VB or ELCS with SPD?

[MrsPaynie]

So, I'm after a little input from anyone that has suffered with SPD and what your preferences were for the birth.
I've had severe SPD with both previous pregnancies that saw me on crutches from very early and housebound from 7 months. With both previous pregnancies I had a VB, completely natural with no pain relief, not through choice but because I labored so quickly there was no time for anything else (3.5 hours and 1hour). After my 2nd birth my SPD never really went away and I was still suffering two years later when I found out I was pg again! I put a lot of this down to my midwife ignoring my comfortable width for opening my legs and forced me into stirrups for stitching after a tear.
Anyway I'm 15 weeks now and already in a lot of pain, I know just how bad it's going to get and I'm trying to prepare everything in advance. I'm debating with myself whether I should go for another VB, as I labor so easily (and actually quite enjoy it) or if I should opt for a ELCS as recommended by my physio? I'm just worried that by another VB I could further damage my pelvis permanently. But on the same hand I don't think I want the long recovery of a CS either! WWYD?

Sorry for the long post, but thanks for any input!

Would you consider water birth? Less chance of tearing, your body will be 'cushioned' by the water, and you will be able to move into whatever position you feel most comfortable.

I wonder why your physio is recommending a CS? I'd say a VB on hands and knees and refusal to allow stirrups at any point would be better.
I had an almighty fight with the MWs trying to put me in stirrups to stitch me. I just said repeatedly that I would not do it, and they complained a lot and said it would be difficult to do, stitches would not be very good etc. I said fine and they got the most experienced MW around to do it through my narrowly parted knees. That was with a second degree tear. It can be done.

RockChick I would certainly love a water birth, but in previous labors by the time I got to the delivery suit there was barely time to get on the bed to deliver let alone fill a pool.

I did argue my case for not having my legs put in stirrups, but living in Germany and only speaking English there was quite a language barrier, so midwives lifted my legs into stirrups without consent while the Obgyn stitched me. I have had continued problems since the delivery and I put that down to my pelvis being forced beyond my comfort zone.

I don't really want a CS, but I also don't want any further damage to my pelvis, especially having 3 young children to look after.

i have had spd, hospitalised with it when preg with ds1, anyway i was lucky enough to see a specialist in spd, and he said the best thing is a natural birht upright or kneeling, on all fours so you are in control of how far open your legs are etc.
absolute NO NO to the stirrups, yo uneed that written on your notes if htere is a language issue get someone who can write german to do so on your notes?

a water birth is also good, wuold you consider home birth as you labour so quickly, then you can have a pool at home and fill it at first twinge?

i had a water birth for ds4, he was 10lb 13oz and i am pretty sure that i didnt tear because i was in the pool and it was also great for my spd.

and you are right about the problems being related to the stirrups, i had this with ds1 and had continued problems for years afterwards, what helped actually was having a natural delivery with ds2, upright. the specialist i saw said often with spd the pelvis is out of alignment and a natural upright birth can help it shift back again.

in the meantime you need to manage ti this pregnancy. i posted about this on another thread recently will try and find it so i can c&p

Thanks for the reply, yeah an upright position is the position I would be trying definitely. I tried all fours with the last two but it hurt so much more in my back than other positions, but every labor is different so will have to try it this time around. I will certainly ask for a water birth as our hospital has a few pools, so hopefully it could be filled quickly if there was one available to me.
I'm not able to have a home birth, I'm covered by the army medical care and that only covers hospital births. A home birth would cost I upwards of €1500 and that's not a cost we can justify at the moment.
I'm doing ok with the home management for now, it's my 3rd time at it lol so feel like I pretty much know how best to help myself. I wish I had access to an osteopath as I've heard they can have amazing results with SPD, but there aren't any local that I can travel to

i found kneeling up and leaning over the end of the bed was the best position in labour, esp for pushing, i did that for ds2, ds3 and no 5 (dd) i was kind of kneeling when i had ds4 in the pool as well, but not so much.

i am sure you know it all already but yes knees together at all times, be careful getting out of bed and when you bend down, no squatting etc. do you have a support belt from phsyio? or tightish trousers, a good pair of fitted jeans that hold your hips/pelivis tight can be just as good as a support belt.

you might find those bump bands helpful as they help hold the baby weight.

if you labour quickly i would say at first twinge can you call hospital, let them know its starting and to plan on getting pool ready for your arrival, they will see your history of quick labours, but to warn you no 3 can sometimes be different, mine was quick once it got going but lots of false starts, thats common with 3rd babies apparently!

anything that can hlep your core strenght and pelvic floor muscles is worth doing, i found swimming really helped, partly because it takes the weight off of course.

oh and sitting on a birth ball much better than ona sofa as most modern sofas are crap for spd sufferers, not supportive, and you dont sit in a good postion on them generally.

Thanks for all the tips, but yeah that's pretty much what I've been doing for the last four years any way lol. I've got my support belt from my physio, but can't wear tight fitting trousers etc as it leaves my pelvis in so much more pain than I would be in loose fitting skirts etc. I've not got the birthing ball out yet, but certainly will do as the pregnancy progresses. I spent more time on the ball than sitting anywhere else last time, I'm sure my visitors thought I was mad when I'd sit down on it to drink a cuppa
Swimming isn't something I can comfortably do at the moment, as I can even open my legs enough for the front crawl. I do love swimming though, so regularly go to the pool to just 'float' lol but even that may have to stop soon as I can't climb the ladder to get out without it being agony. I do still manage all of the core exercises set out by my physio though.

Oh and I'll most likely be in hospital already to be induced as with the last two pregnancies. My consultant has already agreed to induce at 39 weeks if the pain progresses as it did in previous pregnancies, so I won't have to worry about making it to the hospital. So hopefully if I'm already there then they can fill the pool at the first sign of labor (fingers crossed)
I have heard the theory that 3rd babies are unpredictable... I can't wait to see if that's the case! Though I'm hoping I dont end up with a really long labour instead!

Have you been in touch with the pelvic partnership (here, and they have a helpline listed on the website too)?

They are a brilliant resource for all things SPD/PGP, and can refer you to research/people to advise on your best choices. I am currently suffering 2nd time around and have decided to go for a water birth - think it can be a good option for SPD, especially if you have found labour relatively easy previously.

Can you get the information about your pain free gap written in the relevant language (in massive bold capital letters!) on your birth plan?

ELCS can also certainly be a good option for some though - I would collect all the information you possibly can, speak to midwife, consultant, those who've been through it, and then make a fully informed choice based on your own circumstances.

Thank you, yeah I've been directed to the pelvic partnership by my midwife, and you are right there is a wealth of info on there.
My pain free gap will be written in my notes, and I'll have my friend translate it for me too. I did all this last time too but the midwife didn't even look at my birth plan before hand. I was literally in the delivery room about 20 minutes before the baby was born, so I think I caught her off guard as they were convinced I wasn't in labour! (another argument I had with them as their ctg wasn't picking up any contractions but I bloody felt them lol)
I will be writing in CAPITALS this time if I have a VB and I will make my husband stand ground for me if they refuse to listen again!

Have you seen an osteo?

Ive had SPD in two of three pregnancies. The last one was a CS and i can honestly say i would rather have my eyes removed with a spoon than choose CS over VB.

No mosschops I've not been able to see an osteo as said earlier, I don't have any local to me that I would be able to get to.
Thanks for your input. What was so bad about the section if you don't mind me asking?

I know a few friends that have had EMCS and I've seen how they have struggled with recovery, so this is definitely not a decision I would take lightly.

Any chance there is a chiropractor near you (with experience in pregnancy)? I tried an osteopath this pregnancy but have had better results from a chiropractor. Also a good (usually private) physio trained in manual manipulation for SPD can also be just as good from what I've heard.

I'll take a look into a chiro, thanks, I've got my 16wk appointment with my midwife next week so I'll ask if they know of any local that may speak English that could help. I'm a bit stuck living in a little town practically in the middle of nowhere and I don't drive either, so with hubby being away a lot with work I am limited on how far I can travel. (busses aren't great out here compared to uk public transport)

As someone who had pgp and a c section I'd say DO NOT DO IT. I spent 2 weeks getting in and out of bed so awkwardly due to the discomfort, not to mention up and down from seats, that I made my pgp WORSE.

Just my experience. Maybe make things very clear in your notes and brief your nothing partner to be your advocate si the same thing can't happen again. Water birth sounds a good idea, btw. I am very jealous of your easy labours :(

Sorry i didnt read properly, i dont know where you are but if there is any way you can see an osteo i would highly recommend. It only took 3-4 sessions to make me pain free.

My CS was a terrible experience, despite the fact i suffered very rare complications, generally i felt butchered, i totally underestimated how violated and butchered i would feel, i couldnt lift ds2, it took me a long time to recover and i have been left with very heavy periods, possible bowel adhesions and PTSD. I also had a wound infection which took a long time to clear. Recovery from a normal VB is a piece of cake compared to a CS. Im now unable to have any more children, physically or mentally

Sorry but unless your baby or you are in serious danger i would always choose a VB.

Thanks for your honest reply, I'm in Germany on an army base so very limited choices.
I'm sorry to hear of your awful experience. They are some of my biggest worries, especially not being able to lift my newborn baby, or look after my other two children. Id feel terribly guilty for putting them through that.
This pregnancy was a complete surprise, but since finding out we were having another baby I've visualized another natural birth, so that is of course what I want. I just really didn't want to end up I'm agony and unable to look after three children due to a mishandled birth. When my midwife and physio first mentioned it as an option I was completely against it, but have been thinking about it since so wanted to hear of others experience of either. I think I'm swayed more towards VB, I just hope I come out the other end in one piece!
Thanks for everyone's advice

(when the midwife and physio first mentioned ELCS that should read)

Hi MrsPaynie,

Just wanted to add one point that I don't think has been mentioned so far - when you have a CS they will cut your transverse abdominal muscles that are needed to stabilise your pelvis, so a CS may actually make your SPD/PGP worse. My osteopath warned me about this.

I have had PGP for 18 months following the birth of my first child, and I was also stitched up in stirrups which I believe may have made things a lot worse.

I am also pregnant again and never recovered from the SPD first time round, and am worried about looking after my toddler and new baby with SPD. I will be trying the water birth option, upright, this time. Or maybe on all fours.

If you can't get much help because of where you live, there is a book that I found quite useful, link below. In case the link doesn't work, it is called Relieving Pelvic Pain During and After Pregnancy: How Women Can Heal Chronic Pelvic Instability, by Cecile Rost.

www.amazon.co.uk/gp/product/0897934806/ref=pd_lpo_k2_dp_sr_2?pf_rd_p=103612307&pf_rd_s=lpo-top-stripe&pf_rd_t=201&pf_rd_i=0702035327&pf_rd_m=A3P5ROKL5A1OLE&pf_rd_r=1GC7B40WGE2G5W67QN9X

Good luck x

i have spd...but its not just that...i have a rotated pelvis and inflammed socriallic joints which cauased it and dr thinks i broke my tailbone during last 28 labour that went undiagnosed...

I chose to go for an elective c section...just like you i posted the question here and on baby centre and some ladies who had it severe said they would have chosed spd if they had the choice i hindsight

my so called natural birth changed my joints and damaged them for good so i am never having one again...now at 31 weeks i can feel all these bones aching

there are other risks but your pelvic area stays protected with a c section

also i have an osteopath ...she is fab..my spd gets better every week rather than worse and i am privately seeing an obstetrician as well who will deliver my baby ...they do not cut your ab muscles...they move them and cut through the fat and skin layers.
anyway the medical ppl around me are recommending a c section but remember i have more than spd going on

Thanks Billy for your reply. I've also posted on BabyCenter and had a completely different response to on here. A lot of ladies on there told me they went for an ELCS and their recovery was fine and SPD healed quickly.
I'm still in two minds as to what I want, or what is best for my circumstances. I'm seeing my midwife in a couple of days, and depending on her advice I may ask to speak to my consultant for some advice on both situations. In an ideal world I'd have a natural birth and be able to walk away from it without a worry. I know that will not likely be the case though unfortunately.

Hi Billy - who told you that they don't cut the abdominal muscles? Was it your obstetrician?
I asked my osteo if there was any way to avoid cutting them and she said no because of the anatomy, but obviously she is not an obstetrician so if you have been told otherwise please explain what they said and who said it. I may reconsider my own choices based on this information.

(Sorry to take up a bit of your thread Mrs Payne)

Not a problem Pixie, the more info we are armed with the better the decision we can make

Pixie, just thought I'd let you know what I have just read.

Are abdominal muscles cut during a CS?

No, not usually and when they are it should be in the direction of the muscle, so that the fibre of the muscle should on the whole remain intact.

It is rare to use a knife or other cutting implement other than for the skin and for small incisions in the peritoneum (the membrane that lines the abdominal cavity) and the wall of the uterus which are then extended "bluntly" - usually using a finger.

So, usually the skin is cut, the abdominal/rectus muscles underneath are separated, then a small cut is made in the peritoneum which is then torn apart further (and may or may not be repaired). Then a small cut is also made in the uterus which is also enlarged by tearing. There is good evidence that tissue that has been torn rather than cut heals better.

The following description comes from the NICE CS guideline www.nice.org.uk/cg013

"Pfannenstiel, Maylard and Joel Cohen all described transverse abdominal wall incisions used for CS. The Pfannenstiel incision consists of a curved skin incision, two fingers breadths above the symphysis pubis, transverse incision of the sheath, rectus muscles are separated bluntly and the parietal peritoneum is incised is the midline. Maylard incision is similar but the rectus muscles are cut transversely with a knife. The Joel Cohen incision is a straight skin incision 3 cm above the pubic symphysis, then subsequent layers are opened bluntly and if necessary extended with scissors and not a knife." [page 62 - full guideline]

Got this off www.ceaseran.org.uk