So my wife just had a positive pregnancy test, and I've started to do a lot of research particularly on a maternal request cesarean versus a planned vaginal delivery.
Isolating maternal request cesareans in studies from elective and emergency cesareans has apparently just not been done that much yet. So weaving through the few studies out there yields somewhat contradictory information a lot of the time.
What is perhaps most fascinating to me, is that obstetrician's prefer a maternal request for themselves at an astronomically higher rate than the general public, almost entirely citing prevention of pelvic floor trauma as their reason for the preference.
I have found conflicting information on the effects of mode of delivery on pelvic floor trauma. Many studies suggest that pregnancy itself is what contributes most to long term pelvic floor trauma. But I have found other studies that refute this, stating that anywhere from uncomplicated vaginal delivery to assisted vaginal delivery does inherently damage the pelvic floor, from permanently increasing hiatal dimensions to levator ani avulsion etc., some of which never occur in a cesarean without labor.
So what is the truth here? Do obstetricians have a better understanding of a truth that vaginal delivery is just plain anywhere from worse to severely worse for your pelvic floor than a cesarean? If this is the biggest concern they have, then does that indicate that many obstetricians think all the other considerations like mortality are a wash either way? Or even further, are the other morbidities and the mortalities better off with the maternal request cesarean, leaving pelvic floor trauma to be significantly more important?
The biggest reasons why I think my wife, and I have talked to her about this in general, should consider a maternal request cesarean is that a) this is our only planned pregnancy, with a plan to get a vasectomy and foster and adopt any further children, and b) this will be her first birth.
From what I have seen where maternal request cesareans are separated from planned vaginal deliveries, the overall morbidity and mortality is basically the same between the two. However, there is an unquestionable higher rate of mortality and morbidity with assisted vaginal deliveries and emergency cesareans. And in your first birth, where labor is toughest and longest, these latter scenarios are much more likely than in subsequent births.
If severe mortality and morbidity are basically equal between the two modes of delivery, I can't help but reduce the choice to something like the following:
Maternal Request Cesarean
1. A scar. (permanent)
2. A slower recovery time. (temporary)
3. A small difference in time until breastfeeding can be started. (temporary)
Planned Vaginal Birth
1. Anywhere from a minorly to heavily damaged / reconfigured pelvic floor. (permanent or requiring surgeries, although avulsion appears to have no actual solution)
2. Greater chance of organ prolapse. (permanent or requiring surgeries)
3. Greater chance of urinary, or even nightmarishly anal, incontinence. (possibly permanent)
4. An anywhere from slightly to largely more lax vagina and less sensitivity in sex due to pelvic floor trauma. (possibly permanent on some level?)
In the end, the thing that it comes down to for me is that a planned vaginal delivery is exactly that. You are only going for an attempt at an uncomplicated vaginal delivery, and in your first delivery especially, your chances of having an assisted delivery or an emergency cesarean are significantly higher, and these latter scenarios are much more dangerous to mother and baby. And even if you have an uncomplicated vaginal birth, you are still possibly damaging your pelvic floor, especially with the longer labors associated with a first birth.
So where am I going wrong with my thought process? Or am I just on to the secret of why so many obstetrician's silently do a request cesarean themselves? I’d appreciate any extra opinions I can get, as this is no doubt a highly controversial opinion with far reaching and important implications.