My 2nd section was much better than the first. I've had a c/sec, 2 VBACs, and another c/sec. Both caesars were emergency, done while I was in labour. Both VBACs were totally natural, birth centre midwife-only deliveries.
For the second c/sec I asked for a general anaesthetic. I know this is probably shocking but let me tell you why. I had an epidural for the first one and I HATED IT. It made me feel cold (i had to spend longer in recovery because my temperature dropped so low) but most of all I hated the feeling of being frozen and not "owning" my body. I did not realize how long it would take to wear off. I didn't like going back to the ward still unable to feel most of my body from below the breasts and being sooo cold despite the warmed blankets.
I had a bit more leverage asking for the GA this time because I had already had an anaesthesia consultation. The original plan was to have a 3rd VBAC and then go straight to theatre for a manual removal of the placenta under GA (long story which I won't go into). So I had already been reviewed for a GA. Then I had PPROM at 33 weeks, was admitted, & because of placental problems we were going to have a c/sec in a few days unless I went into labour first, which I did that night. I rang a friend who is an anaesthetist for extra support. He told me that a GA or an epi for a caesar is 6 of one, half a dozen of another, and for me a GA might even be better because my normal BP is so low. He, & the anaesthetist I had seen at consultation, both said that an epidural is NOT safer for the mother, which is what my OB had said.
Another factor...because my dd was prem, I knew she would be going straight to NICU and there was no question of cuddles etc. whilst I was in theatre. Also, I knew that she was OK. Had I been worried for her life, I might have chosen an epidural to make sure I saw her alive.
My OB tried again to talk me out of the GA but I was very happy with it. You are awake until the last possible moment in theatre. When I woke up in recovery it was about an hour later (3:30 am).
I never used the PCA once I was out of recovery. I woke up again at 9:30 when my OB came in to see me. I told him how great I felt. I took Endone from that point for pain relief. (With my first I had the PCA for a while. I think the Endone is more effective.) I was up and in the shower at midday, catheter out, PCA gone, up in the NICU shortly after.
Since then I've talked to several mums who have more than one c/sec. Most cannot believe that I was "allowed" to have a GA, and said that they would have liked one but their doctor said no! I do know that it wouldn't be everyone's choice.
Also, it's worth finding out how they will close the incision. With my first I had staples, with my 2nd a continuous suture. so much more comfortable! I asked a nurse friend if I was wrong to think that made a difference & she said it really does help.
So the things that made a difference for me: a GA, taking Endone at the charted times (along with Nurofen and panadol) even when I didn't feel like I needed it, and having the continuous suture. I stayed a week because of access to the NICU, but I felt good enough to go home after 2 days!
I also healed much better. With the first I had hypertrophic scarring and had to see a dermatologist after 6 months. This time, no problems at all with the scar.
Having said all that, you cannot predict surgical results and you can have a disappointing outcome in spite of everything you plan. I do think it's worth trying to control every factor that you can, though.
Most important factor: a great OB who is a very skilled surgeon! I asked around (I know a lot of doctors) before settling on mine.