Elective CS and prolapse

[BeeBread]

After my first DC I developed a mildish uterine prolapse. I have a family history of it - after DC2 my mum prolapsed spectacularly and my grandmother also suffered. I have been horribly upset with the thought that I am heading down the same path and it has taken me a long time to come to terms with even the mild issue I have.

I'm now 14 weeks pregnant with my second DC and my GP and midwife started talking immediately about a c section. I was referred to see the consultant's team and have been told:

(a) they recommend vaginal birth because the damage is already done and it's likely that the pregnancy itself will encourage the prolapse to worsen however I deliver;

(b) if I need prolapse surgery later in life, a c-section scar will make that more difficult; so

(c) they are going to wait until I've had my 32 week scan before letting me know whether ELCS is an option for me.

I just cannot get my head around the idea that a c-section would offer no protection. Surely it has to be gentler on my uterus/cervix than vaginal birth? My baby had an enormous head and I can't conceive that him passing through the birth canal wouldn't have caused damage that you don't get with c-sections.

I realised as I was discussing this with the doctor that I cannot cope with the idea of vaginal birth - it seems inevitable that it would pit me in the same position as my mum who suffered so badly, for years.

Am I being ridiculous?

Please don't say I shouldn't have fallen pregnant; this baby is much wanted.

My women's health physio told me that the pelvic floor damage of childbirth increases for DC1 and DC2 then plateaus so that more DC don't cause any more damage. I am planning a CS if I have a DC2 and she said that it would mean I didn't get to that maximum level of pelvic floor damage. Have they explained what options there are for prolapse treatment for you? They may have better techniques than when your mum had it.

V interesting what you say about the second baby. I don't quite have a wind sock down there yet so it's worth preserving.

At the moment I'm reasonably symptomless so haven't needed to treat. I know from hours and hours of googling what the options are for more severe prolapses and it ain't pretty.

Mum didn't get treatment for years but has only just had the mesh surgery which was major surgery. All the latest techniques I'm sure but I'm keen to avoid.

They also make some odd distinctions between pelvic floor damage and disfunction. When I challenged someone who said "it is pregnancy not birth that causes the problems" as I was absolutely fine while pregnant but my pelvic floor was knackered after birth they said "oh, that would be damage not disfunction, yes you do get damage after birth". That really isn't any help to me as the result is the same.

So sorry. This must all be very scary for you . I can tell you my experience and what my (private - this may or may not be significant) gynaes have recommended, although this may not be that relevant to you, as our problems are slightly different. After DC1's birth 10 months ago I have been left with a cystocele, rectocele, mild uterine prolapse and complete tear through the pelvic floor at the back. My gynaes (have seen 3 at various points of this journey of discovery) have said that I have to have surgical repair (anterior wall with mesh, posterior, possibly a sub-urethral tape, and stitching the pelvic floor muscle) all agreed that I am for ELCS if I have another baby. As my uterine descent is minor, they don;t recommend doing anything about that at present. I have been assured that I will have a good outcome from the surgery and that the newer techniques, particularly of anterior mesh repair and posterior repair where they 'pleat' the skin to provide extra strength, mean that many of the problems of mesh erosion, rejection and vaginal tightening do not occur.
As I understand it, a lot of repair work, including uterine prolapse surgery, takes place through the vagina. So I'd be interested to know exactly how a cs scar could make prolapse surgery more difficult and what that surgery could consist of. That could be a question worth asking. And maybe get a second opinion - you are perfectly entitled to one.

I also wonder whether you would get a different recommendation if you were to go privately - not suggesting that you should do this if this is something that you don't want to or are unable to consider. It's just that there's a huge drive to get CS rates down on the NHS. And I wonder whether this influences recommendations to women to try VB, when if they were to go privately they would be offered ELCS (for good medical reasons) without any hesitation. My GP, for example, in the face of expert consultant recommendation, is adamant that I should have a VB next time.

Like you, I am sceptical of the suggestion that a VB won't make your situation worse. If you are symptom free at present, personally, I think you should aim to stay symptom free. If you are in London and want to investigate the private route, PM me and I'll give you details. Good luck XX

So if there is a risk of pelvic floor dysfunction caused by pregnancy that may lead to incontinence, etc etc, then surely in a woman who already has problems it makes even more sense to offer ELCS so that any pregnancy damage isn't compounded by birth trauma. Or am I missing something?!?! [hits head against wall]

CardamomGinger, breatheslowly, thank you so much for your posts. I'm at work ATM but will definitely come back to you tonight.

Will be off-line tonight until Sat night - but will catch up with you . X

Hi Beebread,
Sorry to hear all this. It does sound strange. As cardamomginger says, there is a massive drive to cut NHS c-sections, for financial reasons. If you really want a c-section, they'll have to honour your wishes, or refer you to another hospital which will carry out a c-sec. There seems to be a policy of discouraging women from having elective c-secs, regardless of their reasons.
Ultimately it's your baby and your body, so your choice should be respected.

I loved my c-section - it was painfree and joyful, and the recovery was easy. A planned c-sec costs the NHS more than a problem-free natural birth (I've heard it costs £750 more), but so many natural births result in major problems! I was in hospital for just 2 nights, and didn't need any trauma counselling, gynae repair ops or aftercare (except for having the stitches removed at home - took less than a minute, I think!). So I guess my ELCs cost the NHS less than your average natural birth. Good luck with whatever you choose to do, and remember it's your choice, not the choice of some faceless NHS bean-counter!

I love the argument that an ELCS costs the NHS so much more than a VB - NOT!!! Admittedly, these are private fees and I don't know how much more private hospitals etc charge over and above the actual cost of treatment, but excluding GP appointments and prescriptions, investigation and treatment of my birth injuries from my VB has cost my health insurer 8,000 quid. And I haven't had my surgery yet. I expect the final bill including the surgery and physio afterwards to be in the region of 12,000.

My insurer wouldn't cover the costs of the restitch I needed. But the NHS has saved money on me as I went private anyway and will be having any future DC privately as I want to be looked after in an environment of overstaffing rather than stretched to the limit.

Swines .

beebread, congratulations!

i have a mild bladder prolapse and suspected nerve damage to anal spinchter but not a uterine prolapse. i am about 8 weeks pregnant and i have been seeing a urogynae privately through insurance. she told me that if i had another vb the risk of symptoms worsening for me was between 25 and 40%.

i think it is a load of nonsense that "it is pregnancy that causes damage not birth" and my urogynae obviously agrees. i have no doubt that pregnancy puts a strain on things and may cause damage but to state that a vb would have no further impact is like arguing black is white.

sounds to me like they are hoping you will change your mind towards the end/not leave enough time for the decision to be made. if i were you i would not let this rest until they agree NOW that you can have a cs. can you ask to see another consultant?

not sure if it would be an option open to you but if you could see a gynae/ob privately who would write a letter saying you need a CS that could help.

so bloody for you.

again, i dont see how the scar would make things more difficult for surgery even if they do it through the abdomen which I don't know if they do. as my gynae said to me, she only starts to get concerned about repeat surgery when someone is on their 4th c section and I dont see how it would be different to that -just the risk of adhesions etc i imagine.

hope that you get it sorted out soon.

oh, and my physio also told me that she would have a cs in my position.

I had a 3rd degree tear with my first baby, so a different issue but developed an anal fissure that became chronic (took 10 months to clear up) and still suffer with symptoms from time to time.

When i got pregnant with my second I was told by a snooty consultant that "it was only a 3a, and anyway the problems I had with the fissure/piles was caused by pregnancy not birth" That was utter bollocks. I never had a moments problem until the tear. She downplayed my experience and was very critical of my desire for an elcs. At the end of the day I had lost confidence in my body and felt that if I attempted a VB I would have been traumatised AND damaged . In the end I broke down in front of my midwife and she was furious on my behalf and I got a different consultant and a different outcome. I had my elcs and am due to have my second one on Wednesday (DC3).

Stick to your guns and insist that you get your elcs to protect your body from anymore damage.

Good luck x

Thank you ladies - you are confirming my suspicions.

It is so counterintuitive to me to think that my chances of worsening the prolapse are the same, however my baby is delivered.

I didn't actually see the consultant, but one of her team (a registrar, I guess). By herself, the registrar was more sympathetic but didn't commit to a position. She then went to consult the consultant and came back with the advice summarised in my OP.

She went from "a c-section won't guarantee that your prolapse won't get worse" to saying that it would make no difference as I had delivered vaginally once before. The first piece of advice I can accept - I know there are no guarantees - but her revised advice just sounds wrong. I'm not that damaged as things stand and there is obviously something there worth preserving.

I wish I had had my brain switched on - I would have pushed harder for clarification as there were so many important points delivered in a vague way.

I did feel that there was a real agenda to push natural birth. Again, once she had consulted the consultant, she felt the need to tell me that if I delivered before she had a chance to see me again at 32 weeks, it is much better for the baby to be delivered naturally. But there is no reason to think I would deliver early - I went to 40+9 with DS - so why raise it?

I am fortunate enough that if I start saving now, I might be able to afford to go privately. But this isn't me demanding an ELCS on a whim - I feel as though is it medically indicated.

Just wish she had said that she would support my wishes, and I could rest easy. I feel now as though I will have a battle to fight or have to scrimp and save for months.

Sigh. And thanks for the support, I feel stronger.

It's pathetic that we need to battle like this. I feel so and for you, when this should be an exciting time as you anticipate your family getting bigger. You are perfectly entitled to switch consultants. And you are perfectly entitled to switch hospitals. Is your GP on the ball and sympathetic? Have you approached him/her about your prolapse before? Could you discuss it with your GP and see what he/she thinks? Your GP might know of a consultant who is more favourable to ELCS in a case such as yours in which case you could try and switch. What does your MW say? From reading other threads on MN, it seems that some are great and get things sorted, whilst some are rubbish. What's yours like? Good luck and keep posting if you need to. XX

Hi BeeBread how did it go in the end? I'm in the same situation as you and have been told the same by Registrar. Seeing the consultant at 32 weeks about 5 weeks from now - logically it makes no sense to risk making the prolapse much worse!

I’m also in this position, and would love some more clarity on this. My consultant was like an automaton and said “we find that prolapse is not worsened by further births”, which would have had more credibility if he’d enquired at all about the details of my prolapses! So glib, about something with such a profound impact

On the other hand, he did confirm something I had heard, which is that in a C-section they often pull the uterus out of the body cavity to do the delivery or sutures. Bit brutal and can’t be great for connective tissues or the uterine ligaments, either.

I keep going back and forth. I’m so angry about the lack of knowledge in this area!

The women's health physio seems to think c section will be better from prolapse persepective.

Hi ladies hope you are all doing well!! I am in the same position I went into this pregnancy with issues 3 months prior & I know I have a prolapse / prolapses but not yet confirmed, my pregnancy has been absolutely horrendous & I fear what shape I will be in after my child is born but I am opting for C section & met with a consultant today to discuss this, he seemed to be on my side due to not knowing what is going on with me yet as they haven’t been able to examine ect.. I just hope I’m making the right choice but I don’t see how a vaginal birth would be a good idea further stretching muscles & ligaments, I know pregnancy doesn’t help but pushing a child out doesn’t help either unfortunately, advocate for yourself & tell them it’s your maternal rights & if they refuse a section you demand you are forwarded to another hospital for the procedure to take place, it is in the “NICE” & “Birthrights” guidelines that they adhere to your request with your concerns as much as they lie & don’t want to do it.

push for what you want girls ♥️