Impact of birth injuries/prolapse etc

Also for me, after the bad experience with forceps, I did consider an ELCS but decided against.

Instead, I talked through with a midwife and had a birth plan that stated if complications arose I wanted to divert to a c-section straight away and would not consent to attempts with forceps/ventouse (unless a section was absolutely physically impossible). DC2 briefly went into distress and the team were very supportive of this decision when working out a plan. Luckily things smoothed out and I had a straightforward vaginal birth with no intervention.

I think a lot of women don't realise you have these kind of rights and can make decisions about your birth and labour, which is why many feel like an ELCS is the only way. Were told not to bother with a birth plan and discouraged from doing any of our own research.

Not read through the thread yet but I still have pain and discomfort with my episiotomy scar six years on :/
The immediate recovery was also nothing short of absolute agony for a fortnight.
I do wonder if the lack of truth is also to do with trying to make vaginal birth seem as appealing as possible compared to a C-section. Obviously a section is major surgery and many would not opt for one anyway, but surely more women would consider the option if they were given the full facts on vaginal birth risks?

Thank you to Shakey. I joined the APOPS support group and have learned so much there. www.pelvicorganprolapsesupport.org it is run by the lady giving the Munsnet webchat...brilliant information. I did not want to learn all of this but it is helping me cope so much better with my bloody bottom!!

I have had posterior Colporrhaphy which has improved my perineum and stopped the tampons falling out but has not helped with the problems with the rectum - mainly difficulty with clearing all of the contents, even when using stool softeners. I was told it did not always help when I had my op

Is there anything else for me, or will I be condemned to digitating for the rest of my life?

I belong to a wonderful facebook support group www.pelvicorganprolapsesupport.org I did not know a thing about prolapse until diagnosed. the group is really supportive and lots of experience with surgical and non-surgical solutions to prolapse. Women only, so we talk about everything. Sherrie Palm will be speaking on MumsNet tomorrow (Tuesday) night at 9pm.

Lilone I can tell you anecdotally that my mum has had to have strangulated haemorrhoids operated on twice, and has pointers towards (though no official diagnosis of her own) the same genetic condition that caused my prolapses and my (and sisters) hernias.
So in that case they are linked (I get them too, but not like my poor mum!)

But they're common anyway, so it is very probably nothing to worry about.

I also thought I'd missed the webchat - in my brain we're at the end of January now

Me too AuntElle

Thank you, was worried I’d missed the webchat. I really hope that after that we can look at possibility of a MN campaign on this area of women’s health.

Here's the link to the MN webchat on Jan23rd about prolapses if anyone wants to post a question in advance

www.mumsnet.com/Talk/mumsnet_live_events/3144287-Webchat-with-Sherrie-Palm-of-Pelvic-organ-prolapse-support-organisation-Tuesday-23-January-9-10pm

Red toothbrush
I'm not repeating what the media have told me, I'm simply going on my own observation of the number of professionals in surgery and aftercare and how much that costs versus the costs of vaginal delivery. Maybe I'm wrong but I'd be amazed if Caesarian birth is cheaper than vaginal birth in itself ( not the long term costs).

Just to make clear I am in no way comparing hemmoroids to the awful cystocele and rectocele at all. I just wondered if there was a correlation as they are both due to muscle weakness.

Hello, it's been very shocking to read a lot of your posts on this thread.

Am I right in thinking that if one has particularly bad hemorroids, it could be more likely to suffer from cystocele and rectocele prolapse issues?

I am aware and don't want to steer this conversation into a ELCS or VBAC. But I am due my second baby soon and have been suffering from hemmoroids. I am currently deciding between an ELCs or VBAC and concerned my pre existing hemmoroids could make me more likely to suffer these prolapse problems. Does anyone know?

As has already been noted caesarian birth is so expensive so it would be a major problem if lots of women started choosing it which they might well if they knew more the risks of vaginal birth.

Strangely enough NICE don't agree with you. Because of the associated costs of long term complications. They said this couldn't be tallied up, but that ELCS were value for money when this was taken into consideration and that ELCS should not be refused on the grounds of cost as a result.

This is NICE who have an obligation to investigate costs to the NHS and have deemed some treatments too expense for the NHS.

Also, its been pointed out there was a point at which so many women had planned ELCS it would in effect be CHEAPER for every woman to have an ELCS rather than a planned VB because it could be scheduled. There are places in the world were this is close to reality and the majority of women are having ELCS (parts of China, I believe).

You are repeated what you've been told by the media rather than what's in the NICE guidelines for cost effectiveness and efficiency. Its strange how they like to perpetuate the myth isn't it?

QuentinSummers I totally agree- caesarian's more expensive there and then, the definite cost of X number of people's time, whereas vaginal birth is more unknown or in the future for some other budget to deal with.

Sorry I've not had time to read the entire thread. I had my DS 7mths ago and had 2 mild prolapses. My GP said she'd refer me to women's health physio (back in October) but as I'd not heard anything by December I went private and saw the lady I'd have seen at the NHS trust. She told me that GPS can't refer to physio for this issue and could only refer to the continence team (I don't have continence issues). It's shocking that the NHS is so short of funds that they cant cover the cost of physio to help us repair/strengthen our pelvic floor after giving birth. I agree that it does seem like once the birth is over women are just expected to deal with it and carry on as normal whilst hiding any problems.

For those of you worried about being told to give up sports, it may not be the case. The physio said I was ready to start gentle jogging in short intervals to start working my way back up to running.

Definitely a feminist issue. My body is wrecked from dds traumatic delivery. I'm pre menopause but can't run or jump.

In my info gathering I've been totally shocked how common this is and how debilitating. Bad prolapse = little exercise = weight gain, depression, poor cardiac health and more.

In France mothers get decent post birth physio and prolapse rates are lower.

It should not be an accepted result of pregnancy.

Imagine if a man walked into a GPs and said my penis is falling off. I think more action would be taken

My forceps delivery and 4th degree tear should have meant anal sphincter and pelvic floor physio was an automatic referral. Women are simply not valued and it gives me the rage

As has already been noted caesarian birth is so expensive so it would be a major problem if lots of women started choosing it which they might well if they knew more the risks of vaginal birth.

Many women do choose a caesarean in order to reduce the risk of pelvic floor damage:
www.researchgate.net/publication/272450469_Why_do_some_women_prefer_birth_by_caesarean_An_internet_survey

Importantly, many women who experience pelvic floor damage say they had no idea what could happen and that had they known, they would have chosen a caesarean. This is not only indicative of poor antenatal communication, but further evidence that the two issues - pelvic floor damage and maternal request caesareans - are and always will be inextricably linked.

Absolutely, there are other improvements in maternity care that could help minimise pelvic floor injury risk, and research (and action) on these is to be encouraged.

But in the meantime, and while it is not the preference of all women, a prophylactic planned caesarean is an important and valid one, and one that needs to be better recognised and supported 6 years post-NICE CG132.

Lastly, for many women who choose a caesarean, no matter what new research or developments are achieved to improve vaginal birth outcomes, they will still not be willing to take this risk.

I think fully informing women, listening to them, and respecting their choices, needs to be the way forward for both PVD and PCD.

Hmm ok well I have done the kegels daily since TTC and I wonder if having strong pelvic floor contributed to tear. I had a 2nd degree bilateral tear ( going up each side of the vaginal wall) but it didn't heal and I couldn't walk far which was devastating to me and has contributed to PND. After seeing 3 different GPs, finally diagnosed with infection at 10 weeks and now at 13 weeks it is finally starting to heal. Previous 2 GPs were dismissive "these things can take months to heal", "why don't you swim instead of walk"? Umm because this isn't Venice, I can't swim to get around! ( Don't have a car).

I did perineal massage daily from 28 weeks. I wonder what difference it made- maybe lessened the tearing, maybe moved the tear from the perineum, but being inside the vagina it was harder to spot the infection- if midwives had picked it up I could be in a whole different place now. They never once looked inside so the value of their examinations was questionable.

Following with interest. My heart goes out to all of you who are suffering.
I'm also quite frightened as after a 36 hour labour 3 months ago I'm clearly at risk of prolapse in future. Also had horrible problems with a tear but won't go into that.

Does anyone know of info about how to avoid prolapse later on?

Just found this on Facebook and thought it was pertinent. After giving birth to her first child, not even Serena Williams could get HCPs to listen to her:
mobile.nytimes.com/2018/01/11/sports/tennis/serena-williams-baby-vogue.html

Took a screenshot of the first comment because, well, it's perfect.

One of the main reasons women ask for an elcs isn't anything to do with damage. It about how they have been treated in the past in a vulnerable situation. Whether it be staff not keeping them informed or disrespecting them. Or a past trauma.

There are several studies that have started to suggest that stress or anxiety before giving birth increases the risk of damage and medical intervention.

Why is that? Is there something going on in the way we manage birth that is adding to problems?

Plenty on place of birth to make you wonder that goes beyond how high risk a pregnancy is.

If this is true then the risks associated with a planned vb v a planned elcs could be being heavily influenced by poor practice in vbs.

Thats an argument to do research into the glaring disparities and inconsistent care that we are aware of.

Its not as simple as presenting the risks of vb v elcs as if they are set in stone. There are dangers in doing so.

I very much admire what you do and your principle Pauline and always have done, but its not as straight forward as you present either.