PGP/SPD - what's best, csection or vb?

[CagneyNLacey]

Hi, I'm 36 weeks and have been pretty much housebound for the past 5 weeks due to pgp. I've been given codeine to take 'as needed' and a tubagrip to support my back but I'm really struggling. I have a 14 month old who I cant really pick up or carry upstairs and I dont drive so we're stuck in the house day in and day out. I've got an appointment with a consultant next week to discuss birth but I dont know what I should be asking.

If I have a vb then I dont know how I will be able to labour and give birth given that I cant actually move much at all. I'm worried that it will damage my back further (think I damaged my cocsyx when I had my dd) and I am worried about tearing again as had a 2nd degree tear with dd which still feels uncomfortable. With my dd I went over by 2 weeks and was induced so wasnt allowed to use the pool and had to labour and give birth on my back as hooked up to drip and monitors and was unable to speak to say I needed to get up. I am also worried

Sorryvor wittering on that this baby will be bigger than dd was, 8lb 12.

However, if I ask for csection then the recovery time will be longer probably and I'm worried that this will mean that the pgp will remain longer and prevent me being able to leave the house again. I'm getting so stressed. I also have no idea if pgp is a legitimate reason to request a csection, or if this is too late in the day anyway to ask for one anyway.

Sorry for wittering on!

[CagneyNLacey]

Sorry for mistakes, on stupid tablet. That should say 'also worried that this baby will be bigger than dd was at 8lb 12.'

[SuiGeneris]

Depending on how the birth goes, recovery fom vb is not necessarily faster than c-section. I too had pgp and took almost 6 months to recover from vb.having c-section this time...

[YouOldSlag]

When I had SPD the first time, I was due a very large baby (he was almost 11lb). the consultant said she wouldn't plan a C section on the grounds of SPD alone as there are measures they can take to manage the birth: something like measuring the furthest the legs can go, usingdifferent angles and so on.

She said only if the mother was writhing in pain and/or on crutches would she consider that.

However, I ended up having an emergency C section anyway after a very long labour. The SPD didn't crop up during labour and to be honest, it went away almost as soon as I had my DS.

The SPD usually leaves when the baby is born and only a very severe case would lead to a C section.

Hope this helps.

PS aquanatal really helped during pregnancy.

[YouChangeWithTheWeather]

Suit PGP is hormonal as well though - it can take years to recover from whatever the mode of birth. However IMO and IME VB at least means you have not cut through the only thing muscles that are holding your pelvis together.

With PGP, I've had an 'active' I.e. on knees rather than on my back like a beached whale birth; one water birth; and one half water half left lateral on the sofa birth.

[duzida]

hello, I had SPD with both my pregnancies, and ended up with EMCS first time (not because of SPD but because labour vvv long and baby not coming out), and ELCS second time because of this failure to progress first time round. I was almost housebound from around 30 weeks, you have my sympathy, especially hard with toddler!

I can't comment on how recovery would have been with VB, but in my case, first labour was very painful, I don't know if that was the SPD contributing, or just my DC being in a very awkward position. It definitely didn't help, although some others with SPD have reported really good labours on other threads.

I didn't find CS recovery particularly bad - in my case, SPD pain has gone immediately after delivery, although returned in little twinges once a month when periods returned (hormonal, I suppose? annoying but NOTHING LIKE pain of SPD during pregnancy). If anything, having been housebound pre-birth, I wasn't too frustrated about relative lack of mobility in first week or two after birth, it was still MUCH better than SPD/PGP, and the fact that I couldn't do heavy lifting or long walks in the early days meant that I took it quite easy and hopefully helped my body recover more gradually than if I'd had a good VB and could do everything straight away. I was used to having to stay in and think up inventive ways to keep toddler occupied, which was very helpful, and I think people who've had CS following 'easy' pregnancies probably find it much more frustrating. Most annoying thing is not being able to drive for a few weeks though...that was the one thing I could do with SPD.

I doubt you'd get a CS on grounds of PGP alone, but if you do end up with one for whatever reason, don't worry that recovery will necessarily be awful.

[CagneyNLacey]

Thanks for replies, and sorry for wittering, nonsensical first post!

Yes, the only downside I can see for csection is stomach muscles being cut through and therefore making pgp harder to recover from.

Based on my last birth I have absolutely no confidence that requests for an active labour would be listened to. If I could be guaranteed a pool labour then I would definitely do that, but I think that I will be taken in to ward and have to deal with whatever the midwife on duty feels appropriate. My husband and me are not very assertive and would struggle to 'fight my corner' again. I wish I could afford a duala so I didnt have to worry about this. I havent even bothered with a birthplan as last time nobody bothered to look at it.

[CagneyNLacey]

Xposts, thanks for your post Duzida. It's hard being stuck in house isnt it? I think I'm starting to feel a bit depressed really and maybe I should just wait and see what consultant says.

[SuiGeneris]

My obstetrician said muscles are not cut when doing a c-section, they are gently separated starting from te mid-line, where they often have begun to separate already.
Also, the pool might or might nt help. I was sure it would, but it didn't. So don't get too upset if you don' get to try one...

[nothingsoextraordinary]

There is no easy answer to this one! It has to be a personal decision based on weighing up the pros and cons as you see them. Ignore the brigade 'for' or 'against' C sections - you're in a completely different situation, dealing with different risks.

I'll tell you what happened to us and hope that is some use to you in making your decision.

I was in exactly the same boat six months ago (pgp was a bit worse than what you describe - couldn't drive for last six weeks or so). I remember it as a really dreadful time, topped by a dreadful tour of the maternity unit (with my husband pushing my wheelchair) in which the head midwife told us: 'Don't listen to what the physiotherapists say, at the end of the day we'll do what we have to do to get the baby out'! Without a midwife aware of the need to maintain safe delivery positions, we didn't feel a normal labour was an option because there wasn't a safe way to do it (like you, I couldn't face up to an angry midwife!). Also, we'd heard that there was a small risk that an accident during labour could lead to pgp being much harder to recover from afterwards (although studies suggest a C section doesn't make any difference to recovery times. I'm not convinced, despite that business about abdominal muscles). There are also many women saying the hormonal element of pgp means your labour will be terribly easy, but they're the lucky ones. Also, I've talked to many women having longer recovery times who look back at interventions during labour and wonder if they could have changed the outcome if they'd been more assertive. That's a horrible position to be in.

We ended up going for a C section at 39+6 and our baby girl was perfectly healthy. My recovery is a long job but I'm getting there. I'll never know how things might have gone with a normal delivery, but I suspect it would have ended up as a last-minute C section, given my immobility at the time and the size of the baby.

Very best of luck.

[YouChangeWithTheWeather]

And one alternative to CS is to have a home birth with a confident, experienced, supportive midwife who is aware of your issues and limitations.

[Ushy]

Gosh, Cagney, I'd certainlyl think about a caesarean - but that's only my opinion. I know two people who had SPD and they both ended up with EMCS but AFTER a long horrendous labour and one ended up with depression which she thought the labour nightmare caused. I wouldn't put myself through it. I have had natural and caesarean and the caesarean was better.

Good luck!

[TruthSweet]

I had SPD pretty badly with DD1 - housebound/crutches/wheelchair to do hospital appts - and when I had my 36w cons. appt (I have epilepsy so I have extra appts) my cons. airily told me he induced all his epileptic ladies at 38 weeks (1st mention of it to me!!) and to go and see the MW to book it.

It took 4 days, a syntocin drip, massive doses of epidural and a ventouse delivery with me in stirrups. In my notes the reason for induction flip flops between 'epileptic' to 'severe SPD' depending on who was doing the notes at that point. Luckily for me I was fine afterwards and left my crutches in the back of DH's car until they needed to returned at 12w pp.

DD2 I had a HB and the pg was fine as was the delivery. If I could go back in time I would have refused the induction and just bided my time until I went into labour on my own (regardless of pain - I can only have paracetamol as codeine causes me side effects).

The thing I would be concerned about is if you have a c-section and the SPD doesn't resolve quickly and you still need crutches - how will you get around with a wound in the stomach using crutches?

Good luck with the rest of your pg and the delivery how ever it happens.

[CagneyNLacey]

Thanks for all your replies and experiences, I really appreciate it. Saw consultant today who was very nice and understanding but said he wouldnt recommend csec as feels it tackles the issue of pain or difficulty during labour but can leave me with other problems in terms of limited mobility and longer recovery. He suggested early induction (which I refused as I'm not mental) or early epidural after trying the pool. All in all, I am none the wiser as to what I would want to happen!

I think I'm going to have to just hope for the best when I go into labour.

I cant reply to individual posters as cant scroll back up, copy and paste very easily, sorry!

[Tinyflutterby]

Hi Cagney, I could have written your original post as the exact same thing happened to me with my ds. I already have a back and coccyx problem and it was thought that existing weakness contributed to my SPD. I had a support belt and was on crutches and it was pretty horrendous. I am now 9 weeks pg with dc2 and it is generally thought I will get SPD again. Am trying to think positive though.

However I have the choice of ELCS or VBAC and I was leaning towards VBAC, however having read some other threads/posts I am starting to think I may be better with a c section as I cannot be left stuck on my back due to my condition and am worried labour and birth may adversely affect my coccyx. Plus my ds was 9lb 3oz (I'm only 5 foot tall and weigh just over 7 stone!) I had to have a c section due to a failed induction, but overall I spent 5 days in hospital stuck on my back and my recovery was horrendous due to the lack of mobility.

Can anyone advise - ELCS or VBAC? Seems like too many uncertainties with VBAC and could end up having c section anyway or just have ELCS and take the unknown out of it? Please help. I know I have lots of time to think about it, but I'm worried.

[krankykitty]

I've been suffering from PGP from 16 weeks, weekly physio, belt, crutches, drugs, the works. I was lucky in that I got referred to a pain management specialist at 29 weeks (although unfortunate as if seen earlier would have been better) and got a nerve block done to some of the offending nerves in the area. I asked him for his opinion on the whole CS vs VB thing and he recommended that the CS would be best, as you can't predict how lengthy the labour or pushing stage will be, and especially as I would have cocyx pain this can be an issue with VB. I know the recovery can be longer from CS, but some people bounce right back, plus you can't predict what issues you might have after a VB if there's a load of intervention done. The way I'm looking at it is that hopefully the CS will prevent any damage or delay to the PGP, and then it will just really be the CS recovery I'll have to worry about, rather than the two.

Good luck with whatever you decide