Intervention: What thought disturbs you more.

[Jakabella]

I didnt get a choice and had an emerg C-sect...
TBH it was not a bad experiance.. I was up the next day and the pain only lasted a day or so and then it was just tender.. I was up and about on day 2 and didnt look back. Obviously I wanted to do it all vaginally but it didnt happen and I really think my c sect was not so bad under the circumstances.

I hope you get the birth you want and dont have to decide on any of the options!!

Kate xox

[Janie]

I personally would avoid a c-section if there was something else that could be done first, either forceps or ventouse. I had forceps (after ventouse failed), and like Mrsmac, my Ob is older and very skilled with them, so it was no biggie.

I've heard too many scary stories about ventouse, especially those done without an episiotomy, to make me ever want to go down that route. Obviously it's safer for bub, but I don't think I'd consider it without an episiotomy.

[BellyBelly]

The thing is with c/s and while the risk is slim, you set yourself up for a risk of rupture next time around (although you do that just by having an induction and yes, also during a c/s), a repeat c/s, infection, hysterectomy, haemorrage and not to mention anaesthetic complications. Its not just that birth, but the impact on future births women need to think about. Most Obs put the most stringent conditions on VBAC women which may result in you not having the birth you want, ever... I'd choose c/s last because they wont bat an eyelid if you want a normal birth next time around and you wont have any birthing conditions.

[Snowy Love]

I'd choose c/s last because they wont bat an eyelid if you want a normal birth next time around and you wont have any birthing conditions.

:yeahthat: Wot she said!

[Snacks]

I'd probably still go vag, either way (vac or forceps). I could never have surgery unless it was my only option.

[2CheekyMonkeys]

i'd go vaccuum, forcepts c-sect. i had a vaccum first time round with no episiotomy, i did tear though.

[Lolli]

OK, I'll be honest- I go for the vac or the forceps before the c-sect, but only if there was no epidural involved. The thought of having a needle shoved in my spine scares me more than the other options put together.

[Inertia]

see, I knew there was a reason to ask this. The extra eyes looking at it from all angles is always helpful!

I figured for me I would be in a good position to not worry about a C-S seeing how I don't plan on having any more kids. But the only way I could possibly be sure of that is to never have sex again - and that just doesn't sound like much fun - so certainly I would have to consider that I would want to vbac. But add that on top of everything else (grand multiparity, prior uterine atony) and I would be hard pressed to find someone willing to let me vbac - not to mention, would I want to risk my baby under all those circumstances.

I don't anticipate that I would need to consider anything regarding this. The last time my labour stalled and they were "discussing my options" without me, I went through a MFER and then my body shut down, causing the PPH. But that is where my problem starts mentally. To put it gently as possible - I have a serious aversion to medicos sticking their hands and god knows what else wherever they please like its open season. I understand for sure that at the time it was a medical emergency - but that really does not undo how it made me feel. As it is I have since left going in as late as possible to minimise the amount of times they decide to check to see how far I have dialated. I'd personally prefer they didn't at all.

I am extremely lucky to have never torn - and the idea of asking for it to be done for me by someone who I don't want down there in the first place is already bad - but then they'd have to stitch it up.

Really - all the options are bad no matter how I look at it. I am just trying to decide for me which is less worse than the others. So much to consider and all the input is very welcome. I just will continue to sit here and tell myself that it wont come to it and it will all just be a discussion on a forum - but at least I will have planned for it anyway.

[paradise lost]

Inertia you are perfectly within your rights to decline vaginal examinations, they are not necessary - checking labour doesn't make it happen betteror faster!

DD gave me a 2nd degree tear with her shoulder on the way out which i didn't have stitched (my choice) and it healed beautifully without any of the painful scar tissue some of the women i know who WERE stitched have. I know a woman who had a 3rd degree tear after her planned unassisted homebirth. She didn't have it stitched either, just kept her legs together for 10 days (tied her knees together loosely when she was asleep so she wouldn't part them too much) and she too healed up fine. Tears are generally not volunteered for but unless you tear through the rectal mucosa stitches are a choice.

Bx

[Inertia]

Hoobley - I was thinking in respect to episiotomy. My perinium has never failed me before, so I have enough faith that it can get through it just fine - but accepting a method that would voluntarily ask for manual perineal dissemination is a whole new ball game.

Oh, and Thank you for the information on examinations. That one is definitely going into the birth preferences. I'm happy enough for them to stand and watch from a distance!

[Tobily]

I would never choose a caesar over a vaginal birth even if there were instruments involved.

Instrument births don't always involve an episiotomy, although your risk of having one is certainly higher where instruments are used.

The midwives there told me that a lot of obs won't use forceps now and would have simply sent me for a c-section.

This is true I reckon. I have only seen one forceps birth which was in a public hospital, and it would have been a ceasar if she'd been with the private OB that she ditched a week beforehand. Forceps are most often used when the baby is still high - high enough to do a caesarean. The use of forceps is on the decline with obstetricians because they are opting for c/sections instead.

Ventouse most often comes out when the baby's head is on view (ie. baby is very low in the birth canal) and there is a desire to get things over with. Sometimes that's from the mother but most often it's from the caregiver. I have seen one situation where the baby's heartbeat was seriously bottoming out and not recovering and the ventouse was probably justified...but most of the time I see it used it's purely impatience.

The point of all that ramble being that it's rare that instrument use is a life and death scenario.

[Ca Plane Pour Moi]

I had a ventouse without an episiotomy. But then I had another one with because DS was posterior. TBH, the ventouse was quite easy and fairly pain-free for me. Trying to turn DS was NOT easy or pain-free LOL. I'd go for... actually, I'd go for kicking the Obs in the head before letting them anywhere near me, but ventouse would be my option I guess if I didn't have the machine-gun to hand.

As for "don't let them"... that implies you have a choice which cannot be overridden because someone else says so. I very much hope no-one overrides your choice, Inertia, but having the plan is a GOOD thing because at least that has more of a chance of being the first option someone decides to try, telling you about it when it's almost done, if not a few hours later.

[widdly]

I would go straight for the c-section.

For me, I tore and got stitched up and that really traumatised me for quite a while, so rather than have the trauma of forceps or ventouse I would go straight for the c-section and keep my vagina in tact.

[Jas]

I'd opt for vac, forceps and the cs and before all that I would be politely be telling them to go stick their time constrains and only opt for any of these options if it was a TRUE EMERGENCY!!! And in the case of a TRUE EMERGENCY I would opt for all and any of the above!!

[paradise lost]

Bearing in mind that the reasons for needing any of those 3 can either be seen well in advance or completely avoided during labour i doubt i would find yself in a snap-decision type situation.

The part of me that is rational would like to know what the sudden need for immediate deliver actually IS, because i seriously can't think of one. Sudden foetal distress - why? I wouldn't let them augment me, or have an epidural, or other drugs, so why is the baby distressed suddenly? In unaugmented natural labours one usually can tell something which might later cause distress (usually poor foetal positioning) is afoot because the labour is slow and doesn't progress much - babies drive labour in normal circumstances and will not do so to the point that they are struggling. If the cord is so tangled inside that the baby can't descend without distress then we NEED a c-section. If there is a prolapsed cord but i am fully dilated and pushing, if i need any assistance at all from forceps or ventouse then my baby is very probably going to die or be severely damaged because you have only a few moments to get the baby fully born in that situation. If there is deep transverse arrest - why? I wouldn't have an epidural and in the absence of them DTA is incredibly rare.

I know i'm not really answering the question, but that's the key issue for me. Not the intervention itself but the reason for it. If you NEED a c-section there is no decision to make. Michael Odent never used forceps and he never needed to, their major popularity grew to a fever pitch in the middle of the 20th century when labouring women were given general anaesthetic and hadthe baby dragged out of them while they slept. Odent states that he used c-section when needed, which was about 11% of the time overall, and didn't offer forceps, or anything else that required the supine position.

Inertia it may interest you to know that in almost all emergency c-sections where the baby has descended into the pelvis (i.e. was "engaged") the Ob uses forceps to drag the head back up and out of the incision, an incision which is as small as possible to minimise damage to the uterus. The baby is fundamentally physiologically designed to be pushed out of the vagina, however tight the fit, and the vagina is designed to massage the baby into life as it emerges. C-sections are (theoretically) used ONLY when there is no alternative but damage or death, and it would be a mistake to think that choosing one over an assisted vaginal delivery would save the baby trauma.

Bx

[mrsmac]

Epidurals scare me more than anything! I know its irrational but I had a friend whose whole body shut down after one and she had to be revived so they have always scared the life out of me.

[Yael]

The part of me that is rational would like to know what the sudden need for immediate deliver actually IS, because i seriously can't think of one. Sudden foetal distress - why? I wouldn't let them augment me, or have an epidural, or other drugs, so why is the baby distressed suddenly? In unaugmented natural labours one usually can tell something which might later cause distress (usually poor foetal positioning) is afoot because the labour is slow and doesn't progress much - babies drive labour in normal circumstances and will not do so to the point that they are struggling.

Bec, with DD she went into distress 1 push before she was born, and i was lucky i was that close that i didn't end up with any intervention TBH. Labour progressed beautifully, everything was perfect. Waters were broken at 9cm (but even if i hadn't agreed to that, realistically they would have broken very soon after), third stage began 10 mins later (2 contractions, but there weren't monitoring her, so not sure what HR was doing in that time). My DD had an extremely long cord (infact, the longest they had seen in a very long time), which was wrapped incredibly tightly around her neck, twice. They couldn't get it off her neck, and said to me that i needed to get her out that push. (i also felt them using the doppler i think??) Luckily i mis-heard them, and thought they were telling me "common, you can get her out this push", because i didn't freak out (well, any more than normal), and she was ok. She pooed all over me straight away, and was born very gray and looked like she was dead.

I was lucky she had the waters cushioning her, because i believe i would have (and probably rightly), ended up with a c/s for feotal distress. And if i didn't get her out that push they would have done an episiotomy and whatever else they needed to, to get her out quickly.

So, it can happen right at the very very end, with no warning signs before hand.

To the OP, i had a vacuum with DS, and no episiotomy. I would go with vacuum, forceps and then a c/s. I think that would be the order of a more difficult recovery. In terms of them not being as skilled any more, that is true, but you would be hard pressed to find any single doctor who will do a mid or high forceps anymore (and if you ask anyone but an older nurse, they don't even know what it is anymore, because they will never have seen one). They are hard to learn apparently (my mum is a mid and she told me about them), and you can stuff it up big time learning, so now the risk isn't considered worth it and they will c/s those patients instead. But perhaps the loss of skills in the obstetrics field in favour of c/sing women to avoid litigation is a discussion for a different time?

I would think you are no more likely to have a stuffed up epi than a stuffed up c/s, and the would both suck. I would take a vacuum or forceps over a c/s, because like Kelly said, the impact on future births is huge.

[Inertia]

To the OP, i had a vacuum with DS, and no episiotomy. I would go with vacuum, forceps and then a c/s. I think that would be the order of a more difficult recovery. In terms of them not being as skilled any more, that is true, but you would be hard pressed to find any single doctor who will do a mid or high forceps anymore (and if you ask anyone but an older nurse, they don't even know what it is anymore, because they will never have seen one). They are hard to learn apparently (my mum is a mid and she told me about them), and you can stuff it up big time learning, so now the risk isn't considered worth it and they will c/s those patients instead. But perhaps the loss of skills in the obstetrics field in favour of c/sing women to avoid litigation is a discussion for a different time?

I would think you are no more likely to have a stuffed up epi than a stuffed up c/s, and the would both suck. I would take a vacuum or forceps over a c/s, because like Kelly said, the impact on future births is huge.

I would think the vac without epi is probably now looking more favourable. I know my older sister had a forceps assisted with her first but she wont talk about it - and she is an extremely open person so I can only imagine that it is a trauma she does not want to revisit. An epi is performed around some seriously important muscles and I have put a lot of effort to keep my pelvic floor in good shape after grand multiparity. I still have MWs marvel at the fact that I have avoided ever experiencing incontinence, and its a freedom I want to keep with soon to be 6 kids to look after. Not to mention the other muscles which I really dislike the idea of putting that close to a surgeons blade with me freaking out on the table.

Its funny, but of the whole birth preferences, I never imagined that the bit that I probably wouldn't need would be the hardest part to write.