Urinary and faecal incontinence in later life due to vaginal delivery

[handlemecarefully]

I have read that it is estimated that around 10% of women suffer either urinary or faecal incontinence due to childbirth (sometimes the incontinence does not manifest until middle age or later).

I've previously had a vaginal delivery (terrible - won't bore you with details)and I am now being considered for elective c-section. However after reading the reassuring thread on 2nd vaginal births being easier I am being braver about possibly going through vaginal delivery again.

However does anybody know whether avoiding a 2nd vaginal birth has protective effects on the pelvic floor and is less likely to lead to later life incontinence,.... or is this locking the stable door after the horse has bolted (i.e. has any potential damage already been done through previous ventouse, forceps and episiotomy during first labour)?

[twiglett]

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[handlemecarefully]

Thanks Twiglett - that would be really helpful to know what your friend thinks. Cheers!

[twiglett]

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[handlemecarefully]

Thanks Twiglett,

That really does help a lot - thanks very much to you and your friend....

[willow2]

Don't want to go against twiglett's friend - who is obviously an expert in her field - but I had a horrendous vaginal delivery and have been told quite categorically that, if I were to have another child, a c section would be the only option. The point I'm trying to make, handlemecarefully, is that surely it depends on what damage you suffered first time around as to whether or not you should opt for a c section or not? Only someone who knows exactly what happened to you can offer expert advice.

[Clarinet60]

I'm in the same position as you willow2. That's why DS2 was a section. Mind you, I was already experiencing the consequences of the damage, IYSWIM, and the consultant said that a vaginal delivery would only make things worse. I think it depends on the nature of the damage. Mine was nerve damage, causing passive incontinence, whereas a certain amount of muscle damage will, presumably, repair over time. Sadly, I'll never be the same down there again, so God knows what sort of old age I'll have.

[marsup]

This is a very scary thread, ladies! I am 34 weeks with my first. Can you tell us what sorts of things lead to such major damage? or if there is anything you think (retrospectively) could have helped? (slowing down birth? episiotomy instead of tearing? vice versa?...)

[Clarinet60]

Didn't mean to scare you, marsup, these severe complications are quite rare. My birth began with waters breaking but failure to progress. They then wanted to deliver the baby because there was a risk of indfection, so induced me with syntocinin (sp). I reacted like lightening to the drug, which meant that labour then progressed too rapidly, there was no water to ease things along and no time for softening and stretching. Then the baby got stuck so they had to use ventouse and I tore really badly (3rd degree). The obstet. reiterated that this was a RARE complication, because those who fail to progress don't usually react to the drug so viciously (which makes sense, really). So I was unlucky.
With hindsight, I would advise you to have an epidural if you are going to be induced AT THE SAME TIME. This is where mine was mismanaged, because although they knew I wanted an epidural, they left it too late, so I wouldn't have one (until after the birth, when I was repaired via surgery, ironically). So insist on an epidural if you have any interventions.
Also, not being allowed to move around didn't help - I was flat on my back and monotored throughout.
This is VERY UNLIKELY to happen to you marsup, so don't worry.

[Clarinet60]

Couldn't have an epidural, not wouldn't. A freudian typo I DON'T think!!!

[pupuce]

Droile.... can I disagree with you ?
Why do you think an epidural might avoid 3rd degree damage? What do you think the epidural would ahve done to you ?
Also IME (Maybe Mears has a different view), if you "have to be" induced (and that is over played generally - including "risk of infection" is too often used) - gettin g an epidural and you increase significantly your risks of distress in baby and chances of section!
So first is to avoid the induction by getting proper information (and that is not always the case from docs and if women have to look for the evidence themselves!!!)... and if the induction is the route then I would try without the epidural still.... but everyone is different.

[mears]

Agree with Twigelett's friend on this one. It is the actual pregnancy that can cause weakness in the pelvic floor. There is also pressure on the anal sphincter and fibres can be weakened prior to the labour process. So caesarean sections do not prevent pelvic floor weakness in later life.
I would not recommend epidural as a preventer of damage either. 3rd degree tears are more likely with ventouse and forceps delivery, the risk of which is increased with use of epidural. Best to avoid any unnecessary intervention at all if possible.

[smokey]

I had a ventouse and forceps delivery with ds. It was a very traumatic birth. I then suffered a vaginal prolapse and had an operation to repair it 15 months after the birth. I was advised that I should have a cs if I had another child, to avoid any further damage. Apparently it is so rare for younger women to have a vaginal repair that they weren't sure what would happen if I had a vaginal birth. I had a cs and wouldn't hesitate to do the same again.

[Clarinet60]

Of course an epidural won't prevent a tear! It would just have prevented the trauma of having an operation without anaesthetic, which is what I went through. I'll tell you what would have prevented the tear - a bloody c/section in the first place, that's what.
'Best to avoid any unecessary intervention if possible' - yeah, great, but they told me I HAD to be induced, and with no fluid left in the uterus after 24 hrs, there was little choice but to listen to the 'experts'.

[Clarinet60]

Avoid the chanches of a section! Do you realise how much better my life would have been if I'd had a section with DS1 as well as DS2? It was a breeze. I'll spare you the gory details, but living with the kind of damage I have is not pleasant. And to think that some people recommend it over a straightforward c/section.

[Clarinet60]

I think the problem is that midwives tend to try to compare a very difficult birth with a normal birth - they try to apply the same rules, same logic, same sequences. But the difficult birth is a different animal and it aint going to fit into those parameters.

[Clarinet60]

Ignore my last posts, midwives. I'm just angry.
Women who have been through it will know what I mean.

[pupuce]

But you won't know if it will be easy or hard until it happens? (or am I missunderstanding what you posted?)
Can I ask why you had no more fluid?

[mears]

Droile - you are quite right that you had to listen to the experts regarding your delivery. What I would say is that the 'experts' are usually doctors who step in often far sooner than required. Where there has been a traumatic vaginal delivery, it is often linked to intervention. It has now been shown that women whose waters have broken do not need to be induced for 90 hours, as the rate of infection is not increased. Had you contracted on your own Droile, you may well have had a completely different outcome. Women often contract too frequently on when on syntocinon as their bodies take over or it is increased too rapidly. We now increase syntocinon much more slowly than we did 5 years ago. Also, sometimes women are beginning to contract on their own and the drip puts them into overdrive. Many a time I have told a doctor that syntocinon is not necessary, despite them wanting it started.
The experience you had was horrendous Droile and no wonder you did not want the chance of repeating it. Thankfully there is a move away from intervention but we still have a long way to go. There are of course instances where intervention is life saving, but it is making sure that the intervention is managed safely.

[smokey]

You don't know if it will be hard or not until it happens and clearly you can have a good or a bad time with either a cs or a vaginal birth. All I can say is that my cs was an absolute doodle in comparison to my 'normal birth'. I only spent 4 nights in hospital instead of 9, had no operation 15 months later to repair the damage and had no pyschological trauma.

[smokey]

I meant doddle.

[pupuce]

Smokey you are right : "you can have a good or a bad time with either a cs or a vaginal birth" - both can go quite badly wrong or quite easily

[misdee]

my waters broke and 24hrs no baby. so was induced, had epidural, which didnt work very well, i could feel everything down one side, could have booted the midwife who told me that i couldnt feel her stitching me up even tho i was crying out in pain and just wanted her to stop so i could hold dd1 and feed her. hated it, hated the fact the midwife was a cow, hated the way she just plonked dd1 on my breats with no advice on breastfeeding just so she could finish her shift. just hated the whole thing.

but with dd2 couldnt have been better/easier. quick delivery onto my belly as requested, help with breatfeeding posistions, decided tearing wasnt too bad so was left to heal naturally, midwives were lovely, showed me how to hand express b4 i left the hospital and i just loved it. cant wait to do it all again.

[mears]

I should have said Droile that when a labour is becoming abnormal and intervention is required, an epidural is a godsend. You are right that there is a difference between an abnormal and normal labour. Unfortunately, in many cases labour is made to be abnormal by unnecessary intervention. Some of that intervention is requested by women who do not realise the consequnces of asking for induction because they are 'fed up' etc. Some of it is because of impatient medical staff who like to control labour. Labour works best when it is allowed to start on its own and not interfered with. Epidurals can interefere with the flow of normal labour and lead to intervention and difficult labours. But as I said earlier, where labour is not progessing well and intervention is required, epidurals can help the woman immensley.

[misdee]

forgot to say, when they inducedme with a drip with dd1 i was already 4cms dilated.

[pupuce]

Misdee - were you induced "just" because of the 24hours?