Birth positions for mum with prolapsed bladder

[Pbelle]

Hi everybody, I'm new here and really hoping that one of you ladies at least might be able to help. I have a 21 month old son and am 31 weeks pregnant with no.2. I was diagnosed with a bladder prolapse 6 months after my son's birth. I have managed it with exercises (pelvic floor and kegel-type), but am now terrified of the havoc that a second delivery will cause.

Not being one to sit back and blindly trust the medics (my MW and gynae are openly honest that they don't have much experience of ladies with this problem), I want to know myself what is likely to help me to avoid blazing a trail through my pelvic floor and destroying what little of it is left.

I seriously want to avoid more pelvic organs prolapsing. Does anyone have any advice or experience of this?
Thanks xx

Have you seen a uro-gynae or a physio? I would ask to see one before you deliver for some advice. I imagine that the position you birth in would not have a huge impact but it would be important to ensure you do not have a long second stage and try to avoid an instrumental delivery.

good luck

Oh dear . Did you have any symptoms of incontinence before this pregnancy? Did you sustain any other damage? Bad tearing? I take it you have had no surgery to repair things (yet)? If you have had any surgery, of course, you'd need to talk to your surgeon to ask about the most sensible method of delivery. I agree that a referral to a uro-gynae might not be a bad idea.

I sustained multiple birth injuries including several prolapses. Before I had my surgery, I looked into whether a repeat VB pre-surgery would likely cause further damage and the consensus of opinion was that it was unlikely to, as all the damage had been done and things were 'open' enough for a baby to come out more easily. Of course they couldn't guarantee that a prolapse wouldn't get any worse.... Prolonged pushing would make a prolapse worse, so I would have though that positions and interventions that are more likely to result in prolonged pushing should be avoided.

Don't want to put the cat among the pigeons - but have you considered ELCS? Has anyone suggested this to you as an option? If you have had urinary incontinence or you've had other injuries, this might be something to think about.

BTW - I am and that your MW and gynae don't have much experience of women with your sort of problems. Really?!?!?! Can you get referred to someone who does?

Thanks so much for your replies. My son was a big 10lb baby and I had a long pushing stage with him. That said, I had no tears and no intervention (apart from a short while with ventouse to help his descent a little, then it was taken off and I did the rest naturally). It was all done without any pain relief and I felt pleased that it had gone so well... until this all started.

I have had no incontinence problems (so far), although now have trouble emptying as I think the prolapse is trapping part of the full bladder with a baby sitting on it to seal things off.

I actually live in France so there is a limit to the health care professionals I am happy about trusting myself to. I'm not a total control nut but I have found a wonderful private (and British) midwife and a (very, very rare) ob/gyn who believes in natural, demedicalised birth. These are the people who helped me deliver my son. My MW has 25 yrs experience and I'm amazed she hasn't encountered this before, although the French are seriously obsessed by their 're-education' of the perineum which possibly avoids it in a lot of cases. They have months of follow up physio on their lady-bits in fact.

My gynae is a bit more clued up and his first advice was, under no circumstances to have surgery until after having finished my family. TBH I have managed it well with the HAB-IT exercises so far and haven't felt too bad non-pregnant.

I did consider an ELCS although apparently cutting through the transverse-abdominus muscles can do more harm than good as these play a major role in keeping together/holding up what's left of my pelvic floor. Also dealing with a toddler once hubby is back at work, in a country where I have no family at all (and no friends in a position to really help), frightens me should I have a CS to recover from at the same time. That said, I doubt I'd be lamenting that a few years down the line if I'm dealing with worsened prolapse. Did anyone here have a CS after prolapse and find it wasn't worsened after recovery?

My major fear at present is actually pushing my bladder (and whatever else), out when I give birth. I haven't even 'pushed' going to the loo for over a year now and I'm terrified of the thought. Heaven help me! Thanks for any advice you can offer.....

Forgot to say that the reason the gynae is so rare is that the French don't, as a rule, believe in natural birth and love to have you strapped down, permanently monitored, and epiduraled as soon as possible. It scared the crap out of me the first time (hence finding the HCPs I did), but scares me more now given that that their instrumental delivery rates are so high, and knowing how they do favour this delivery method.

Hi, just a thought/comment about 'core strength', pelvic floor, transverse-abdominus, etc: doesn't the pelvic floor provide a 'hammock' for the bladder, bowel and uterus? And, if you were to push (particularly for a long period) and stretch those pelvic floor ligaments, wouldn't they weaken further and provide less support to your already prolapsed bladder?

I saw a chiropractor recently (for imput on a totally separate issue regarding my second baby's mode of delivery. If you are interested, please see my thread 'Coccydynia and secod delivery: what to do?') and the issue of weakening the transverse-abdominus came up. She said that the way these muscles are cut/torn and then re-stitched makes them able to knit together again. They can again be strengthened (together with the pelvic floor). Sooooo, might an ELCS be a better choice for you? I do take on board the issue with your support network, but I suppose there is the potential for more damage to your pelvic floor if you were to pub again.

It's certainly a tough decision, and I wish you the very best of luck in getting the best birth outcome :)

Oh, and a big 'hello' to Cardamom! x

Oh yikes - I really see your quandary!
Don't really think that I have much else that I can say, other than the first stage of my reconstruction surgery involved some procedures through a large c-section type incision. Although the surgeon didn't cut into my uterus, he went right through all the transverse and deep abdominals. I still have one more procedure to go and the problem I still have that needs repair is preventing me from doing that much in the way of exercise. But I have had no trouble engaging my deep abdominals and getting a pelvic floor lift. I am a bit of pilates nut and it's going to take a while before I can get back to my advanced stuff. But in terms of day to day strength and more basic exercises, I am as strong as ever.

When deciding on my first surgery, we had the option of one set of procedures cutting through the vagina, and the other set going through the abdomen. We made the decision we did for a variety of reasons that I won't bore you with, cos it's not relevant to your situation. But what is relevant is that at no point did my (extremely eminent and all round fab) surgeon say that I might compromise my pelvic floor by going for the large c-section type incision. And I'm prolapsing all over the place (bladder/front wall, uterus, back wall) and have badly ripped my deep pelvic floor - anything jeopardising my pelvic floor would be really bad news for me. So I am sure that if there had been something to worry about, then he would have said so.

In terms of things worsening after delivery, I've just remembered something my surgeon said. I sought several opinions and most people I saw said that any worsening of a prolapse would be because of the pregnancy, rather than the delivery. My surgeon says that's true to an extent, but that any further damage is done in the very very final stages of pregnancy when the head starts descending and the cervix starts to open - this is all even before labour properly starts. If I have another baby he wants to do an early ELCS, possibly even just before 38 weeks to avoid this. So I suppose that if he is right, but someone has an ELCS at full(ish) term, then, yes, there might be some worsening of the prolapse. But according to him, that wouldn't have been because of the method of delivery, it would have been because the head dropped, etc.

Sounds like if you want VB, you need to be as upright and active as you can be. Is any of that possible where you are? Sounds like you have the right people behind you. Where will you be delivering?
And yes, I think if you can manage, then wait until you've done with kids before having any repairs. I was so bad that waiting wasn't an option for me .

Sorry, should be 'push' not 'pub'! And I should add that core-strength exercise which involves working/strengthening the transverse-abdomens/pelvic floor that has been recommended to me (by chiropractor and physio - and consultant obstetrician, come to think about it) is pilates and yoga x

Hi Lunarlyte, thanks so much for your reply. Just about to read your thread now. Just wanted to say that yes you are right about the whole 'hammock' support. That's exactly what frightens me. I've searched and searched for info but it all seems to be divided into those who believe that pregnancy already does the damage and that labour doesn't really worsen it, and those who believe that it's best to choose a CS to avoid exactly what you say.

I'm so confused (hesitated to use the word 'torn'!!), starting to believe that the HCPs don't really know one way or the other themselves and the best advice is from those of us who have been through it. I'm wondering if I'm going to have to study anatomy to decide for myself. It's greatly comforting to know that I'm not alone (although crap for all of us with these pelvic floor issues).

Thanks :)

Hi Cardomomginger, think we were both writing at the same time. You have my total sympathy for your experience. The more I look at things the more I am fearful that the rest of my pelvic organs are going to prolapse too after this baby turns up. I'm not convinced that the back wall hasn't already (I have a notion that it's only the bladder that is holding back the back passage if you follow).

Anyway, enough of that. Yes, good news is that, with the people I have behind me, I can birth upside down if I choose. I really wanted another home birth this time (first time we HB'd until I'd pushed for nearly two hours, then MW asked me to consider transfer, which we did. I tried pool, upright, dancing!, birthing stool, leaning over things, the works). I've resigned myself though to the likelihood of the clinic being the wiser option in case I do shove more out of me than the baby.

I just wish I could decide what is the best way to go about all this. I trust my MW implicitly but this is too important to go into blindly given her lack of experience. (She is researching, but there's no substitute for having dealt with it successfully is there?).
Thanks x

You are very welcome Pbelle: sounding off on here and getting thoughtful and informed feedback has certainly helped me in thinking through my situation.

I hurt my tailbone during the pushing stage with my daughter's birth 3 years ago. I agree with my HCP's that the softening of ligaments in late pregnancy contributed to this, but I won't have anyone tell me that the 2 hour-push-fest didn't take it's toll! I'm 36 weeks into my second pregnancy now and have been getting the same lower backache as I'm sure most women experience, but also a straining/pulling pain in my coccyx. I tried to turn over in bed by swinging my leg over my hip last night and the sensation in my tailbone this movement caused woke me up!

My OB is convinced that this renewed coccyx pain is proof that the pushing stage of DD1's birth had nothing to do with the condition, rather, it's a symptom of late pregnancy. He thinks that mode of delivery won't make a difference, so he is in favour of a VB for me. But I'm not so convinced, and cannot help but doubt how my tailbone will hold out against the enormous strain of labour; for me, I think that an ELCS might be the wisest choice.

My OB did give me some good advice - listen to your gut instinct. Think about things and weigh up risks/benefits, but also listen to your instincts.

Yes - it may well be that you have a back wall prolapse too and that the front wall is holding it in. My back wall is the problem that still needs to be fixed and since my front wall and uterine prolapse were repaired, this has got much worse - it now has room to collapse as much as it wants to.

I dunno. I think that whatever all these surgeons say about repeat VBs not doing any further damage, it just feels that if you have another prolonged pushing stage, or end up tearing for whatever reasons, you are going to do more damage. All these arguments about a second VB not making things worse (provided no repairs have been done) seems to be predicated on the assumption that a second birth will be easier than the first because the 'way is clear' so to speak. Well, fine. But someone needs to make sure the baby is aware of that too! And that it doesn't get 'too big', have a funny presentation, come out with a hand/arm by it's head.......

Waves back at lunar XX

Great advice on the instincts :) I also had horrid coccyx pain for a year after my son was born. I think that a large contributory factor was the position I was kept in for two hours after I delivered.

All in all I had a very short time on my back (although this was eventually how I delivered, following the ventouse after the Ob/gyn took a final look). He freed whatever was stuck then I pushed and pulled my baby out simultaneously with my fingers under his shoulders. At this point the bed back was raised and I had immediate skin to skin, BF and then a two hour cuddle. Problem was that the bed back was kind of inclined. Comfy with pillows but the pressure down on my coccyx was immense. When I tried to get up I nearly fainted and couldn't move. Sure you will do but avoid this at all cost!

Totally agree Cardomom. Let's hope baby is in agreement with that school of thought lol. After a monster baby first time round I'm not holding out hope for a 7lb-er this time! And ob/gyn said himself that I wouldn't need him this time. Short-sighted thinking really, as you say. My son may have blazed a trail but that doesn't mean much when my pelvic floor is held together with the strength of cotton wool...

Hello Pbelle,

Not sure if you going to see this now, but just wanted to come on and say that I'm on exactly the same position as you. Except I'm 36 weeks pg. I have a front wall (cystocele) prolapse after birth of DS 20 months ago and am also really worried about pushing another baby out. First birth, same as you, was an attempted home birth that ended in transfer to hospital after pushing for two hours. I was then made to push for another hour in hospital and I'm pretty sure it was the pushing that did the damage - hence my fear. No tearing luckily, just the prolapse.

Up until now I've wanted to go through with a natural birth second time in the belief that it is pregnancy that would do further damage rather than the birth, and am perhaps being over optimistic that the second one will come out much more easily. But now I just feel I'd be silly to risk it and I should just push for an C section. If things down there were to stay as they are I could live with it - I really, really don't want any more birth injuries.

Are you being very careful not to lift your toddler by the way? This is VERY important.

Pbelle, I googled pregnancy with bladder prolapse and this thread came up and its crazy cos I delivered a baby over 10lbs in UK and got a prolapse and now I'm pregnant in France and freaking out. How did you find a British midwife? How did the birth go in the end? Help me please!