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?
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Childbirth
elective c-section for birth #2, after traumatic birth #1 (and subsequent poo issues) ?! What would you do?
mummyagainin2016 · 19/11/2015 11:37
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. 
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
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
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 
Need, that sounds awful. So sorry to read about your experience
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.
!@#?
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 
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? 
]
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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. 
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