My reasons for wanting a planned c-section at term with my first pregnancy were very rational. I was very well informed about my options, and had found an OB who I thought would respect my wishes. I was looking forward to meeting my baby in a calm environment and avoiding the physical changes that can be expected when a woman undergoes a normal vaginal delivery.
This next time around (which isn't even on the cervical horizon - so might not even happen), I cannot ignore that my body has been subjected to a normal vaginal delivery - no matter how unwanted it was. I cannot undo those physical changes, no matter how much I may want to. No more so than a woman who has undergone a c-section can undo the c-section. No obstetrician will ignore this fact either - and it's likely to make finding one to agree to my request for a planned cesarean harder than it was the first time.
In a second delivery, labour and delivery tends to be much faster (typically half as long as the first, which for me would be about 3 hours). Further the risk of emergency c-section is greatly reduced when the first pregnancy resulted in a spontaneous vaginal delivery. If I go into labour spontaneously (as I did last time), the risk of c-section is 2.3 percent, if I'm induced the risk is 7.5 percent (source: BC Perinatal Services Annual Report).
As such 2 of my reasons for electing c-section last time - avoiding a real and significant risk of emergency c-section and wanting to avoid the physical changes of a normal labour and delivery - aren't really valid this time around.
So what is there to gain by having a c-section this time around?
1. Avoidance of labour pain - given an expected labour that would be very short 2.5 to 3 hours, there's a good chance there might not be time for an epidural the second time around. Labour pain is hell on earth - before I suspected that it might be hell on earth, which is why I wanted to avoid it in the first place and now I know it is hell on earth.
2. Avoidance of further physical changes.
3. Avoidance of the experience of a second 'normal' birth.
And at what cost?
1. There's a good chance I won't find an obstetrician to agree to my request locally - as such I'm looking at travel expenses, and medical expenses. I should anticipate that acquiring a c-section this time around might be around $20,000.
2. Increased length of hospital stay and a longer recovery.
3. Increased risk of maternal morbidity and mortality.
From a physical standpoint - there's not a lot of justification in requesting a c-section this time around. Going through a c-section isn't going to reverse the physical changes that resulted from the first delivery and is unlikely to resolve any of the psychological issues. I know this.
And yet the idea of subjecting myself to another 'normal delivery' is deeply disturbing to me in part because I would be doing so because my right to choose was violated the first time I gave birth.
My situation logically sucks...