Second baby with prolapse

[DrG13]

I had a moderate prolapse following my first vaginal delivery (rectocele and cystocele) and am now pregnant with my second child. My prolapse has been manageable with lifestyle changes and lots of kegels, but I am noticing it is slightly worse again now I’m pregnant. I have looked for research into prolapse following a second vaginal delivery, and the research seems to suggest that a vaginal delivery the second time round doesn’t usually cause existing prolapse to worsen, long term. However, I also often read about women with prolapse choosing a c-section for baby number 2, and wonder if this is just preference or if they believe, and have reason to believe, that a second vaginal birth will worsen their prolapse.

Mums of two with prolapse who have had a vaginal delivery both times, did your prolapse get worse? And mums who had prolapse after number 1 and chose c section for number 2, what were your reasons? Pregnant mums with prolapse, what decision have you made for your next delivery? Thanks in advance for any answers!

[DrG13]

Anyone?

[Anm4]

I had my first baby 2010, second in 2011, had a very mild prolapse with baby #1, opted for a normal birth for #2 as was told it wouldn't make it any worse, BUT her labour was 50 mins start to finish & the placenta was stuck which is what took ages to get out.. the first few months i let everything settle but the prolapse had become very bad ( i was still carrying 3 stone extra weight so this probably didn't help but due to other illness was impossible to exercise) i had to have to the surgery as it wasn't wise leaving it any longer as i couldn't toilet properly and the prolapse was bulging out of vagina (sorry tmi) i then fell pregnant with #3 in 2014 and was advised an ELCS to prevent any damage to my repair, pregnancy didn't but was religious with pelvic floor exercises. I'm now 36 weeks with #4 (our last) and so far no problems to my repair but again have been advised to have another ELCS. It is possible to labour with a prolapse but i personally wouldn't of if i could of predicted the damage after but this is only my personal experience from it so yours could go smoothly. x

[Anm4]

I'd also like to add if i could have had naturals with no prolapse problems of course i would of as csection was a harder recovery but as much as i would like to vbac this time the risk of damage is too high & i can't go into natural birth due to the speed i deliver. If you have any more questions feel free to ask.

[StuntCroissant]

Hi OP. I had a minor prolapse after DC1. I've just had DC2 with a 19 month gap. I was told the same, that a vaginal delivery wouldn't necessarily worsen the prolapse, so decided to stick with a vaginal delivery.

Both my deliveries were quick and straightforward home births. But now my minor cystocele has got much much worse and I have a rectocele too. To be honest, I think these were largely worsened by the pregnancy (as the rectocele was confirmed by my gynaecologist during my pregnancy and it wasn't there before). So I'm not sure having a c-sec would have made a difference for me?

Unfortunately I'm now awaiting surgery as is gone too far for kegels!

[DrG13]

Thank you for your replies!

Hi Anm4. I’m sorry to hear about your prolapse issues. It makes sense not to have a vb after a repair. Did you find the surgery worked well for you? Did you have the prolapse during pregnancy 2 or was it the speedy vaginal delivery that caused it, do you think? That’s a fast delivery! Glad to hear all is well for #4!

Hi Stunt! I really feel for you. Prolapse is no fun at all. Interesting that your pregnancy, rather than birth, worsened yours. I’m concerned that’s what will happen to me. I also had an uncomplicated Home birth with an average-sized baby and no tearing, so felt really aggrieved to prolapse! How are you feeling about surgery?

[Anm4]

Hi OP, i had a very mild prolapse after my 1st baby, i didn't even know, it was the doctor at my check that noticed but i did put on four stone and 1st baby was 8lb 8oz, i kept doing pelvic floor exercises and then fell pregnant with my 2nd when my son was 9 months, 100% my daughter's fast labour made the prolapse as bad as it was.

I did plan to wait to have the surgery due to wanting more children but it was really bad so they advised having the repair and any future children by csection but would always be my choice.

The repair was fab, i had an epiosiotomy with both my natural births and they also reconstructed that scar so it is neat, i wouls recommend the repair if your prolapse worsens.

I think when you have a prolapse the extra pressure from a pregnancy can weaken it but the damage to mine was definitely the labour, nothing had time to stretch baby was 8lb 4oz and the placenta was stuck.

X

[DrG13]

Anm4 it’s really good to hear that the surgery worked for you. It’s nice to know that option is there if things do get worse. I am leaning towards another vb, but it’s not an easy choice. I didn’t even know this stuff happened before I had a baby! Why isn’t everyone talking about it more!

[Tumon]

It’s all pretty shocking isn’t it! I am pregnant with number 2 and going for a c section (had third degree tear and prolapse post birth of first )
I’ve also been told that subsequent vaginal deliveries don’t worsen a prolapse but have yet to be shown any evidence of this. There are no studies of women with prolapse after one birth that go on to have sections versus women with prolapse after one birth that again deliver naturally. Also it is known the risk for prolapse is greater the more vaginal deliveries a woman has so I can’t see how having a vaginal delivery again wouldn’t increase the risk of an existing one worsening?
Just my thoughts though. I’m dreading the section to be honest but it seems the lesser of two evils to me at the moment

[Anm4]

@DrG13 i didn't know anything about prolapse either! If the doctor hadn't mentioned it, i would of been none the wiser after my first birth, i just thought it would naturally be different after a baby! The surgery seems like a drastic option but it wasn't bad at all.

I think with a prolapse the chance of eventually having surgery is likely anyway to repair it.
I was apprehensive about the csection first time round but I'd rather proceed with that option now because of having the repair already.
Unfortunately there is a chance of prolapsing again in the future anyway the surgeon said as it happened when i was 21.

I'll just cross that bridge if it happens x

[StuntCroissant]

Hi OP, I'm feeling ok about surgery - I'm just looking forward to being able to (hopefully!) walk without discomfort and maybe even go running again (I used to run 5 times a week-ish).

Incidentally I also had 2 fairly fast labours - DC1 was 6 hours and DC2 was 3. Although this may not have helped my prolapses, I know (as I said above) that my prolapse had worsened during pregnancy anyway.

I've also been told I will not be "allowed" surgery until I have finished having children. I think I would like a 3rd but am not 100% sure, but I am 100% sure I can't live with the prolapse anymore, so definitely want to go ahead with surgery.

[DrG13]

Hi tumon . Yes it has been a shock! I agree that it seems logical that a second vaginal birth would worsen a prolapse. The two bits of research that I’ve read on it suggest that’s not the case, but I’m in no position to know how robust they are. They’re here if you’re interested: www.ncbi.nlm.nih.gov/pmc/articles/PMC3458705/ ; obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/uog.13252

Im sorry you’re dreading the c section. I have heard lots of people say that elective c sections have worked out well for them, so I’m sure yours will be the right choice for you. There’s not really an easy option is there!

Amn4 good luck with your section. If it worked out well before, I’m sure it will again. It’s nice to hear of someone managing ok after prolapse and I don’t feel so bad about the prospect of surgery hearing your story.

Stunt I would love to run again too! I’ve just assumed that running and weightlifting are a thing of the past for me. I really hope you’re up and running again soon. My labour was also pretty fast, so maybe there’s a correlation there. I’m with you - if the prolapse is disrupting your quality of life that much, you have no choice but to have the surgery as soon as you can really. If you do decide you want a 3rd, it will still be possible and you can cross that bridge when you come to it.

[Anm4]

Thankyou, good luck with whatever choice you make in regards to your second birth & if surgery is needed in the future don't be afraid, it helped me massively and if i have to have another repair in the future i wont hesitate! Good luck with your pregnancy and birth x

[WoolyMammoth55]

@DrG13 I'm in the same boat and wondered what you chose in the end? I'd love a second chill vaginal birth - was genuinely so special! - but the thought of this gettting worse makes me pretty scared. Could you share an update? Much love X

[Eri19]

Funnily enough I stumbled on this thread today too. I'm also curious how it worked out for you DrG13. I hope all is well? I have a mild cystocele after giving birth to my daughter last year. With that has come USI which I am still trying to correct with kegals. I also had a really quick birth. Mine was under 4.5 hours. So maybe there is a link like you all said. Interesting!

WoolyMammoth55 congratulations on your pregnancy! I'm sorry to hear you are scared of things getting worse. I hope you get the answers you need and take some comfort in this thread. Just knowing that other women are going through the same thing is comforting.

I hope you are all doing well x

[WoolyMammoth55]

Hi @Eri19, that's sweet of you to reply, thanks! FWIW my first birth was interesting - very chill for the first 40 hours :) but then he did come shooting out on the first push! I'm also hypermobile with very stretchy ligaments so was always going to be slightly more likely for my body to over-stretch. Things seemed ok at first but then when he was 5 weeks old and DH was back at work I struggled to get into a good routine at home alone with first bub, got myself really dehydrated and constipated, and bust out a grade 2 rectocele prolapse instead of pooping! (TMI sorry!)

Very luckily I'm not very symptomatic at the moment but the feeling of being 'broken' and the shock of the damage (which like so many first-time mums I had no clue was a possibility, never mentioned by NCT teachers, midwives or doulas or any of my 'what to expect' books...) I think did contribute to my PND.

SO - at the moment I'm leaning towards chancing a (hopefully) relaxed natural birth again, and then if I'm going to have to have a surgery I'd choose to have that be a surgical prolapse repair rather than a c-section... But from what I've read prolapse relair ops can fail. If anyone on the boards who's either had more births after prolapse OR has had a surgical repair wants to share, I'd love to hear all the thoughts of women who've gone through it.

Love to all the hero mums putting their bodies on the line for our kids!

[Eri19]

@WoolyMammoth55 thanks for sharing your story! I hope you are feeling better now and more positive about things. I totally agree that nobody talks about prolapse after birth. It is like a dirty secret or something. I also felt, and still feel, broken. You have put it into words perfectly. I also had PND and this was definitely a contributing factor. I went to see a physio and I also found a woman on YouTube who educates about pelvic health and she has exercise videos. She fully believes you can heal a stage 1 or 2 prolapse naturally. So I hope that gives you some hope. I have been doing the exercises and my symptoms have improved. I hope you get the answers you are looking for x

[WoolyMammoth55]

Ah bless you @Eri19! It's so tough isn't it? I'm glad that you've had improvement in your symptoms. Would you be happy to share the info for the YouTube videos that have helped you?

It makes me so furious that there is so much information out there, so many resources for new mums, but this isn't talked about AT ALL - like you say, as if it's a dirty secret. And then there's so much pain and shame and feeling broken - all on top of parenting a newborn! Aaargh!

Sending you so much love. Congratulations on being a mum and I hope by the time your daughter has her kids we'll have broken down this taboo and got all the mums-to-be educated on their pelvic floor health BEFORE they get prolapses! X

[Eri19]

@WoolyMammoth55 thanks so much for the lovely message! I also feel really angry about the lack of knowledge too! Surely it should be one of the main areas of discussion?! It is so common yet I feel so alone with it. I feel like I'm the only one. It helps to chat to others who are in the same boat! I have vowed to myself that I will educate my daughter about pelvic floor health when she is young. When she is old enough to understand I will explain what happened to me and the steps she can take to prevent the same happening. I want her to have all the knowledge and then she can act with it and make informed choices.

The YouTube resource is femfusion fitness. This lady is amazing! So knowledgeable and a good soul. She explains why she is teaching certain exercises and how the body responds etc. I recently started her kegal camp. It is 30 days of pelvic work 10 mins a day. I try to do it every day but this is hard with a 14 month old! However I still have found a huge difference already. So I think I will continue with it for a long time. She also has a programme called lift. On YouTube. It is all free and very good! I trust what she says too. Hope that you enjoy following her advice as much as I do. I feel that she has given me hope that things can get much better. I hope it can help you as much as it has helped me!

Sending all the love to you too!x