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elective c-section for birth #2, after traumatic birth #1 (and subsequent poo issues) ?! What would you do?

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mummyagainin2016 Thu 19-Nov-15 11:37:54

Long post, sorry.....I’m 16 weeks pregnant and considering my options for this delivery as I had a rough time having my son who was born in 2012. I’m considering an elective c-section, though I know they come with their own risks and issues. Both the consultant midwife and my consultant have agreed I can have one if I choose but equally would support me if I choose vaginal birth.

A bit of background…I had a long labour – 80+ hrs from first contraction until delivery. Despite planning and preparing for a hypno / water birth, and not wanting pain relief other than G&A, I couldn’t use the pool due to a small bleed shortly after getting to hospital and I ended up on the syntocin drip after a while to augment things as they weren’t progressing and I was exhausted from not having slept a few nights already. I stuck with just G&A as per my birth plan until we knew we needed intervention. I ended up with low forceps with episiotomy under spinal in theatre as my son was back-to-back and facing the side, and just wouldn’t come out (though I didn’t know this about him being back-to-back until months later when I was informed at a birth review meeting). Before we moved to theatre, I pushed for well over an hour, including a fair bit of time on my back (not knowing he was back-to-back – gah!!).

After delivery I had a retained placenta which had to be manually removed and then had a PPH of about 1.5l due to uterine atony and became faint a day or two later while still in hospital and so chose a blood transfusion before I was discharged. I had a catheter in for a bit in hospital and shortly after it was removed I remember feeling I needed a wee and I stood up only to then find urine pouring out of me onto the floor. Midwife came to clean up and got the women’s health physio to come and see me and exercises were prescribed. I also struggled to control the passing of wind for a couple of weeks after but was told this is normal. With hindsight I wish I’d taken an epidural so I could have rested more during such a long labour. I ended up with lots of interventions anyway and breastfeeding was very difficult for months!

My episiotomy healed with no issues but a few weeks after my 6 week check (when I wasn’t examined, just asked how I was), I went back to the GP because I was finding it hard to control bowel movements. For example, the first poo of the day was tricky. I’d get the urge and would need to get to the loo asap and sometimes didn’t make it. GP referred me to Women’s health physio who checked me over and gave me exercises for the whole pelvic floor, with instructions to tighten the vagina and anus when doing them. I also got dietary advice to help manage symptoms in the meantime. Physio also queried if I’d had a ‘missed’ tear. I’ve no idea obviously as there’s nothing in my notes if it was missed. I then had weekly physio appointment for the next couple of months and the problem was resolved. I still have less control / time than I used to pre-baby when needing the loo after a spicy meal etc but I no longer poo myself!! I also have no issues with urinary incontinence (can run etc with no issues) and sex is also fine.

So, I’m still considering an elective c-section. I’m worried about needing another epi or tearing and having the same or worse issues. Consultant midwife was supportive of me choosing either c section or vaginal birth. I know subsequent labours are often quicker and easier and tearing and need for forceps is less common etc but equally I feel there’s no guarantee as you do hear of people having difficult second labours too. Midwife said one option would be to try vaginal delivery but rule out forceps / ventouse so if things need help they would move straight to c section. This appeals but I’m worried that it may not play out in practice…? She also said that I could use water pool this time if all normal and so avoid epidural and associated increased chance of interventions. She also said water reduces risk of tearing? But she also said that faeceal continence issues are quite unusual and she understands me not wanting to risk repeating the past situation and can see why a c-section might be the best option for me. A comparatively ‘easy’ vaginal birth appeals and I know I can deal well with the pain. I would love to have a natural birth with no issues and be home later that same day – who wouldn’t?

I am waiting to see the women’s heath physio again to see if they will take a look down there and give their view on whether a c section is best or whether another vaginal birth would be ok. Then going back to see the consultant midwife and the consultant in February, by which time they'll both have had time to look at the full notes from my last birth.

Another consideration is that I also have diastasis recti (separated abdominal muscles) after my first pregnancy and have been working to improve this but I’ve heard that c-section is bad for DR.

I’ve no idea how common faecal incontinence is after childbirth but I know it can re-emerge and worsen during later life so that’s a worry. A few of my friends also needed women’s health physio after their births and some had to have those electronic probe things to use for weeks after, (I didn’t thankfully!) but I don’t know what their issues were e.g. faceal or not. We talk about a lot but not at that level of detail! 

Anyone been in a similar position or have any other useful knowledge to share please?

pinguina16 Thu 19-Nov-15 13:00:24

Faecal incontience following childbirth is usually associated with a severe tear.
www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-third--or-fourth-degree-tear-during-birth.pdf

That's why the physio asked you if you had a missed tear. Even the RCOG leaflet above acknowledges that tears can be missed.

You should really have an endoanal/rectal scan to see if there was a tear and how severe it was (why aren't people following you already requesting this is beyond me).
Once this has been done, you could also ask for a strength test (done by a colorectal department). They put a small probe in your back passage and ask you to squeeze. They then should be able to tell you if your sphincter is working within normal range or not.

Faecal incontinence following childbirth is not common (although probably more common than acknowledged by healthcare professionals). It often is the sign of a serious injury and therefore should always be checked.
No one wants to talk about it and this might make it hard to get the treatment/advice you need.

Personally, amongst the healthcare professionals I have seen, I have found the physio the most knowledgeable. She's the only one who gets to see women just after birth but also much later on in life (midwives, urogynae and colorectal surgeons have knowledge of course but don't see patients in the same way as physio if that makes sense). If surgery is needed then yes surgeons are more knowledgeable but for overall view of the pelvic floor, my physio is the best I find.

My physio always tells me that any type of incontinence is NOT NORMAL after birth. Urinary stress incontinence is common (30% of all new mums) but should never be accepted as normal.

I hope you get to ask the questions you want to ask with an obstetrician (or two?).

mummyagainin2016 Thu 19-Nov-15 14:05:41

Thanks pinguina. Glad I'm seeing physio then. Do you think she'll be able to arrange the scan you mentioned?

LumpySpaceCow Thu 19-Nov-15 14:38:34

Gosh you had a rough time. Your first birth sounds like intervention after intervention (starting with the synto) which tends to lead to more problems- very much like my first birth.
Do lots of research and speak to the professionals. I have had both, a traumatic ventouse and elective section for breech and this time will.try for vaginal (only because I have a toddler and recovery will hopefully be easier if straightforward) but I am not starting with any interventions - the first sign of 'trouble' e.g. meconium, slow contractions etc I will have a section and not go down the route of lots of interventions x

LumpySpaceCow Thu 19-Nov-15 14:39:53

Cascade of interventions! That's the term I was looking for!

pinguina16 Thu 19-Nov-15 14:43:27

Yes, I think so. She should definitely know who can refer you.
The endoanal scan is important because it will help assess the damage (is there a tear? what severity are we talking about?)

I was faecal incontinent after birth (the I-now-know-all-too-common forceps + major PPH). I had a scan 3 months after birth and the sonographer classified my tear as 3b (it was not detected and therefore not repaired after birth).
At 6 months I saw a colorectal surgeon who did the strength test. At that point he said that in his view my tear was only a 2d degree tear. Obviously it didn't change what had happened but my anal sphincters are intact, it is more encouraging for old age.

Personally I found it difficult to understand my birth and the scale of it. Just to give an example which relates to your story too, PPH represents 5 to 10% of births. A major PPH (losing over 1 litre of blood) represents between 0.3 and 1.86% of births (patient.co.uk).

You seem to have a very good outcome (you can run!!!!) and that's great!!!!
I hope you can discuss what would be best for you and your family for this second baby. smile

OhGood Thu 19-Nov-15 14:44:19

lumpy without any comment or judgement at all, can I just say that I have 2 friends who had traumatic first births, and went on to have elective c-sections for 2nd births, and both had absolutely brilliant births.

So, if it's what you decide you want, go for it, and don't be swayed. Your body, your baby, your birth.

Good luck!

LumpySpaceCow Thu 19-Nov-15 17:14:07

ohgood
No judgement inferred at all 😀
I enjoyed my section and it was a really positive birth experience. Recovery was a lot easier than my first traumatic birth (led to PND, PTSD, years of counselling and antidepressants), however I'm still apprehensive about electing for another as a will have a 15 month old to look after as well as a newborn (last time I just had the newborn and was waited on hand and foot whilst my DD1 was at school!). As the op was unsure on what to do, I was just offering my experience and suggestions, not telling her what to do at all. I am lucky as my hospital is very pro active birth and use wireless telemetry, I can have a water VBAC if I want - if it wasn't wireless I would go straight for section regardless (my hospital would be happy for me not to have continuous monitoring and go on mlu but I can't get over the what ifs).
As op stated, an easy birth would be easier to deal with recovery wise than a section but there are no guarantees of crystal balls, that's why I've done lots of research (I also work professionally in that area) , spoken to the professionals and will have a very comprehensive birth plan-first sign of trouble I will have a section. If babies breech again I will be straight for section smile
No birth is risk free and whatever you choose Op, you are simply swapping one set of risks for another. It's a matter of what risks you are most comfortable with
Good luck x

magpie17 Thu 19-Nov-15 17:39:21

I had an episiotomy (much more straightforward birth than yours) with my DS and all seems to be ok now and I am still nervous about the prospect of another birth in the future. In your circumstances I'm not surprised you are apprehensive! My honest answer is that I would have the section in your position. My friend was in a similar boat to you and had an elective section for DC2, all went well and she regards it as a much more positive experience than her 'natural' birth.

QueenMolotov Thu 19-Nov-15 19:52:15

There's some great advice here, OP. What a terrible experience you had first time around. Wanting an ELCS is completely understandable.

FWIW, I damaged my coccyx when I gave birth to dd1 in 2009. I was in labour for 30 hours and pushed for 2hrs. She just wouldn't make the final turn; I was utterly exhausted and I ended up needing an episiotomy as she was born via ventouse.

Healing from the episiotomy wasn't pleasant and I remember feeling completely numb when having a poo for a couple of weeks. That was very weird. It took several months for everything to settle down internally and around my poor perineum (thankfully no continence issues) although my coccyx has never, ever been the same since. I needed (private) physio to alleviate the main causes of pain and to this day I still have a degree of pain. It's not always bad but I can't sit directly on it for long or over-stretch my legs.

Anyway, the pertinent thing about my experience for you is that I elected to have an ELCS with my dd2 in 2012. My CMW was supportive but the consultant wasn't. He overplayed the risks of ELCS and make out like there were no risks to VB. It was essentially 'You have a vagina. You can push another baby out of it.'

Which I disagreed with and still disagree with.

I had to jump through some hoops which is emotionally draining the more pregnant you are but I was adamant that I wanted the ELCS because I was terrified of fucking my back up again and possibly having incontinence issues (the tailbone is the anchor of the pelvic floor. Over stretch them and boom, you'll pee or poo yourself).

Once I demonstrated I wanted an ELCS and fully understood the risks, I was booked in. The ELCS itself was fine, very upbeat and controlled and I was fully 'there'; not zoning in and out due to pain, exhaustion and G&A. The recovery, whilst uncomfortable for the first few days, was as expected.

What you need to do is identify how a CS would impact upon you having had DR. Do you have it now? Is it likely to get worse with this pregnancy?

Also, CS potentially affects future pregnancies. Certain risks increase with each CS (e.g. placenta praevia, less likely is placenta accreta) so you need to think about how many children you want to have. For me, I knew we wanted at least 2 dcs, possibly 3, which meant at the most, I would have 2 CSs.

Someone once said to me that there's no easy way to have a baby and I think they were right! Wishing you the best of luck thanks

Needaninsight Thu 19-Nov-15 19:58:35

I could actually have written your post. Identical first birth story almost. I opted for elective c section with no 2 (to avoid further damage)

Sorry to say, worst thing I could have done sad

My c section (although planned) turned into an emergency and my recovery was awful. My traumatic first birth was topped by a more traumatic second birth. You couldn't have bet on it!

I have since been seeing a consultant with regards to corrective bowel surgery. He was adamant, from visit one, that I wasted my time opting for a c section to prevent more bowel damage. He said, once the bowel is damaged, it's the act of actually being pregnant that causes more damage. That is, the weight pushing down onto the damaged bowel.

His belief was that I would have been 100% better having a natural birth. I'm inclined, after my experience, to believe him. Please feel free to pm me.

I'm now waiting for surgery but still haven't decided whether to have the open wound type surgery or have a pace maker fitted. Neither is a particularly appealing opttion, but running to the toilet to poo with 10 seconds to spare (if that) cannot be continued for life either.

QueenMolotov Fri 20-Nov-15 08:26:26

Need, that sounds awful. So sorry to read about your experience thanks

For the benefit of the OP and anyone else in the same position, why did your ELCS turn into am EMCS? Why would a VB have been of more benefit to you than an an ELCS? Is this for definite, or with hindsight?

Please forgive me for asking as I'm not trying to badger you. I'm asking because what you've written seems scary, especially to someone yet to make a decision re. mode of delivery. More context is needed, I think.

TaliZorah Fri 20-Nov-15 10:41:27

I'll give my perspective as I had an ELCS as I was terrified of a traumatic birth. I have never had a natural birth to compare it to, but here goes:

My ELCS physically was easy. I had gone into labour but didn't progress and had decided an ELCS months before anyway, so technically it was an EMCS, but it was very calm.

I walked into the hospital, got given the socks, then the surgeon came and explained everything to me, and I had to sign to say I understood the risks.

I then walked into theatre, and a drip was put in by the anaesthetist, I asked for the smaller cannula as I hate needles and they were fine with it. I had the numbing cream and it didn't hurt. The spinal was weird, I had a feeling like I'd banged my funny bone down one leg. Then my legs went warm, and one went numb before the other one.

I didn't even realise they'd started the section, 2 minutes after cutting my son was born. Now mine turned into an emergency as DS was blue and had aspirated meconium but that's nothing to do with the section.

I was stitched up, DS had gone to SCBU so I don't have any experience of skin to skin straight away. I was then taken to recovery and then the ward, I had a private room.

The pain the first day was sore when I moved but it's not the worst pain id ever felt. By day 2 it was just a bit annoying, by day 3 it was barely noticeable and by day 6 I was out the house with the pram on no pain relief. I have had sprains that hurt more.

That's not everyone's experience but for me it was fine. Just to offer some perspective of a positive c section.

mummyagainin2016 Thu 26-Nov-15 14:35:22

Thanks all. I think I didn't realise how 'extreme' my birth as until I started asking about it online and doing some research. I mean, I assumed that while not commonplace, forceps, long labours, even haemmorhages weren't that unusual either. I would love a straightforward vaginal birth this time but it's the uncertainty that I fear.

I get annoyed with those who constantly go on about natural birth as I feel I tried (and failed!) at that last time, and most of them had nothing like as hard a time as I did. Ditto for those who catastrophise about c-sections.

The experience of those who've had a traumatic vaginal birth and a c-section (ideally a planned one) are the ones I think I could learn most from.

mummyagainin2016 Thu 26-Nov-15 14:43:02

lumpy the consultant midwife did say I could choose to go into labour naturally and then ask for a c-section if things look to need help in any way. I'm just worried that in reality, they might not act on my wishes soon enough, or even be able to - theatre availability etc - if they don't deem it an emergency c-section at that point.

JoMalones Thu 26-Nov-15 14:48:31

I had a horrific birth with DC1 which also caused problems afterwards going to the loo (once was almost as plead as labour pains, actually screamed, blood everywhere, horrible).

DC2 was ELCS and was amazing! I did drink a lot of orange juice to avoid constipation and if you are worried about splitting the section open, I was advised to hold a sanitary towel on it when I pushed. A totally different experience to birth one and for me I healed far faster second time. It's your choice, you need to feel comfortable with what you choose.

mummyagainin2016 Thu 26-Nov-15 17:07:55

Thanks JoMalones. Your experience fits with most women I know who've had an elec c-section 2nd time around...

JoMalones Thu 26-Nov-15 18:14:58

Feel free to pm me with any questions. I went through everything after DC1 and you know it's bad when the enemas don't work! I also didn't feel confident that I could actually push a child out and felt far more comfortable handing the birth wholly over to the professionals!

mummyagainin2016 Wed 02-Dec-15 17:20:22

So I spoke to the women's health physio yesterday. Not been offered an appointment but they just spoke to me on the phone. They basically said the couldn't advise me whether to have a c section or VB as 'all we look at is risk factors and all births are different. You need to speak to the consultant and make your decision.' (It was the consultant and birth choices midwife who said speak to physio....!) They'd not heard of any scan to check the strength of the tissue in that area either. So, a total waste of time. Where, if anywhere, do I go next please?

QueenMolotov Wed 02-Dec-15 19:22:24

Maybe a referral to a colorectal consultant?

Sorry it was useless today. Must have been frustrating and upsetting for you.

QueenMolotov Wed 02-Dec-15 19:24:42

*I might add that I asked my physio (the one who helped me overcome sciatica from coccydynia) about whether I should VB or CS with dd2 and he was much the same. It was a private osteopath who concluded that I was more likely to do damage agin with a VB.

pinguina16 Thu 03-Dec-15 08:58:30

!@#?

Looks like the system is not helping you.
I don't know what services are available where you live but I'd try a couple of things.

1-Ask to be referred to an obstetrician (instead of being followed by midwives)
If you eventually want/need a planned c-section, you'll have to see them anyway.
If they look reluctant, say you want a c-section because of faecal incontinence (even if you're unsure now, it's just so you get the opportunity to discuss your options)

2-Go and see your GP to ask to be referred for a rectal scan (to assess the damage and help you make a decision)
Personally I wouldn't leave the GP surgery unless you are given a clear plan: either a rectal scan or the certainty to see an obstetrician.

It looks like things won't be done in a logical order but if you're trying to get as much info as possible to make a decision then I'd start both pathways (colorectal and obstetrics).

Stating the obvious but it's your life and family and therefore your decisions, not theirs. They should be transparent and helping not hindering.

Hope that helps.
Keep us posted wink

pinguina16 Thu 03-Dec-15 09:08:56

Reread thread after posting.

The strength test is called an anal manometry. It tests the strength of the muscles around the anus. It's normally done after a simple rectal scan.

Also forgot to say there may be delays to get rectal scan and anal manometry so don't leave your GP without a plan.

[Aside remark: how come MN forum seems more helpful than healthcare professionals? blush]

pinguina16 Thu 03-Dec-15 09:19:23

Sorry, you're of course already followed by obstetrician (tiny mobile screen).
Have they had cases like yours? What in their view are the pros and cons? Does it come down to how many children you'd like? What would the benefits of a VB be in your case? (do bear in mind that going for VB means accepting risks of instruments, something HP tend to forget)
If they still don't get that you're trying to get a medical opinion then I suppose you'll have to ways pros and cons on your own.

Sorry for confusing posts. Still hope it helps. fwink

DownstairsMixUp Thu 03-Dec-15 09:31:23

Hi Op, sorry to hear about your first birth. Mine was nowhere near as bad as you but I will say why I had a elective the second time.

My first ds i went 5 days overdue, when to get a sweep and found out my BP was sky high and protein in urine so they said I had pre eclampsia i needed to go home, get my things then come back to be induced. Got back, was already in labour (5cm to!) just didn't know. They were worrried about my BP though and still ptu the drip on to hurry it up. Basically ended up having ds within two hours and one hour of that was pushing but he wouldn't come out, was cut and had a ventouse to get him out. Straight after though the placenta kind of dropped out a complete mess, not even looking like a placenta anymore and then 1.5l of blood, it was bloody horrible and scary and I had terrible anameia for weeks after to the point walking up the ward i was out of breath. Honestly felt like death and it was a terrible experience.

Second ds I chose a ELCS and i can honestly say it was the best thing i ever did. Went in at 39 weeks, they played the radio while he was being born, spoke to me etc. The most painful thing was having the canula in (not the spinal funny enough) recovery was nice and easy. lot easier and quicker than my natural birth where the stitches made everything awkward and i had issues for a few months with sex where it felt too tight and uncomfortable. I'd say I was back to normal within 3 weeks after a c section though I think I'd of been fine within the 10 days but DH wouldn't let me do anything.

Anyway, I look back on my second birth a lot happier than my first. Hopefully this gives a positive side to the ELCS side of things!

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