Wow fionas, you've come a long way in 24 hours I'm glad that you were prompted to dedicate a physio appointment to getting some more information to aide in your decision, and that info has taken you quite a few steps closer to making a decision. Woohoo!

Try not to put too much pressure on yourself to make the best decision. As you said, it's not like a VBAC vs repeat C/S where all the stats are on hand and easy to access and therefore a truly informed decision is easy to make. For you, there's no way to know ahead of time what the outcome is going to be. All you can do is what you're doing - seek out evidence-based information and make the choice that you feel is right for you with the information that's available. I agree with Inanna () that you need to go deep and find peace with your decision - whatever it is.

It sounds like either way has some potential to cause some problems afterwards - but the good thing is that it's probably not likely to be as bad as last time; if you have another VB, you know which positions to avoid (who knows, maybe you'll be fortunate enough to have a 5 min pushing stage and also be one of the lucky %age for whom it resolves straight away), and if you have a ceasar, the effect of the muscle being cut is unlikley to cause difficulties beyond a couple weeks at best and a couple of months at worst.

One thing stands out to me - I think it could be difficult for the hospy to guarantee that you can have a ceasar exactly 20 mins after pushing starts. Of course, they can do it in an absolute emergency, but I wonder if it would really be treated like an emergency on the day? If I were you I'd want clear answers there. You'd be relying them to come to the table on the day if your second stage isn't nice and short. If you really do only have 20 minutes I think I'd be nervous about that, even if they are onside as there are still variables which may interfere even if you do have a prior understanding with your care-givers.

If you do end up going c/s, I highly recommend getting on your feet as soon as you can and starting the physio exercises the very next day. Anecdotal evidence wont help you much and I certainly didn't have the compounding issue of SPD, but after both my ceasars I did find that I had very little pain in the first couple of days thanks to the meds and not much more than a twinge in the mornings after about 5 days. In fact after the second I was out the front weeding on day 5 (not recommended, just to demonstrate how fine I felt). But then my SiL says she was in agony for weeks (but she did have a long labour prior to c/s, didn't do a jot of exercises and had major abdominal muscle separation, so things weren't stacked in her favour). So it's different for different people, but I think doing the exercises *really* helps.

And if you end up going VB, I think it is is SO important that you your caregivers have detailed knowledge of your history and condition and are really 100% behind you to help you achieve the best chances of avoiding the terrible outcome you had last time.

I must say, you seem to have coped brilliantly with the card you've been dealt. I myself would have been very angry that poor (I would say negligent) labour care contributed to/caused the ongoing problems you had post-birth.

If you would like me to search academic journal databases for anything in particular that could help you further feel free to PM me