natural way.......my god I am so happy that I didnt go through with it, I ended up having a normal, textbook birth (long) but so exciting to do it myself - and I feel so proud and have no regrets, I just have fantastic memories of when my waters broke, rushing to the hospital, ringing the family for the exciting news!!

I have no pelvic floor problems, I did a little of the exercises but was quite slack really, my second birth was much quicker and not as painful and great memories also.

GOOD LUCK it is a hard decision - I just wanted to share my experience.

It's fantastic to get so many different views and the benefit of so many different experiences. Thanks so much to everyone who has shared so far.

Hi there "Not Posh",

You poor thing!!! I too damaged my sisters view of a natural birth. She was in the birthing suite with me and was so freaked-out by how much pain I was in she went straight for a cesarean with her first child.

I have had two natural births and, yes, it is absolutely scary and painful but I am now trying to conceive my third child and will go through it all again because I just believe it is apart of the process. My "down there bits" have suffered a little, but nothing major. It really is amazing how the body bounces back from that sort of event.

What I'm saying is that you shouldn't let your sisters bad experience influence your decision. Do as much research as you can on both options and look into your heart for your feelings on the issue. Not everyone's body is damaged by giving birth naturally. Just remember that a cesarean is major surgery and the recovery is (apparently) a lot longer and more painful.

Natural was the only way for me, cesarean was the only way for my sister. You still bond with your child regardless of how they they come into this world and I can't comprehend how people close to you would suggest otherwise.

Anyway, I could go about this forever, but I wont bore you with it.

Just do whatever you want to, either way you're still going to have a gorgeous baby at the end of it.

Cheers,
Megan

I don't have an additional advice to add except to say that I can understand why some people might respond negatively to your decision. Despite the fact that it's your decision and no one else's business, if someone thinks you're making a decision that is not in the best interests of your child then you can understand why they might disagree with it.

If you think of any other situation where someone might intentionally choose to do something that puts their child at a higher risk than he/she otherwise would be, without what they see as a particularly solid reason, then perhaps you'll understand where your friends are coming from.

I'm not saying this to change your mind, simply to say that there are sincere and fairly valid reasons some people find it difficult to hear about women who make this choice, in the same way they hate seeing a pregnant woman smoking a cigarette or getting drunk.

Just presenting an 'other side' perspective. And I'm not in any way saying a decision to have a c-section actually DOES equate to as a bad a decisions as smoking during pregnancy, just using it to illustrate a point....!

I'd be interested in actual facts about the safety of c-sections vs vaginal on babies, since the OP's expert seems to say no studies have actually been done. I had thought it was generally agreed that vaginal posed less risks for a baby under 'normal' circumstances but now I'm curious as to where this idea comes from.

frankly i am shocked at your selfishness just being pregnant is enought to weaken the pelvic floor muscles . I have had five children 3 viginal births 1 emergancy ceasar (3 months prem with twins) and 1 planned ceasar. So if anyones pelvic floor muscles are shot they should be mine BUT if you excercise they stay strong as mine have ,my mother only had one child and she has had to have an op to repair her pelvic floor but she never once did any excercises. Also if you for go the natural birth now the chances are you wont be able to have a natural birth in the future .

Both my bubs were natural (vaginal) births and I had no tearing, ripping or stitches for both. And, the only leaking I've ever had was only the occassional sneezy wee during pregnancy.

My pelvic floor is just as strong now as it was before babies, and I'm no mad pelvic floor exerciser either! In fact, I was really lazy about doing my pelvic floor exercises before, during and after each pregnancy.

It just goes to show that each woman's body is different and that there are no hard and fast rules about what will happen with yours. Just because a lot of women experience something doesn't mean you will.

All the best with your birth, no matter which way you decide to do it. In the end, bub is what is important, as is your happiness. Do what you feel is best for you and your bub and don't let other people's judgements get in the way. No matter what you do, someone somewhere (usually the childless) will always think they know better!

hi i had 2 csers as first was emergency breeched after 15 hours labour i had choice in second wether to have vb or cser i chose cser as i didnt want to put my baby at risk gyno ended up nipping my bladder and now preg with 3rd baby i have trouble holding bladder even though i did do pelvic excercises to strengthen muscle.
11yold girl and 21 m old boy and 21 weeks preg with girl
i also have bicornurate uterous anyone else in my position i would love to hear from use thanks

.

.

because being pregnant, giving birth and raising a child is the most selfless thing to do.

I had a VB then an emergency cesear, and I would "recommend" if you were choosing the VB hands down anyday. for all the reasons other posters have written.

You're right Cathode, my examples was too extreme - apologies.

Re the pelvic floor damage thing, I don't think necessarily having a c.section will avoid that! My DD was a VB and I had no pelvic floor problems post her birth. DS was a CS and I have had pelvic floor weakness since his birth (and I was a religious at doing my pelvic floor exercises with both pg) . From what I understand pregnancy in itself causes damage.

I have experienced a natural VB and an CS (emergency). Even so, I don't think I can say one is better than the other definitively as it birth of any form is so different and individual for each woman. both my births were complicated and traumatic and both types for me were horrible. Overall I say my labour (which incidentally I laboured to 10cm dilated) with the emerg CS, failed spinal, GA and PPH was preferable to my VB which had numerous complications. But obviously someone else would find differently. Thats why I tend to get annoyed when people claim to know best for other people!!

As for bonding, I bonded beautifully after DS' CS birth despite it being under a general and not being at all straightforward. I was feeding him in recovery 30 mins post op and it was instant bonding. I didn't get to hold DD after her VB until 6 hours later, I bonded with her too of course, but it was a bit different.

Good luck with your birth whatever way you choose.

I don't have a scar on my stomach or on my fanny

Personally i would like neither ,but taking my chances with a vaginal birth meant i came out "intact" both abdominally and vaginally.

As PP have said 90% of pelvic floor damage is done during your pregnancy.

Good Luck with your decision Not posh. It's always good to make an "Educated " decision, not on based on fear. So do your research properly is my only advice.

if your unsure about vb or caesarean the csection ive heard from alot of clients that it not only left scars but also left them with continual overhang of their stomach.

ive had a vb myself which shouldve been a csection but due to being in the public system the student dr let me tear apart full recontructive surgery of inside and outside of both vagina and anus he was too big had told each of the drs in the public system even the dr on that day that all of the females in my family had problems giving birth and they didnt listen n just let me tear when if she hadve cut tearing wouldnt have been so bad but she still did a great job in fixing me up as well.

in relation to my business with natural therapies they do say that natural birth is the best but i stress to you to leave it up to your dr and hopefully you go through the private system my mother went thru the private system and didnt have any problems cause her dr did care and knew what to do. the reason natural birth is the best is the after birth left on the baby gives bub the best antibody defense start on the skin they generally dont wash it off till the following day. if you leave it in your drs hands and hopefully you have a great one you'll have no problems no matter which way you decide to go ultimately the decision is up to you there is no right or wrong decision in this i also suggest you ask all female members in your family this question and ask if they had any trouble with birth most will tell you if you say im trying to decide whether natual or csection is best for me.

it doesnt matter which way you chose but you need to figure out which way is best for you if none of the female family members will tell you ask your dr for advice or see a gynochologist cause they are hirer up and will be able to tell you more about this area and give you the best advice you need for this question.

anyone can say oh my goodness your a bad parent for not having it naturally but no your not especially if it risks both you and your babies life get the best advice you need let me know how you go hope this helps you.

Hi,
Thanks for all of the stories of great VB and Great C/S.
For an interesting summary of the risks/benefits for mums & babies of VB vs C/S...

http://www.cmaj.ca/cgi/content/full/170/5/813

Also rather than trumpeting the benefits of VB for bubs (usually focusing on respiratory problems) ppl need to look at the overall picture :
'With cephalic presentation, there was a trend towards a reduced odds ratio for fetal death with elective caesarean, after adjustment for possible confounding variables and gestational age (0.7, 0.4 to 1.0). With breech presentation, caesarean delivery had a large protective effect for fetal death.' (http://www.bmj.com/cgi/content/abstract/335/7628/1025)

There are also some interesting studies looking at the effect of elective caesar on reducing fetal encephalopathy and brachial plexus injury rates inc 'the rates of birth injuries such as fractures and nerve injuries are reduced by more than 50 percent among neonates delivered by cesarean.' (http://content.nejm.org/cgi/content/full/348/10/946 - this is really worth checking out for a great overview of the medical evidence but you may need to sign up for the free New England Journal of Medicine trial membership to view) This article even cites some recent studies that indicate that elective C/S may have a lower mortality rate for woman than VB - 'In the most recent British survey, a new classification of cesarean delivery permitted an assessment of the risks for women undergoing scheduled cesarean deliveries. Such women actually had lower mortality than did those having a vaginal delivery, with only one death occurring among 78,000 women who had a scheduled cesarean delivery. Similarly, data from Israel demonstrated that mortality associated with elective cesarean delivery was lower than that associated with vaginal delivery. Furthermore, all these analyses may understate the risks associated with not undergoing an elective cesarean delivery, since a woman who elects a trial of labor cannot be guaranteed a vaginal delivery. If a woman eventually requires an emergency cesarean delivery, she will face a risk of death several times as high as that faced by women who have a scheduled cesarean delivery.'

One of the reasons I've having an elective C/S is I'd prefer not to have a baby who gets brain damaged due to birth trauma. I do however accept that there are risks and costs to this decision as there are with most medical decisions. Also that there is not medical proof of the true risk/benefit profile of the decision due to a lack of comprehensive studies. Incontinence is also an issue though I accept that the evidence about the need for later pelvic surgery (for prolapse etc which is now done in >10% of women) is not in, however is seems logical that higher incontinence rates secondary to VB are likely to lead to higher needs for pelvic surgery later on...

The simple truth is that there have not been comprehensive scientific studies done looking at risk/benefit of elective C/S vs other outcomes ie VB with or without instrumentation or attempted VB ending in emergency C/S. Till these are done, with long term follow up to look at rates of prolapse repairs etc later on people can speculate on risk benefits but there is no certainty.

It would also be interesting to look at the effect of refusing an elective C/S to a woman and the subsequent effects on their deliveries and infant interactions... If anyone has come across some evidence about this I'd love to see it.

Different people do have different attitudes so birth for one may be a joyous experience and for another a hellish one even if the birth occurs exactly the same way. It would be nice for ppl to try to move past the dogma and stop slagging each other off for their choices. I say this as someone who has been demonised when ppl find out I'm having an elective C/S. The issues are much more complicated and the decision should really rest with a woman and her Dr rather than being on for public concern or debate.

I've never had a caeser, so can't comment on whether they are better or worse than a VB. I'm all for women having a choice, especially if there is a medical reason. There is a big difference between a c-section for medical reasons, and one becuase you don't want labour, or pelvic floor problems, or your dr is going on holidays. But I can't imagine voluntarily giving up the moment when that baby slides from your body - it is the most magic experience ever. Yes, labour is not a joy ride - but neither is recovering from major surgery. Yes, there may be pelvic floor issues - but my friends who have had casears tell me they had them as well.

I try not be critical of women who choose c-sections - you have to do what is right for you, and we all make our own choices. But like i said, voluntarily giving up that moment when they leave your body and enter the world? I wouldn't have missed it for anything. It doesn't make you bond better, make your milk come in quicker or any of that stuff - it's just a magical experience that I wish everyone was lucky enough to have.

I have had one planned caeser and am due for another next week - both based on medical advice from my doctor for different reasons.

You have a baby, not a birth - the way the child comes out is not important, it is what you do afterwards that really matters. Don't let anyone tell you that you have not "done it properly" because you haven't struggled through labour. The main thing at the end of the day is a healthy mother and baby.

So many people I know these days have had a long labour only to be followed by an emergency caeser - the worst possible outcome in terms of recovery.

Having said that, my ob also warned me that there would be a lot of people who would have a go at me for not trying labour, even though my caesers were for different medical reasons. He suggested only telling people if I knew that they were not going to be judgemental or difficult about it, like very close friends and family.

Good luck - my recovery was fine and I had no trouble bonding with my beautiful daughter.

I have had both, my first DD was VB although she was very large and got stuck requiring forceps delivery and an episiotomy. I had fairly extensive internal and external damage, but a few months after the birth all felt back to normal. I have just had my second DD1 12 weeks ago via csection due to being breech and large and whilst it was less pain initially for me than the VB I hated not being able to do all the normal things you can due after a VB. I also hate the way my tummy looks and feels now around the scar and and the funny little bumps/mini muffin top it creates around the scar. Pain wise the caesar was easier but I certainly preferred the VB. I bonded much better with DD1 than DD2 and I hated having the midwives care for her for the first 24 hours.

Personally I would go the VB all the way. Only you know the right choice for yourself. Good Luck

I believe its a mothers right to choose what ever birth she wishes.

My first birth was a nightmare very long birth with stitches and forceps. My son was born with two black eyes from the difficult birth and it was a very worrying/stressful birth as he was in distress and I was very sick.

Next time I had medical issues and ended up with C Sections anyway. At the time I was petrified of operations and vomited all the way down to theatre with fright. Rather embarressing to think about now.
However the birth was wonderful and I realised Id been scared for no reason.

Ive since had more C Sections due to medical issues. But admit my MIL and SILs do look down negatively at me even though I was hospitalised each time and it was for medical reasons. However my kids health is more important than their opinion of me.

I have always been wonderful experiences and my children were born quickly and safetly.
I would go as far as now saying I love C Sections.

Therefore I reckon mothers should have free choice what way to give birth. I will have no qualms about telling my daughters what a great experience I had with C Sections. Ultimately I am happy for what every their choice for birth is natural or C Section and would never judge.(both very young so years off)

** However have to say my sister has had 7 very easy and quick natural births. Also other sister had a good natural birth. So you cant really go by what a sibling experienced as it doesnt mean it will happen to you.

J

Hi

I didn't have a choice I had to have Caesarean with all three of my children and I had no trouble with bonding. I was in a bit of pain later with moving around. I do have a scar and a bit of overhang. I was lucky I had a lot of help from my husband to move things or lift things around until I was able to. It does take a little while to recover from caesareans.

Good luck with the birth.

Jenny.

I had an elective c-section for my first (and so far only) child. It was called 'elective' because it was booked in and I didn't go into labour, but I didn't really want it. DD was huge and wasn't going to fit. My Ob advised that she might get stuck and that for me and bub a c-section was the safer option. I recovered VERY well. Hardly needed any pain relief and I had no trouble with milk coming in. I did have some trouble with bonding, still do and yes, I think it was due to the c-section... But who knows? I may have had trouble bonding anyway...

I would NEVER choose to have a c-section again unless necessary. I still think my choice to have a c-section in the circumstances I was in was the right choice, but I still don't like it and probably never will. I would have much prefered to give birth to my child rather than have someone else cut her out. That is just the way I see it.

If you NEED a c-section, it's not the end of the world, but I honestly can't understand why anyone would outright choose to have one unless their Ob told them that it would be better/safer for them. Sure, it's your body and your right to choose, but I think you're mad. If I were your friend, I probably wouldn't tell you that though... Actually, I might, but only because I've had a c-section... If I'd only ever had a natural birth, I probably wouldn't comment...

Hi,

I believe that in the NSW public hospital system they have banned elective c/s because they are considered more dangerous for the baby - in a normal healthy pregnancy. Obviously there are time when they are necessary and life saving.

I have had 2 vaginal water births - the experience was amazing for me. After the birth of my first daughter I immedialy knew that I wanted to give birth again I found the experience so incredible. It was a long labour and a big baby - 9 pound 2oz, second baby a bit smaller 8 pound 5 ounces. The second time was definitely easier.

I have had absolutely no problems with my pelvic floor muscles - and no damage from the birth. Things that I believe are helpful:

- do your pelvic floor exercises!!!
- don't be induced or augmented (labour will be more painful, faster stronger contractions, more likely to require forceps, venthous, epidural and ultimately end up with a c/s and/or vaginal damage/trauma)
- have a midwife as your primary care provider (obstetricians are for emergencies - the midwife will know if you need one, most births don't require an obstetrician)

I believe that having a water birth s was very helpful in coming out of birth without any injuries/damage.

Good luck. Just remember that c/s do impose extra risks on both mother and baby. As a vet (having desexed a lot of animals) I was very definite in not wanting any unecessary abdominal surgery performed upon myself.

My births (which resulted in 2 very healthy babies) were the most amazing experiences of my life. This contrasts sharply to the all that matters is having a healthy baby / it was like having a tooth pulled reactions that I have heard from some people who had c/s.

In both cases after routine scans I was told that my babies were going to be very large - risk of shoulder dystocia etc, etc. Remember that scans estimating the size of your baby are very, very inaccurate. Also large babies may be normal for you. I delivered these large babies under the care of a midwife without any problems.

hi, i have three kids and i had them one after the other all within three years! all of mine where vb and i have absolutyley NO problems with my pelvic floor. i would recommend having a epidural as then the pushing is very controlled and you do less damage!!!
my youngest is 1 now and i have never had problems peeing myself or anything. i was very strick with my pelvic floor exercise, both pre and post delivery! hope some of this info helps
good luck!!
oh and accupressure can help you to have a easy quick labour if applied correctly!

HI,
My baby was breech so my obstrecian booked me in for a planned c-section. My daughter is now 18mths old and we couldn't be any closer, our bond is very strong. So I believe it doesn't matter how you give birth, whether you breast or bottle feed, if you have a loving relationship with your child you are going to bond naturally.
I was always told that if I didn't breastfeed I wouldn't have the same bond with my baby, I did breastfeed for the first 3-4wks and then went onto bottle. I don't think it would of made any difference to the bond me and daughter have.

You know what, it's your body and frankly, no one else's business. As long as you are making an informed choice and it sounds like you are - then I don't see why anyone else should care. My sister in law is an obstetrician, she had 3 elective c-sections for non-medical reasons (had seen too many births). I'd say she was pretty well qualified to assess the risks and make a decision. I am pregnant with my second child and am hoping for a natural birth. I had a natural birth first time round and had a very superficial tear but it didn't heal well and I ended up having to get it 'fixed' afterwards. I've opted to have the obstetrician who did my operation afterwards to deliver this one and feel in safe hands. However, I had a small baby. If I thought I was going to have a 4kg whopper, I'd seriously consider a C-section. Childbirth is no walk in the park although it is amazing. But at the end of the day, the most important thing is healthy baby and healthy mum. And you can have that with a C-section as well. The recovery is probably a little tougher(from what i hear from friends) but you'll still be able to breastfeed and bonding with the baby in my view has little to do with the delivery. People focus way too much on the birth and it's the years afterwards that are so much more important.

My advice is that to avoid the reactions just on't tell people that you are booked for a c-section or if you do, just say it's for medical reasons and leave it at that. I don't understand why women feel they have the right to judge others for their choices. Most men couldn't give a rats! Your partner is probably relieved that he won't have to see you go through the pain - my husband is a doctor and is pretty keen for me to have an epidural second time round!
Good luck and enjoy the rest of your pregnancy, regardless of other people's opinions.

I can honestly say that I never wanted to give birth. From as early as understood about giving birth, I knew that I did not want to do this and was frankly quite put off by it. I was determined that I was going to have a C/S.

When I went to the hospital for my booking in appointment, they asked whether I had thought about how I wanted to give birth. I was too scared to tell them that I wanted a caesar. I felt railroaded into giving birth, railroaded by the perceptions and opinions of others.

I had trouble with the pregnancy from 24 weeks. I have a large Vena Cava to my heart, which DD was pressing on and it gave me a rapid heart rate and I was basically put on bed rest from 28 weeks. There was talk that I may have to have a CS due to my heart rate. The negative comments that I got from people were disgusting. I was told that I knew the sex of my baby and I knew her name and I was also going to know her due date and i was going to have a real let down of a birth. I was told that my OB was knife happy and I was taking the easy way out.

At 39 weeks, I was booked in for an elective C/S which would be 4 days after DD's due date as I was told that she was posterior and being on best rest for 12 weeks, they were not going to let me go too much overdue. Again I subjected to so many comments - "Dr;s just give out caesarians so easily these days" and worse.

I went into labour the day before my due date. I spent a whole night contracting at home in pain with horrible contractions. I went to the hospital the next morning. I was told that I could have my CS that morning, I told them that I was too tired to give birth as I had been awake for more than 24 hours, but again too scared to say the words "I want a CS" I was railroaded by the midwives who told me that I was going to give birth vaginally with an epidural and I was moved into the delivery suite.

Without going into too much detail, DD was born after 26.5 hours of labour, 3 hours of pushing, with my requiring 3 epidurals as i was in horrendous pain. I vomited many times whilst giving birth and DD was born with forceps. I suffered from a tear and an episotomy. They would not tell me how many stitches I had, and I lost nearly enough blood to warrant a blood transfusion.

I have pelvic damage, I will wet myself if I sneeze, I cant run anywhere as I will wet myself. Sex was horrendous for the first year after DD was born, the pain would make me grit my teeth and cry. I am pregnant again now, and I can tell you that there is no way that I will be giving birth again. I wish I was confident in what I wanted the first time and stuck to giving birth how I wanted to.

You may be completely different from your sister. My mum gave birth to 4 kids, she is just over 5 foot and had all of us with no drugs and thought nothing of it. My friend can push a 9 pound baby out in 45 mins, but that does not mean that I can.

Trust your instinct, that is the reason that we have been given it. Dont worry what other people think of you, it does not matter how you give birth to your baby, as long as it is healthy. If you are worried in the slightest and you decide to have a CS, tell them you are giving birth vaginally as it really is no ones business barr your own.

its ur baby and ur body u can do wat u want with it u are still going to bind with ur baby the same way i say screw everyone and ur doing wat u feel is good for u and for baby its ur choice gd luck and congrats

hi,

i can understand your concern about damage to your pelvic area...but personally, i've given birth to 4 kids in the last 6 years natuarally and i have no problems with my pelvic area. there are heaps of pelvic exercises which you can do during pregnancy and after birth. i found that walking around shopping centres, even just window shopping, helped me a lot.

i wish you luck and i hope which ever way you decide, you have a safe and healthy birth.

HI There
It is of course your body, baby and choice. From personal experience I will share that I have had one ceaser (first baby after 26 hrs labour) and two natural births (one 4.5hr and the 3rd was 13hrs) both vaginals were not drug assisted, although I would have happily taken some for my third but they kept thinking I had progressed so quickly that it was going to be over soon so kept saying no - but another hour turned into another hour etc etc!!! In the end I am glad I didn't end up with another c-section. The recovery is so much harder and people don't realise it is major abdominal surgery. It gets dismissed because you have had a baby!! I coped with it for my first as I only had one baby to look after but when it came to my second, I knew it wouldn't be easy to go through that again with a toddler and by my third it was just NOT going to happen!! At the end of the day, the female body was designed to birth children and if you try to let it just do its thing, it generally will. That is not to say anyone is wrong for having a c-section either planned or emergency, having a healthy baby is blessing enough so I guess how it gets into the world really doesn't matter and also it really is true what they say - in years to come it is irrelevant how you came to have your children, just relevant that you actually have them!! Good Luck

DAH PLEASE EXPLAIN HOW HAVING AN OPERATION IS PROTECTING HER BODY CHILD BIRTH IS NATURAL AND SHE MAY NEVER NEED AN OPERATION FOR HER BLADDER

How can you say you have made an informed choice about having a CS, when your own OB has not cleared up your misunderstanding that incontinence is not solely caused by the vaginal birth process, but by pregnancy itself.

I couldn't care less if you choose to have the baby via your ear, but PLEASE make some INFORMED choices. You should be discussing your concerns with your OB, and if s/he didn't give you similar information to the OB referred to in this blog then I would be asking why he witheld this information.

For goodness sake, empower yourself...

Hi Not Posh,

Before I continue with my response, please take a moment to re-read your letter (using rationale) and then read on to my response.


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.

Now that you have re-read your letter - can you see how flimsy the reason is for your determination to have your Caesarean? If your OB was happy with this reason then she has serious issues of her own.

There is a reason why there is a cap on the number of C-Sections performed in each state. To perform one of these - it is considered major surgery - just because you are not knocked out - doesn't mean that you are doing any less damage to your body. The surgeon (yes your OB is also a surgeon) has to cut through the layers of fat and muscle in the abdomen and uterine wall therefore immediately compromising both the future strength and reliability of both the abdomen and your precious uterus. You run the risk of a future uterine rupture(which can prove FATAL) and also you cannot become pregnant for a minimum time following a C-Section -and if you do fall pregnant quickly (under 18mths - 2 yrs) you are again running the risk of rupture and therefore death .

Declan's mum is right on the money - it the PREGNANCY and not the birth that causes the pelvic floor problem due to the pressure constantly placed on the Pelvic floor especially in the third trimester - so you might want to ask your OB for a delivery around 26weeks so that you can avoid that too.

Oh just to let you know - P/Floor surgery is quick day surgery which heals very quickly. C-Sections stay with you for your entire life - especially if they a botched. One more thing - you are not allowed to bend, stretch, lift or carry anything over the weight of a loaf of bread for a minimum of six weeks, and you are doing this while still trying to cope with all of the issues of becoming a mum for the first time - lochea, baby blues, after birth pain as the uterus still has to contract, lack of sleep and of course - BABY!!!!

Do yourself a favour - ask your OBGYN why there is a cap on the number of C-Sections and also ask her what can go wrong in a C-Section - like golden staff (post-op), bleeding and the general risks involved with any major surgery.

Women were built to have children - how can the intervention of man be better than the natural process itself? I am not saying go out into the wilderness and be one with the earth. I am saying that - if you walk every day, ensure your water intake is what it should be and perform your pelvic floor exercises each day you will most definitely not have a problem in your pelvic floor area.

I summary, while you rave on about the baby bonding argument from your friends I truly think that you may just be a little frightened of the pain of child birth(which is very normal) and regardless of your excuses (and yes you have made your sister's problem your very own excuse!) you are just going to have all that pain on the other side and not where it should be and that is while working to bring your beautiful baby into this wide world. To top it all off you may just still end up witht eh same Pelvic Floor issue that your sister had.

Cheers