ELCS or vaginal birth after episiotomy?

[pogthecat]

I’m currently pregnant with DC2, and would like some advice about the birth.

I was induced for my first labour. DC was back to back and got stuck, I had to have an epidural at 9cm to stop my body pushing. Many hours later, I had to go to theatre and had an episiotomy, 2x failed ventouse and DC was finally born by forceps.

My episiotomy didn’t heal. It got infected and split. 6 months later it was still leaking pus and not right, so I had surgery to repair my vagina. All has been OK since then.

Due to this, my current pregnancy is being considered high risk and I will be seeing a consultant to discuss my birth. I know that they will suggest a c-section.

The surgeon who did my repair suggested I would be able to have a vaginal delivery, but would have to take things very slow.

I’d prefer a vaginal birth, but am worried about causing irreparable damage to my body. I fear that if I attempt a vaginal birth and the episiotomy splits (or something?) it will be too late for them to do anything to help me, and it will just have to rip open and deal with the consequences after.

The thought of a c-section scares me.

What would you choose in my situation? Any other thoughts, comments or stories of similar situations that may be helpful either way are welcome!

[polkadotpixie]

Personally I'd go for a c section. I haven't had a vaginal birth so feel free to ignore my opinion but you had a very difficult recovery last time and in my experience I found my c section very straightforward and easy to recover from (& it was an emergency not an elective)

[pogthecat]

Thank you, polkadotpixie. The recovery (or lack of it!) was by far the worst bit about it all. No one tells you about that as a possibility beforehand.

[Bobojangles]

I had a similar but not exactly the same experience (open gapping wound for 12 weeks, lots of physio a few procedures to remove excess scarring etc etc) I'm 34 weeks and hoping to get my elcs booked tomorrow. I'm just not prepared to risk any more damage to my bits and my pelvic floor, or missing out on those early days. Plus scar tissue (I opted against reconstruction in the end as by the time I got a date for my op (1 year pp) I was ok) is naturally less elastic and more likely to tear. Csection recovery sounds like a breeze compared to what I went through!

[Alittlelessconversation0]

Something similar Happened to me. But mine was a bad second degree tear not a cut.
Stitches broke down after an infection and took months to properly heal.
Thankfully however I didn’t require surgery.
Now pregnant with dc2 and desperately want a c section.
Unfortunately the hospital are trying to put me off and push me into another vaginal birth.
The stress that they are causing me, I feel is unforgivable as they won’t agree the c section until very late in my pregnancy.
If I were you, and I was offered it without a fuss, I’d take it in a heartbeat.
There is no way I would risk that Happening again if I can avoid.
Good luck to you, whatever route you take.

[greenybluey]

I had similar first birth and stitches split but mine didn't require surgery.
2nd baby (18months later) was born vaginally without any complications. It was a lovely birth, which I was glad of after my first experience.

And yes no one tells you about the recovery. I thought I'd be out jogging with my pram the next day.

Wishing you luck!

[pogthecat]

Thank you for sharing your stories! Sorry that so many of us have had problems with the recovery.

How frustrating that they won’t consider your request for a c-section, Alittlelessconversation0. Keep pushing them. They have to consider maternal request even without a medical reason these days, so I’m sure you’ll get there eventually.

I think I must be a bit mad to even consider trying for a vaginal birth, but I suppose similar to greenybluey, I just want to experience a ‘lovely’ birth ... I know that anything else could go wrong so even without my history that’s not guaranteed! But I feel like I missed out last time and want to have a birth experience which kind of overwrites the traumatic one, if that makes sense? I live in a dream world

[Fieldsofcabbages]

I had something similar- episiotomy, stitches split, delayed healing and healed with a painful skin bridge. Had surgery about a year later and since then it's been fantastic. It made such a huge difference. Currently pregnant with no 2 and having been told of my history my midwife asked straight away whether I wanted a CS this time around. Bloody right I do esp as the surgeon told me before the op that a further vaginal birth was likely to cause further damage and would probably mean I would need to have the op re-done with no guarantee that the result would be as good as this time around. There is no way I'm prepared to take that chance.
If you are being offered a CS I would definitely take it!

[CrookedMe]

I had a vaginal birth after episiotomy. However my epi healed really well, no issues at all. Second birth was very fast so just as well really.

I suspect in your case I'd have opted for the section. The thought of being left with long-term damage, just doesn't seem worth it for what will be one day in your life.

[Oct18mummy]

I’ve just had an ELCS for another reason, I had a vaginal birth before. The ELCS itself was absolutely fine but the recovery is tough basically couldn’t do anything for first week and in a lot of pain. Feel better 2,5 weeks in but still painful. Still it Sounds better than what you went through before. Good luck with what you decide

[Alittlelessconversation0]

It is difficult and they talk a lot about risks of this and risks of that.
But ultimately, as fieldsofcabbages points out, we will have to live with these risks if the worst happens.

So I suppose you need to way up how euphoric you would feel if your vb went to plan.
Against a mediocre planned c section, which really, I don’t think will ever compare to how great you feel after doing it yourself. But the risks are far more predictable.

I know wholeheartedly what I am more comfortable with. And I would trade off the chance of a brilliant experience of normal birth where everything goes to plan, for a more predictable experience of a c section every time.
I had a ‘normal birth’ last time and it made me utterly miserable.

[pogthecat]

The thought of being left with long-term damage, just doesn't seem worth it for what will be one day in your life.

I think ultimately it comes down to this. I think I’ve done a complete 180 on this in the last couple of hours! Still got loads of time to decide, so I’m not going to set my heart on anything yet.

[pogthecat]

And congratulations on your new baby, Oct18mummy! Sorry to hear your recovery hasn’t been brilliant so far.

[Rachelover40]

You poor thing, you've really been through the mill. Very brave too, many wouldn't want to go through it again.

In your position I would opt for a C-section.

[BrioLover]

I'd go for a c section personally.

A good friend had a very similar situation and had an ELCS with her second. The consultant said the chances of her having a prolapse/painful sex/bladder incontinence with a vaginal birth the second time we're about 5%. That was 5% too much - do you really want to risk it? She did say her ELCS was fabulous and she was so pleased she did it.

I have had two babies vaginally - first one needed a large episiotomy that got infected, but no scary stuff after that, the second one progressed v quickly and I needed a second but smaller episiotomy. I am finding it harder to regain strength in the area this time around tbh, and it's been a year now. My pelvic floor isn't great and I'm only 34.

I wouldn't risk it.

[Alicia870]

I'm in the thick of recovery from vaginal burn at the minute. All I'm thinking is if I have another baby, I am under no circumstances putting myself through this again! Horrible recovery with all sorts of pelvic floor issues. I would definitely go for section in your case too. You know what will be ahead of you, and any risks of long term damange are so slim compared to risking another vb

[pogthecat]

Thank you all so much for sharing your comments and stories I think it’s pretty much unanimous that a CS would be most women’s preference in my situation. I’m definitely going to talk to my midwife about it, I think I would need plenty of time to get my head around the fear/anxiety that an ELCS would cause me.

[gamerchick]

I had a similar first birth to you. Back to back, intervention birth etc...

My second birth was vaginal and the scar didn't tear, I did tear a little bit in a different place though. No stitches needed. My third birth the E scar didn't tear or the second tear, just in a new place and had a couple of stitches.

I didn't have a repair done after the first time though, I don't know if I would want to risk that.

[pogthecat]

Wow gamerchick, your poor vag! It’s encouraging to know that your scar didn’t tear though

[Bobojangles]

Got mine booked today! Consultant said it was "a very reasonable decision"

[pogthecat]

Great news! Out of interest, what gestation will you be on the day of the ELCS?

[Alittlelessconversation0]

Bobojangles really happy you have this sorted I hope you can relax and enjoy your pregnancy.
Any hints or tips that you could suggest to help? Did you have to push and state your case much or did they just give you the facts and then let you decide?

[PhaLANge]

I've had a c section with my first then two subsequent vaginal deliveries (1 episiotomy but no major damage or issues with healing at all) I much preferred the vaginal deliveries however, in your situation I'd definitely go for the elcs. It could be fine but it could cause a hell of a lot of painful damage by the sounds of it, I wouldn't want to risk it personally. I hope it all goes well and straightforward whatever you decide and no issues with healing as it sounds like you've had a hard time of it good luck!

[Bobojangles]

I'll be 39 weeks. I thought I'd have a fight but once I'd gone through everything that happened first time they where totally fine with it, especially as they can't rule out the need for another instrumental delivery. They go through all the risks of c-section in a factual way but agreed with me that in my case the longer recovery etc doesn't really apply as it was a good 7-12 months recovery after my vaginal delivery! The doctor seemed almost apologetic That he had to put it down as "maternal request", I guess some people take offense at that but it's just a technicality

[Hezz]

I had an episiotomy, failed ventose and then forceps. Lots and lots and lots of stitches.

Second time round I had vaginal delivery only tire a tiny bit and no issues, just two stitches.

Good luck

[bumblebee39]

Sounds much like my first labour.
Baby 2 natural birth but on the induction drip and a minor tear.
Baby three will be natural birth I hope...