please help - need to know the truth about bad pelvic floors and second babies

[pregnabrain]

Am in a state of crisis. dd is 2.5 and I am so desperate for another baby. But it's not a straightforward decision. I had bad pelvic floor problems after dd's birth - horrible incontinence which left me depressed and unable to enjoy large parts of dd's babyhood. With much time to heal and plenty of kegels, I've got back to near-normal. Still can't run, sneeze or cough without worry but that's MILES better than I was before.
I feel sick with fear at the thought of a second pregnancy. What if I get the same problems again but can't fix them through exercise?
I keep thinking that I can be a far better mother to my one daughter by being healthy than I could to two children with a severely restricted lifestyle.
I'm being torn apart by this. All my mum friends either have number 2 already or are pregnant. I can't bear this feeling of wanting a baby but not being able to take the plunge.
Sorry this is long - have had too much wine and am probably rambling.
Please tell me your stories, good or bad.

[lulumama]

have you had a referral to a gynae/ urologist/ physio? there might be more that can be done, things that can be done / prescribed or advised other than kegels...

so sorry that you are feeling like this, it would be such a shame if you do not have more babies because of this..

do get specialist help if you can x

[pregnabrain]

Hello and thanks for your reply.

I've been seen by one uro-gynae specialist and am about to see another for a consultation. I've had a course of physio too.

It's just so hard - there's no getting round the fact that it's a risk. The problem is that none of the medical people so far seem to be able to tell me how much of a risk a second pregnancy / birth is. If I had an idea of what the likely outcome is, then i might feel less scared.

Argh! Am so envious of women who have straightforward experiences of childbirth. Why did this happen to me?????

[lulumama]

bless you sweets.... you are not the only one...trust me

the problem is, no-one can give you an exact answer of how your pelvic floor will cope, you could try contacting the birth trauma association, to see if they have any volunteers on their list who have this experience, who could talk to you about it.

i suppose it is risk versus benefit..the risk of pelvic floor problems , versus the benefit of another child...

and no reason you would have such a bad time again..

were your problems caused by bad tearing?

apologies in advance if i don;t answer tonight! have family over ...

[pregnabrain]

The worst part of feeling like this is that I feel that I'm letting dd down. She'd make such an amazing big sister and i feel like i'll be depriving her of so much if she never has a sibling. I'd do pretty much anything to make her happy but i just can't bear the thought of going through all that again, and it being a permanent problem.

I think my problem was caused by a variety of things - long second stage with epidural (so not really feeling when / how i should push). At the end of that dd flew out in one go (while midwife on the phone to docs), taking the inflated catheter with her (still makes me wince to think about that). I did tear, but not terribly.

I've visited the BTA site before but didn't think of the possibility of talking to a volunteer. I'll have a look there. Thanks for the advice.

[Heated]

Hi, I know what you are going through, except I jumped in feet first got pg the 2nd time and then did the panicked thinking!

Like you I had a traumatic time with ds1. Part of my problem was that I laboured relatively fast with my first baby/no pain relief and then the baby got stuck - 4 hours of pushing ouch! I tore and then tore again post-natally & was referred to women health with limited success. With my 2nd pg I was referred to a consultant because of my problems, who advised an elective since she could not guarantee worse tearing but I then got conflicting advice from the mws who still advised a vb.

I did A LOT of reading and agonising and in the end having read the medical studies I had to decide somehow, so based it entirely on the mathematical odds. For 2nd deliveries, 75% of women do not tear or tear as badly again (meaning 25% do). Out of those 25% who require surgical help aferwards, 75% achieve a good outcome. So I could either have definite major abdo surgery or the chance of a surgical repair. I then went back to my consultant who said I was better informed now than she was, saw the mw who guaranteed me an epidural so I could just concentrate on the pushing without the pain. Outcome was a painless 5hr delivery from start to finish and no complications. It laid to rest the ghosts of a truly horrendous time with my 1st.

I can advise that you look at the following websites: www.radmid.demon.co.uk/perineum.htm
www.radmid.demon.co.uk/thirddeg.htm

Your ligaments stretch in pg anyway so you might find a return of your problems temporarily whilst pg. This didn't happen to me but my consultant said if I had this, definite ec. You should also ask to see a proctologist who can examine you and see whether you can have another vb or whether you'll need an ec.

Hth

[pregnabrain]

Thank you Heated. This is really helpful. I'll definitely take a look at those sites.

The logical part of my brain keeps telling me that, chances are, a second birth would be less difficult than the first. And I am so desperate to 'lay the ghosts to rest' of my own first birth. I just wish I was on the other side of it, as you are, and able to say 'it went well,i needn't have worried'.

When I see the consultant I will definitely try to get from her the kind of statistics you have mentioned. It's an understanding of the mathematical possibility that would put my mind at rest, I think (or completely put me off!).

btw, what's a proctologist?

It's so good just to be able to discuss it with women who know what it's like.

[Heated]

I hope I have used the right term, but it's somebody who will look at your back passage and with your consultant see if you could have a vb. The indignities of child bearing!

I would guess, given your medical history that they will offer you an ec.

[pregnabrain]

Sounds delightful. Not.

Funnily enough, no-one has recommended a c-section. In my consultant's words - "the damage is already done so there's no point".

My best friend announced her second pregnancy to me today. Am over the moon for her, of course, but feel so sad inside.

[sweetkitty]

I had a 6lbs 3oz baby and tore badly loads of stitches afterwards, had a 9lbs 3ozs baby at home only a little graze. A lot to do with skill of MWs knowing me (I was at home) and my previous tear they really slowed down the head coming out and made me wait whereas DD1 shot out MW was a bit useless really.

Would speak to your GP about a referal to a gynae etc too

[pregnabrain]

Hello Sweetkitty

Thanks for replying. How was it for you during the second pregnancy? Did your problems get much worse? And have you got back to normal since?

[Heated]

Pregnabrain, that's not good. My consultant was persuaded after two women required bags afterwards (hopefully temporary, I didn't ask) but it made her much more cautious especially if there was any kind or incontinence. If the wall between the vagina and back passage if fragile (there's a special word for it, but I've forgotten) then an ec should at least be considered. I'll try and find the link.

[sweetkitty]

Second pregnancy was worse in terms of SPD and I was incontinent at the end too (sorry if TMI) but as soon as the baby is out all my problems go too I've been lucky I've suffered no ill effects of the first tear.

If it were me I would go for it with a second although you may have some problems you will be monitored more and it's so worth it in the end.

[pregnabrain]

I know. I was really surprised he said that. He's a bit odd. On another occasion he said to me really bluntly "your bladder will be an issue for you for the rest of your life". Gee, thanks.

I'm going to see the top specialist at the hospital in a couple of weeks. She's a woman, which I find reassuring anyway, and I'll make sure I ask her about what he said.

[pregnabrain]

Sorry to hear you had SPD, sweetkitty. My friend had it and it sounds really awful.

Don't worry about tmi. It sounds mad but it's such a relief to be able to talk about it. I never would in 'real life'.

It's good to hear that neither of you suffered long term effects. I can handle things getting worse during the pregnancy if it's likely that i'll get better again after.

[Heated]

I can't find the studies that gave me the statistical data I quoted earlier but I did come across this discussion site:
www.pregnancy-info.net/QA/answers-c_section_after_3rd_degree_tear_/

[pregnabrain]

Hello again and thanks. Just tried the link but it comes back as page not found.

Did you have a third degree tear then? That must be horrible.

[Heated]

Not sure why that link didn't work, but if you type www.pregnancy-info.net and then third degree tear in the search box, there is a really informed discussion.

Yes, I had a third degree tear and because they didn't give me pain relief I did unfortunately know that I had torn during delivery - eyes water now thinking about it! But I subsequently had a brilliant 2nd vb delivery, having been offered an ec.

If I had a third pg I would give serious thought to an ec, having now read the discussion posted above, since no one discussed with me the possible consequences in old age.

Do you want to have an ec?

[morningpaper]

I would see another consultant, if possible, in fact try to see a few if you can!

I would say that 2.5 years is NOT a long time - if I were you I would think about leaving it a bit longer perhaps, for your body to recover? So you could decide that you WILL go ahead, but maybe leave it a bit longer?

[pregnabrain]

hello

Thanks - I got onto the main site and found the discussion, which was very interesting (if a bit scary).

my eyes are now watering too, in sympathy! I can see why you were so keen on the epidural the second time.

I'd really rather not have a c-section, if possible. My ideal scenario would be what happened to you ie. a well-managed, consequence-free vaginal birth. My nightmare, obviously, is that i'll go for it and something dreadful will happen. Or that, as you suggest, I'll be risking a miserable old age.

I'll see what this new consultant has to say but, so far, no-one has suggested a c-section.

Morningpaper - thank you for your message. It's refreshing to hear that you don't think 2.5 years is a long time. I've sort of got it into my head that i'm as well now as I'm ever going to be, but i suppose i could continue to improve gradually. I suppose I'm just concerned about the age gap between the two but, really, in the grand scheme of things, that doesn't matter so much. Maybe I need to get a bit less stressed out about the timing of it all. Then I wouldn't feel under so much pressure to make a decision.

[MumtoBen]

Hello,
I had a traumatic 1st birth (ventouse and forceps and 4 hours of pushing)and my episiotomy wasn't unstitched up and neither was my internal tear. It took 1.5 years to heal and even then the internal tear was still a bit sore. Although my pelvic floor was been fine.
The consultant recommended an elective c-section as they were concerned another vaginal delivery would make things worse. Like Heated I looked into the risks involved of a natural delivery. I wanted a home birth as I didn't want to go into hospital. In the end they agreed to it. I did have to transfer to hospital as I went into shock as my labour was progressing quickly. But I still had a natural delivery luckily. I had another small internal tear and small 2 degree external tear, but these have healed really well and quickly (within about 6 weeks).
The original internal tear is not much worse than before.
I was incredibly worried during the whole pregnancy about how it would all turn out, but luckily it has been fine.
Good luck.

[pregnabrain]

What a great story, Mum2Ben. It's reassuring to hear from women who have taken the plunge and had a good experience.

am seeing the consultant on Friday so I should have a good idea of the risks after that.

fingers crossed.

[sopgeo]

Wow, I could have written your message myself. I too had the inflated catheter balloon come down my urethra and ended up with complete urinary incontinence post delivery! Not a great way to start motherhood, couldnt lift anything, still cant run, hop, jump etc (and I was an aerobics teacher right up until I delivered!). They wouldnt operate until I had completed my family, so 2 1/2yrs on from my 1st pregnancy I have just (2 weeks ago) had a beautiful baby boy (family now finished!). He was delivered by elective caesarean, this time has been a so much more positive experience and I am feeling great already. Last 8 weeks of pregnancy a bit dicey with baby putting weight on the bladder!! Bladder feels ok now though post delivery.

[pregnabrain]

How amazing, sopgeo. Never thought I'd 'meet' anyone else that had happened to. How wonderful to hear that your second preg went without a hitch, too. What are you going to do now? Are you going to have the TVT op?

Bit of an update on my situation. dp and I went to see world mega top bladder specialist yesterday. Was a bit nervous beforehand but she couldn't have been lovelier. She was really kind and understanding in a way that previous doctors haven't been. AND, best of all, she was totally reassuring about me having another baby. She actually said "I don't really know what you're worried about". She said that, in all probability, a second labour will be much easier and quicker and that I'm unlikely to suffer anything like the same sort of damage second time round. She also said she will ensure that I am put with a really good midwifery practice who work with one of the specialist obstetricians at the hospital. So my care should be excellent this time. She definitely said that there is no need for a c-section (so that's three consultants who've said that now), unless it looks like baby's going to be a whopper (her words ). She did say that I'll probably need the TVT at some point anyway, baby or no baby, because the leaking is bound to get worse as i get older. But she said that by the age of 80, 11% of women in this country have had it, and that it's no big deal as an operation and gets really good results.

So, am full of positive feelings about a second baby today . In fact, dp and I agreed last night that we're going to start trying (AARRGHHH).

Sorry, this is turning into a diary. Will stop!

[MumtoBen]

That's great news, glad it went well. Good luck ttc.