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Birth and vulval pain issues...what to do for the best? (Very long!)(13 Posts)
This is going to long so thanks in advance if you stick with it...
Back in early 2014, months after our wedding I suddenly had extreme vulval discomfort. Pain/tingling/throbbing all over. As the months went on things got worse. Physical symptoms like swelling/red raw patches appeared. I tried everything. Creams, lotions the lot. I had to sleep with an ice pack between my legs. I once got into a hot tub. Although I showered afterwards, the day after the pain was horrendous. My vulva went 3 times it's normal size and turned bright orange.
Sex went out of the window. The whole area was a big red angry swollen mess afterwards. My husband was amazing, and although we managed a sex life of sorts intercourse was off the menu for a year and a half in the end.
Doctors didn't know. Dermatology passed me to gynecology and back again until gynecology admitted they really didn't have a clue. So by chance I found a private gynecologist. An amazing bloke, I finally found someone who believed me and gave a shit. We tried a couple of drugs (antidepressants for vulvodynia) but no joy. However a steroid cream finally started giving me results and I had good days and bad days, instead of bad all the time. We never got to the bottom of a cause, DH and I decided to TTC as soon as we could as time wasn't on our side. That took nearly 2 years as I was found to have stage 3 endo, which I had surgery to remove.
I'm now 38 and due my first in January. I've avoided the steroid cream since finding out and sure enough things are getting shit down there again. Some quite rough days, can still have sex although despite a ton of lube I will end up with a red raw sore ring at the vaginal entrance and some swelling afterwards.
So... I had always thought no question for me I would go straight for an elective section. But now I'm actually pregnant I have no idea what to do for the best. I'm consultant led as also epileptic (and have arthritis as well!)
The consultant has mentioned pain being a fit trigger so if I went down the vaginal route I'd be on epidural from the get go. This is great, BUT I know this increases the risk of interventions. Forceps (which I really don't want especially high ones), cutting, tearing. All fine when I can't feel it but what about once it wears off? The very bad years were a very low time for me. I hardly slept, I drank too much. Dark thoughts etc. How can I cope with that potentially coming back due to damaged bits, AND a newborn? I also have read about the risk of these being linked to age.
On the other hand, C section. I'm not concerned with my recovery. I know it's major surgery and I'm prepared for that. We have a huge support network in place. My only concern I guess is breathing, I know there's the risk of breathing issues for baby. I don't want to have her come out and be in any kind of danger breathing wise. What if she comes out and she can't breathe? That's my major fear.
I thought maybe go down the route of vaginal with epidural but any chance of intervention being used I want a c section. However once I'm in labour I get the impression they would rather have me finish and I'd be fobbed off until the bitter end with all the instruments and tearing I am trying to avoid.
One day I think "no. C section is better on reflection". The next I'm doubting it again. What would you do? (Apart from pour yourself a massive wine for reading through all of this!)
I'm not sure my opinion is worth much OP because I haven't suffered like you have but I have had uncomplicated deliveries and I would still say have a section. It is less of a lottery and in my humble view, you have been through enough. Once labour progresses you don't really get the choice to opt for a c/s; you get told what is in the baby's best interests / safety, and choice goes out of the window. Good luck and safe delivery whatever you choose.
I would look into the stats properly on c sections vs vaginal birth- look on the rcog website. The risk of breathing difficulties in baby is temporary and is still low if you have your section at 39 weeks. Overall the risks for baby are slightly lower for a planned section than a vaginal birth, risks to you are slightly higher- but the risks are different so it's a question of which risks are more acceptable to you as well as the idea of unpredictability with a normal birth.
When you have skin breaks, does it take a long time to heal? Also, does the tissue feel very fragile? In your position, I'd be worried about healing post delivery. Could you ask your dermatologist for advice? Although CS is not to be undertaken lightly, preserving your perineal/vulval integrity is a serious consideration.
Were you advised to avoid steroids / steroid creams in pregnancy? My DD2 was on oral steroids from 16 w until the full term birth due to her autoimmune illness flaring. Baby and mother remained well (DGC was slightly small : 6lbs). Just wondering if you might be suitable for the same? She saw a maternal physician as well as the obstetrician and her immunologist, they all worked together on her care plan. If your symptoms can be controlled wouldn't you feel better about the rest of the pregnancy and beyond? Maybe worth mentioning.
No idea about c section versus vaginal. DIL has to make the same decision after EMCS last time, whether to go elective or try for VBAC.
Good luck, sounds like your life had really turned around except for this health issue, happy days.
Thanks everyone, I'm taking everything on board. Thanks for the rcog recommendation, good reading.
Not sure when you say 'skin breaks' Mayhew, if you are thinking I've had splits in and around the vulva that hasn't happened (thank fuck!) normal cuts to my skin don't seem to take longer than a usual heal time though.
I haven't been advised to avoid steroid creams, have had a mixed message in that a midwife nodded and said 'yes that's best' when I mentioned I'd stopped using it when I knew I was pregnant. But the consultant said I could use it, I don't know what to think really; just want to make sure I don't put baby at any risk. The only thing I am using at the moment is a moisturiser with the charming name Vulva Harmony (a mix of natural oils, aloe vera etc). It's no steroid but helps a bit.
The arthritis I have is classed as an auto immune disease though interestingly. I have done a lot of looking into potential links. Sometimes the pain does feel like my bits are attacking themselves!
As an RA sufferer myself I think if the doctor's prescribe something they will be very sure it's safe, the lethargy alone is bad enough without being pregnant. What other drugs are you on?
DD was on steroids and montelukast for her autoimmune disease which was more risk to the baby than the steroids. Have a dekko at the Auto-immune pages under Health on MN where there is a nice bunch of people with various conditions to help.
I've had here vaginal drug free births so I've got nothing in saying this but really, epidural, c Dec etc. They're fine. Absoluty fine.
Section and epidural are practically standard in America and they've got great birth outcomes just like the UK (if you're insured...) the main problems with epidural and csections is that they can be a pain for the mother. They're perfectly fine for babies.
One day when you're on you're third baby you'll look back and think why didn't I listen to the doctor and make my life easier and use the cream (and then take another glug of wine)
I have vulvodynia and I've had two normal vaginal births with a few stitches and both have healed without any resulting pain which would lead to a relapse. However I've had vulvodynia since 2004 and haven't had any pain for a few years pre children. Any stitches I've had have taken 1-2 weeks to heal. That's fairly normal I think.
However if I had recently had as much pain as you describe I would be opting for a c section. You do not need to make it any worse.
I would also be continuing with the steroid cream. It's a really small amount of steroid.
In both of my pregnancies the midwifes didn't know what vulval pain was nor did the consultant I saw specifically regarding it.
(I had SPD and the physio knew more! She gave me lots of exercises to help core & pelvic floor issues and they worked.)
Thought you'd appreciate a very recent perspective. I have vestibulodynia too, was diagnosed in 2007 and had it very badly for a few years although it has improved greatly in recent years (although it does seem to flare up in pregnancy). I gave birth to my first DD in 2015 with epidural - had an episiotomy and I wouldn't say things were any better or worse down there afterwards as a result. Five days ago I gave birth to DD2 at home in the bath. It was absolutely fine. I was very committed to a natural birth this time even though I was TERRIFIED of pushing and crowning, but to be honest although there was a ton of pressure there I didn't even feel like I experienced the "ring of fire" - the contractions were tougher to cope with than pushing her out so I don't think my vulval pain added an extra layer of pain to delivery. I had a small second degree tear this time (which I knew I would due to the friability of my tissues) and it feels like it is healing fine.
I'm 10 days on from a section and I can tell you the recovery is NOTHING.
I was walking in hours, showered that night and fully mobile and active ever since.
Have the section and for god sake find out what's wrong with your bits, it must be miserable.
No experience personally but two things:
1) as an asthmatic I inhale a steroid every day. Because it is inhaled rather than oral it is considered safer in pregnancy and I wonder if a topical steroid is the same. (Though I appreciate a much closer bit of the body)
2) you can get specialist vulval dermatologists if you haven't seen one of those. Dr Fiona Lewis based in St Thomas' in London is one.
Good luck with whatever you decide
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