Hypermobile? Given birth? Please tell me about your experience!

[oikopolis]

I'm pg and have hypermobility syndrome (www.hypermobility.org/), and I'm finding it so hard to locate information about how my body will cope with birth!

I'm aware of, and not fussed about, joint pain becoming an issue as I get heavier. That's fine, it will be hard for a bit but it will be over eventually, and I have a physio who can work magic with SPD rehab and so on.

What I AM fussed about is the possibility of birth injuries from a labour that progresses too quickly, or that's obstructed by my pelvic floor. I am also concerned about prolapse and so on, since my tissues are so stretchy and easily damaged. Dr. Google hasn't yet come up with much.

My GP has already assured me that I can have an ELCS, there will be no argument if that's what I want. I've previously been subject to obstetric trauma so he is keen to 'protect' me from any experience that I'm not comfortable with.

But it's not that I'm not comfortable with the idea of VB I'm not afraid of pain or labour or anything like that I'm just very keen to make a smart choice for my body that will minimize long-term risk! I don't care if the recovery's a bit much, as long as I CAN recover iyswim. I would rather have a hairy CS recovery than permanent incontinence/rectocele/hernias/etc.

Anybody got some insight for me?

Is a CS a better option for someone with HMS?
Is a natural birth worth trying for, or would I be taking a significant risk?

I will ask my obstetrician when I am referred at 20 weeks, but I would like to be armed with some information since many drs have no idea about HMS and what it entails. So I need to be able to tell whether the OB is clueless, so I can ask for another opinion.

[MummyNic]

I have HMS and developed SPD at 16 weeks. I was very uncomfortable towards the end but live in a bungalow and used a lift at all times at work.

Sadly I had to have an emergency CS, before labour started so I can not advise the potential issues surrounding a natural birth. But my HMS weighed heavily on my mind - my consultant reassured me I'd be ok though...

What I can tell you is that my CS was nasty due to the urgency and I had 'more pain and swelling' than a planned one, that said, I had no 'normal' to compare to. I had tenderness / pain for 6 months after but not debilitating once I was on my feet.

I had to have treatment for 18 months for my general bone issues though, just because of pregnancy. It was nothing too bad but my pelvis has always liked wondering around and it was a fair bit worse after pregnancy. I'm lucky that my friend is an osteopath and she treated me regularly. I still have a monthly MOT, 3 years on.

My advice would be: You know your body best, if you are fit and your muscles are tight, you might get away with a natural birth but if you are like me on the unfit side, you might just want to go for an elective.

[Grockle]

I am hypermobile and had a VB no problems. Pregnancy all ok and birth was fine, just aching muscles afterwards but I am fairly sure everyone has that - much preferable for me to have a straightforward vaginal birth than major surgery.

[DarcieandSkysmum]

I've had 2 vb's - my DD2 is 4 weeks old and my pregnancy & birth was fine just the normal aches & pains. I'm now suffering a tad with my hips but other than that am okay.

I'd say go with a vaginal birth If you can - stay on your feet in labour and rock your pelvis. - helped me and I didn't tear both times

Hope you have a positive experience

[woopsidaisy]

Hey, I have this! although I have discovered this by looking at your link. I used to do yoga and my yoga teacher told me that I had this...I couldn't do some of the standing positions because my knees would bend the other way and really hurt. I didn't realise it was an actual thing IYKWIM.
Anyway, I had two VBs. I actually found the last trimester incredible hard, particularly the second time around. My hips just felt so "loose", and I developed a rectrocele prolapse-although I didn't know this until a few weeks after the birth. My insides were indeed outsides long before the birth, I was very swollen and bruised, again long before the birth.
But the births themselves were absolutely fine! Standing up for DC1 ,standing up for DC2 until last 5 mins. No stitches.
I found the yoga after birth absolutely brilliant. I felt it made everything stronger and put stuff "back' IYKWIM? I only started it after DC2, and as I say after the first class the teacher asked where I had done yoga before-when I said I hadn't she was amazed! 'Twas her who mentioned this hyper mobility.
Will have to do some research! Oh, and I should mention that my cubs were massive, 9lbs 7oz and 10lbs 11oz!

[woopsidaisy]

Sorry that should have said incredibly and bubs not cubs. Am expecting DC3 by the way!

[phlossie]

I've had two normal VB with no significant problems (SPD was bad first time, really bad back pain with this pregnancy - 37 weeks/DC3). But my hypermobility isn't that bad - 5/9 on Beighton score, plus only two joints that dislocate. I don't have any tissue problems, no prolapse and my pelvic floor is ok.

I don't think you can do better than go by your medical professionals' advice. Consultants would always rather do ELCS than take risks, so your physio might be more useful.

I find pilates amazing, btw. Strengthens core muscles to support joints.

woopsidaisy - I call my children my lion cubs!

Good luck, OP!

[WombOnTheBroom]

I have HMS. Had moderate SPD with both pregnancies - it was worse with my second but I was more careful and actually maintained more movement as a result.

DC1 was an induced birth and I ended up delivering in stirrups with forceps. Not fabulous and it took a long time (months) to recover and for the SPD pains to lessen. I also had a bruised bladder and some incontinence after the birth. I was catheterised for a fortnight and had to self-catheterise for another few weeks. This has completely cleared up now but was very upsetting at the time. As a result of the physical trauma my GP was supportive of an ELCS for subsequent births but (provided I wasn't induced) I was willing to try for a VB.

DC2 was a natural spontaneous labour with water birth. No tearing (having stretchy skin can be a VERY good thing) even with a 10lb2oz baby. Recovery after the birth was incredibly quick. SPD was gone straight away and no recurrence of the continence issues. I felt genuinely fully recovered within a week/10 days.

I found antenatal yoga very helpful (although I had a great teacher who ensured I didn't do any of the positions that aggravate SPD). And I got excellent advice from a physio about birthing positions, including what to shout at tell the doctors if they needed me in stirrups again. I found birthing in water great as it allowed me to change positions easily without putting pressure on my pelvis.

Whatever you go with, good luck with your birth!

[cardamomginger]

If I were you, I'd have the ELCS.

I am hypermobile, although this was not pointed out to me until after I had given birth - I had always though that I was just interestingly bendy in certain respects and interestingly stiff in others.

I had a VB with DC1 16 months ago. I had a horrific time and sustained very bad birth injuries - displaced coccyx and damage to pelvis, rectocele, cystocele, uterine prolapse, and bad tears to the pelvic floor. I have already had some work done to my back (injections and manipulation) and have had my first big operation to repair the gynae side of things. I am due a second big operation in May and more work to my back, which may necessitate removing the end of my coccyx. Fortunately we have health insurance so I can access the best specialists quickly.

ALL the HCPs who I have consulted concerning my birth injuries have immediately said that hypermobility carries an increased risk of serious birth injuries for VB (3 consultant urogynaes, 1 consultant orthopaedic surgeon, 2 specialist physios). One Prof I saw said that if she had seen me antenatally she would have told me to have ELCS, no questions. The explanation given is that hypermobility can go along with a 'too strong' pelvic floor (nothing to do with how much you exercise it or not) and that the pelvic floor goes into spasm during childbirth and doesn't want to relax to let the baby out. The prolonged pushing stage and the extra effort that's needed to basically rip through the pelvic floor causes all the damage.

I will be very surprised if you find anything through Google. I didn't. And I didn't find anything searching through the medical publications databases (am PhD student so have access to these). But just because nothing has been published doesn't mean that the association does not exist - all the people involved in my care have seen this in their own professional practices. I am in the middle of 'correspondence' with the hospital where I delivered and the obstetrician who had read my notes categorically denies that hypermobility poses an increased risk of anything. Personally, I put more faith in the clinical judgement of people who spend their professional lives putting women back together than I do in the judgement of people who discharge women a short time after birth and who don't see even the medium-term, never mind the long-term effects of method of birth. So if you get the message that 'it will be fine - you are as capable of VB as any other woman' be wary of it. And be very sceptical over the usual arguments of longer recovery time for ELCS - by the time I am done with rehab after my second operation, DD will be almost 2. So that's 2 years, and that's assuming I don't end up needing surgery on my back.

This past 16 months has been utter hell for me, and it ain't over yet. I have been left with permanent damage, which may not be fully repairable - we shall have to see. The damage to the relationship wiht my extremely supportive and concerned DH has been significant and it has undoubtedly impacted on my relationship with my DD, turning me into an anxious, frightened parent who has little confidence in her abilities to parent her child.

I wish to God I had been able to have an ELCS. The usual risks/benefits of VB vs ELCS just do not apply to people like us so I am very pleased that you have a GP who is taking this seriously and hopefully will help you to come to a fully informed decision.

If you want to talk further, please do PM me.
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[Cyclebump]

I have hyper mobility and had a lot of hip surgery as a child because of an unusual presentation of hip dysplasia.

I had a straightforward VB nine months ago. I had stitches for a minor second degree tear but recovered quickly. The only simulation my consultant had on my notes was NO STIRRUPs as my hip could dislocate.

Do what's right for you.

[oikopolis]

Thanks everyone who answered.

Cardamom I'll talk to my OB about the problems you had as an example of the worst case scenario, and the opinions you've been given. Perhaps I can ask my physio to contact one of her gynae-physio colleagues for their opinions too.

I am leaning towards ELCS simply because it's a more controlled option, and the problem with HMS is that it's so unpredictable in nature. A VB could be a complete disaster.

But then I've worked hard on my core strength in order to control spasms and pain... CS means lots of little muscles will be cut and I will have to start over with rehab physio.

It's so hard to choose.

[FutureNannyOgg]

Oiko, you are right about the muscle loss in c sec, you lose the support for your pelvis and CS is not very helpful for SPD (neither are epidurals as it is hard for your caregivers to know what your "safe" range of movement is.)
I am very hypermobile, and I had SPD, but DS was born by EMCS due to a bad presentation and baby getting in distress after a long labour. My chiropractor was very useful for putting things right again, but it's not the option I would have chosen.

[cardamomginger]

My first big op was a colposuspension and uterine suspension through a c-section type incision. 8 weeks on, I have just started on rebuilding my core muscle strength, and whilst I do notice that I am weaker, I can feel the muscles engaging. My physio is very confident that I will get things back, and my surgeon is convinced that I will have a completely flat stomach again (not that he thinks this is the most important thing to me - but he knows that after everything I've been through, body image does matter to me). But I guess only time will tell whether I get back to my original strength (was doing advanced pilates pre-pregnancy).
You're right, HMS is so unpredictable. I think the only certainty is that there is increased risk of a bad outcome. Are you under consultant's care for your HMS? What does she/he say?

[oikopolis]

cardamom I am under consultant care, with a rheumatologist.

He has been more focused on gathering evidence to reassure my OB (when I am assigned one) that I don't have Ehlers-Danlo of any type, nor Marfan's, and that they should therefore not subject me to interventions/scare-mongering about those risks. He seems to think that OBs are 100% clueless when it comes to HMS and conditions that includes HM as a symptom.

He has said I will probably labour rapidly and therefore should be in a hospital, no HB. No mention of birth injuries. He is not focused on that though, he doesn't see ladies for birth injuries only for rheumatoid arth usually! I am probably his youngest patient by decades.

Most of my care has been under the consultant-appointed physio that I see. The rheum has held his hands up and said "there is almost no research put into HMS and individualised physio care + anti-spasmodics + NSAIDs is really all I can offer you", which I can appreciate.

Annoys me though. If men had to give birth, there would be tons of research about how every little condition might affect things

[oikopolis]

btw cardamom, thanks for the detailed info.
And I am so sorry for what you've been put through, you must have been in an absolute state (physically and emotionally) after the birth. Dreadful.

[cardamomginger]

Thank oik - yes it has indeed been horrifying . I have sent you a PM about something.
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[cardamomginger]

BTW, how old are you? I am assuming this is your first child? I was 39 when I gave birth and although the NHS likes to treat all women as having the same risks regardless of age, it just simply isn't so. My surgeon told me that the case of an 18 year old giving birth vaginally for the first time is very different from an almost 40 year old. The condition and strength of the uterus is not as favourable to get a baby out easily in an older woman, meaning an increased risk of complications with VB. Nothing to do with fitness, by the way: you can be as fit and strong as you like through exercise, but you will still have an 'older' uterus! The NHS isn't having any of this and doesn't consider age to be a risk factor. But if you are on the older side too, then that is something else to consider.
Hope this isn't all a complete downer for you .

[erikab922]

I was diagnosed with HMS when I went to an osteopath for SPD at 18 weeks, she said it was quite pronounced and was surprised I didn't already know that I had it. Then a few weeks later I saw a physio and she said the same thing. I'm aiming for a very active birth and hadn't even considered that it might limit my birth options (ever the optimist, me) but based on this thread I will bring it up at my 28-week MW appt tomorrow for sure. Been doing lots of core exercises - about 12 years ago I had laparoscopic surgery with five very small puncture wounds on my abdomen and that took freaking ages to recover from, definitely don't want to repeat that experience x10 with a CS but you never know what will happen on the day.

[oikopolis]

cardamom I'm 28 and yes this will be my first baby after a loss years ago.

Again, v touch and go! I mean, I won't be an older mum, but I certainly am not going to be called a "young" mum at 28. Who knows what the old uterus is up to??

It's not a downer though! I knew there would be challenges, and ultimately I'll go into this more equipped than I would have been. At the end of the day I am relieved to know I have the option of a CS if I'm not able to get solid opinions one way or the other.

erika I hope you're getting good info. And that you are not too frightened! Maybe the key with HMS might be NOT to push yourself hard while in labour. (this is JMO, from what I have picked up in this thread.) I can certainly say from experience that many people with HMS tend to thing they can push their bodies harder than they should. I can imagine that this does not bode well for pelvic injuries, esp when there is pain relief involved and you are losing proprioception, for example.

So you might push and push and push, but injure yourself awfully. When it may just be better to "breathe the baby down" a la Hypnobirthing and resist the push reflex as much as is humanly possible. Or you get into stirrups on the advice of a Dr., who then over rotates the joint and leaves you open to injury.

Again, I know nowt, have never given birth so cannot say either way, but possibly that approach may reduce injury, who knows. I would be interested to hear how things go for you. An active birth is a beautiful thing and I truly hope you experience everything you hope for.

[oikopolis]

bump

[cardamomginger]

Yes, me. The sad and sorry tale has been recounted in my posts on this thread. What's your situation? If you have any specific questions about what I've written, please do ask!

[oikopolis]

BB do you actually have EDS, or just hypermobility symptoms?