Worried about and stupefied with pregnant friend

[PeaceAndHope]

My dear friend in America is expecting her second and has me worried sick:(

Last time she had a fourth degree tear and rectovaginal fistula which hasn't yet been properly repaired. Her baby was 10 pounds and it was a very complicated birth.
However, she just called to tell me that she has decided on a vaginal birth again, even though her baby weighs about the same this time. She says she will get the repair after her delivery.

I tried to explain to her that leaving severe tears and fistulas unrepaired can make them harder to fix. IMO the course of action would have been to have it repaired ASAP and get an ELCS the second time around.

It's not my place to say this of course, and she has a right to pick a VB but that isn't what concerns me. Despite dealing with the worst outcome of a VB she is convinced that it's 100% safe and that CS is "too dangerous". I fear she is is putting herself and her macrocosmic baby at risk for birth injuries and worse still she doesn't realise it.

She says she has done a lot of research and she thinks a CS will be an "injustice to her baby". I understand her worries over breathing difficulties after a CS, but what about the risks of shoulder dystocia and brachial plexus palsy in macrocosmic babies?!

What is even more concerning is that she has been blogging about her decision to have another VB instead of "major surgery". I don't know if she's trying to prove something or has some evangelical urge to go natural, but I can't understand why she would deliberately mislead others?

What would you do in her position? And in mine?

In her position id birth whichever way i felt best.

In your position id seriously take a step back.

So neither way is perfect or withou risk...how on earth did you ever get to the point where youd interfere so much?

Honestly, its not normal. Let her get on with it.

Mmmm you appear rather interfering....

I'm sure she has her own medical advisors....

its her choice and if she is researching it and has the support of her midwives/drs then its totally up to her and also estimates of a babies weight are notoriously wrong so they baby may not actually be as big as they think, i had an almost 11lb baby, then next time they said the baby would be big, she was actually 8lb exactly so not big at all!

In her position I'd go for the ELCS, but then I'm not her, so it's not my choice to make.

In your position - I'd probably mind my own business at this point. You've explained your thoughts and concerns, and now it's up to her whether or not she wants to take them into consideration. I'm sure she will have the risks and benefits of each approach explained by the medical professionals looking after her.

Of course, I'd never say all this to her! It's her decision and none of my business. I'm not interfering, I haven't said all this to her. Just gently pointed out that a CS is not so bad but shut up afterwards.

I'm just very worried about her. For the record, her OB has told her that a CS is better for her and has explained the risks and benefits already. That's why I'm even more surprised.

I guess I'm venting here because I can't say anything to her.

There are plenty of other risks attached to CS beyond breathing difficulties. It is major surgery, I don't understand why you're trying to minimise it?

Also the word's macrosomic, not macrocosmic...and unless she has gestational diabetes it's pretty unlikely to be macrosomic. It might be on the large side, but scans are notoriously inaccurate at predicting weight and bigger babies can be birthed vaginally quite easily.

She also has the recovery period and her toddler to consider. Recovery from VBs is generally much quicker.

And like pp said, none of your business really.

Hellsbells:

Sorry if I gave that impression, I'm not trying to minimise the risks of a c section at all. I'm simply saying that in her case (with a prior fourth degree tear and RVF) a CS is probably safer.
When I mentioned breathing difficulties I was referring to the risks to the baby as they compare with shoulder dystocia, erb's palsy etc. not the overall risks of surgery.

I know it's macrosomic, but I'm typing on an iPad with the stupid auto correct on.

I'm not sure how you define macrosomic but from my understanding it's birth weight beyond 4kgs. In her notes, her last baby at ten pounds was called macrosomic, and this one is estimated to be quite big as well.

I wouldn't comment on the recovery. She still hasn't recovered from her fourth degree tear and rvf completely and another VB will make for a tough recovery either way. Moreover, I had a CS and recovered within 2 weeks in comparison.

NatashaBee:

The doctors have recommended a CS but she will not listen. She's 35 weeks.

She keeps talking about some research and says CS is an injustice to children.

Peace you're venting here which is great, but it's rather unusual to know this much about a friend's plans.

That's not necessarily a problem, but you can say 'We feel differently about this, let's change the subject', you know!

Fine to vent here, but honestly don't think there's much you can (or should) do about the situation.

I don't agree with her views on CS either, and suspect she is cherry-picking 'research' that supports her personal feelings about it. But you probably need to let it go if you want to maintain the friendship.

Macrosomia definition varies, some (inc. the Trust where I work) put it above 4.5kg. It can't be diagnosed antenatally, so you can't say this baby is macrosomic. Even if it is above that weight, it is quite likely to be delivered vaginally with no problems, particularly as she's now a multip. Shoulder dystocia is a bigger risk for babies affected by maternal diabetes, as there's uneven weight distribution and they tend to lay down a lot of fat around the trunk/shoulder area. Erbs palsy is a very rare complication of SD, the vast majority of cases are resolved through simple manouevres with no damage to the baby.

She's quite right to weigh up the risks and benefits of a CS v VB both to her AND her baby. She's obviously made her choice and I'd suggest that your role as a friend is to support her and respect her right to make her decisions as an adult about her own body whether you agree with them or not.

I had a CS

She keeps talking about some research and says CS is an injustice to children.

Any chance you're taking this personally?

Hellsbells:

No, I'm not taking this personally at all. I'm just quite stumped at her views, and very worried about her.

I agree she has the right to make her choice, nowhere did I deny it.

I also agree that a CS is major surgery with serious risks. However, it's evident that for her the benefits will outweigh the risks. As for the baby, as long as the c section is performed after 39 weeks, other than transient breathing difficulties and the extremely rare possibility of a scalpel nick, there are no other valid or concerning risks.
I don't see it as more or less of an "injustice" than a VB since both are capable of causing the baby injuries.

She took 2 years to recover last time and as you pointed out, with a toddler this time will be even harder.

it's evident that for her the benefits will outweigh the risks

I really don't think you know enough to make such a definite statement. You're not (or haven't claimed to be) a medical professional, you don't have sight of her notes.

Fistulae are normally repaired under a general anaesthetic, something that is best avoided in pregnancy unless it's a life-or-death situation, so I wouldn't think that having it repaired 'asap' as you suggest is an option. If she has a CS, she then has major abdominal surgery to recover from in addition to her existing fistula. And a toddler and a newborn. I think I'd be going for a VB in her position too.

The baby's size is something of a red herring, small babies can have complicated births and large babies can deliver like a dream. Fetal positioning is far more relevant.

But anyway, none of this is really relevant because as we both agree, it's her decision as a mentally competent adult. In the nicest possible way, I would advise you to find something to worry yourself sick about that is within your control.

With respect Peace, a few people here are aware you have very strong views against VB, regardless of previous medicial history, and are very pro-CS.

Whilst I understand you are worried about your friend, your own very strong don't help in this situation. And certainly from what I've seen you are just as guilty of cherry picking on the subject too.

Which means you are unlikely to ever agree on the subject, and under the circumstances you would be very wise to bite your lip and let her get on with it or risk loosing a friend.

There are certain subjects, certain people should never discuss with each other. In this situation and in your case, I very much believe this is one of them. I think you are getting far too emotionally involved in her situation because of your own feelings on the subject, and you need to really distance yourself from it.

I know that isn't always easy, but it is her choice and you need to respect that, even if it does end up going badly.

Oh is there an agenda here?

Ah.

HmmThinkingAboutIt:

Given that I've had a VB myself, I'm hardly anti VB. I just preferred my c section, but that doesn't mean I'm against VB. Not sure why you say that?

I'm not guilty of cherry picking research, and again I'm not sure why you say that.

I have three friends in the states who have all had children in the last few years, given her history I would be astonished if she is not given a cs.

That said I don't really think it is any of your business, you could state your opinion to her if you really feel it neccessary, though I would urge you to consider why you feel the need to do so, will it be in any way helpful to her?

Other than that back off and just be supportive of whatever happens and let the medical people deal with the medical stuff.

Your friend is the one who will have to live with the consequences of her choice, to her body and her baby. So in that sense, it's no one else's business. I think she's crazy opting for a VB in her position, but then I'm not her and am very likely to attach quite different values to the same set of risks.

More pragmatically, it sounds as if she has made a very firm decision - if she's talking in terms of 'injustice to the baby', whatever that means! then I don't think she's going to be open to any discussion you might want to open up. Don't waste any time/energy. If she becomes another evangelical blogger spreading emotive misinformation about birth - so what, the internet is full of them. One more won't make any difference.

Hellsbells:

Not sure why you thought I was suggesting she go under GA to have it repaired during her pregnancy. That's simply not possible.

I don't think you understand. She had her first three years ago, and developed a RVF and fourth degree tear. It her two years to recover and she still can't control her bowel movements or have sex properly.
Now, she refused to have it repaired 6 months after the birth of her first when it's usually suggested and let things go on.

Even if she refuses a CS she will still end up having major surgery to repair her condition. (which she could have had much earlier)

I respect your views but would you actually attempt a VB after suffering from a RVF and fourth degree tear and risk permanent incontinence and sexual dysfunction? Not to mention a recovery that will in all probability be longer than a CS recovery (as it was last time)?
There is also the fact that another VB may posdibly make the situation beyond complete repair.

I know I can't control her decisions, but given that she's a good friend I suppose I'm very concerned.

FFS you're not listening.

You asked What would you do in her position? And in mine?

Everyone has said that in your position you should butt out.

No one has offered any advice as to what she should do because it's not our business

HTH

What on earth do you think you can do? You've made your position to her clear and she's made her decision. I don't know why you're getting in such a lather about it really