Doing it again after traumatic first labour - what would or did you do?

[backinaminute]

Sorry as this has probably been done a million times before but I'm after some objective opinions.

I have a 15 month old ds and number 2 is due in December. Last time I went over due, was induced at 40+11. The pessaries kicked off the contractions but after 12 hours of those was only 3cm dilated so went on the drip (as well as having an epidural). He ended up back to back, he got stuck - was a failed ventouse and delivered by forceps in theatre. Other than being a bit squashed he was fine but I had an episiotomy and a 3rd degree tear followed by a post partum heamorrhage (1.5l).

So now pregnant again, I'd convinced myself that second labours are usually better, body knows what to do this time etc etc. my plan was that I would do everything that I could to avoid intervention as I'm a little bit convinced that it lots of small things that went wrong - a kind of chain reaction from the induction. I thought i will be as mobile as i can in labour etc etc. I've seen 2 midwives who agreed with me. Then I saw the consultant who basically said that if I was to do similar damage (tear-wise) as last time they wouldn't be able to repair me as well and I might be left feacally incontinent, possibly forever, and basically advised me that I should have an Elcs which I really wasn't expecting.

I've seen my midwife again who hasn't changed her stance and maintains that what happened last time is unlikely to happen again. She also said that maybe I should get a second opinion.

Dp and Dm think I'm completely insane for not snapping their hand off for a section but I'm just not sure. I've kind of got my head around it but I'm terrified of having to look after a baby and a 20 month old after a section (although I'm really lucky as have lots of help being offered as everyone thinks I've lost my marbles for considering a VB with these risks).

On one hand I know the risks are low and it will probably be fine but on the other I also know that if it was that consultant that had to deal with another bad tear she'd know that she wasn't doing the best repair job. (luckily I don't have any symptoms from the tear). And as much as those around me don't seem to believe that I think shitting myself for the rest of my life is a bad thing it's not something that I want to have to deal with if possible.

Sorry this is so long - I guess I'm asking if anyone has had anything similar and how did go second time? And generally after some thoughts. I don't know why I feel so guilty going for a section for the risks for me rather than the baby?

I know I don't have to make the decision yet and keep pushing it to the back of my mind but I just keep mulling it over. Thank you for reading me droning on.

I promise you that no two labours are remotely the same,

there is every chance that you will have a normal delivery,

If they are happy to let you try, thats a great sign, as they really do err on the side of caution.

good luck

I had similar experiences to you. DS1 was late but I went into labour naturally and he was born with ventouse and a small tear. I then haemorrhaged as placenta failed to deliver. I had a blood transfusion.

Got preg with DS2 so there is also 20 months between them. I asked several times why things had gone wrong 1st time but never got a straight answer. They induced me with DS2 at 40 + 11. I had full on contractions but no more than 3cm dilated. Had waters broken in theatre. Then they tried to get a blood sample out of his head and hurt me badly at which point I yelled enough and asked for a CS. I was in theatre before you could blink and he was delivered safely, the cord had been wrapped around his neck.

I never wanted a CS, all along I was set against it but actually it wasn't too bad. I BF straight away in the recovery room and, with help, looked after him just fine. I managed the 2 very well, the first few weeks were far easier than I had thought and I asked the Dr if I could drive after 4 weeks. Obviously you need to take things slowly and carefully but it really wasn't so bad.

If I had my time again I would go for a planned CS. I know it is a hard decision but I hope my experience helps you a bit.

1st DD = long second stage labour, forceps. Venteuse (sp?) and eventual vaginal delivery then anaesthetic for operative repair for internal tear plus a blood transfusion, in hospital for a week!
24 months later DD2= straightforward spontaneous vaginal delivery, no stitches home in 5 hours. No way of knowing but experience one does not necessarily mean you have the same experience next time! Good luck.

4yrs (exactly) between mine (pretty much to the time as there is 10mins between their birth times).

Ds1 - induction on due date due to OC. 26hr labour, epidural, clip due to losing heart rate, vontoose, large pph and paralysed bladder requiring me to be catheterised for 3 days.

Ds2 - spontaneous labour at 42 weeks. Go to hospital after 2hrs, back to back baby very painful, monitored for a while and checked, only 4cm. State I need an epidural as g+a made me vom, get transferred to clu. Anesthatist (sp?) Waiting for me, starts epidural immediately, puts needle in my back....I start to push. He had to quickly put the line in to remove the needle, no time for the actual anisthetic, push out baby, tear again as he shot out and they used the line to numb me for stitches as it was there anyway. 4hrs from first contraction to baby in my arms.

I couldn't have had two different experiences. Ds2 is 9wo and I already say I could do that labour and birth again with no pain relief (as I didn't actually get it until I was stitched).

I'm so sorry you had this trauma.
I can only speak from the experience of one ELCS, but I can say it was a wonderful, pain-free, magical experience.
I was up and about a few hours after delivery, and out pushing the pram after a week. I felt completely normal 2 weeks on, and at my 6-week post-natal check I could hardly believe I'd had a section.
The only discomfort I experienced was the getting in and out of bed in the first week. If your partner is on leave, he'll be able to help with the toddler while you're recovering.
A planned section is very different from an EMCS.
Good luck, and congrats on your new arrival!

Similar to you first time, so pretty much set on ELCS second time. However changed my mind, ended up with a very easy relatively quick water birth. Left hospital 3 hours later. No two births are ever the same! I think lots of walking in the last weeks helped me to go into spontaneous labour, as i dreaded the thought of another induction, though was overdue both times!

Thank you, I really appreciate you replying. I'm going to shelve the thought again for a while and see how it goes for now.

Hello

I had nearly the exact same experience as you with ds1(induction at 40+11, drip, epi, back to back baby,tear, episiotomy, ventouse snapped, forceps, blood transfusion)

during pg with ds2 I read a sheila kitsinger book about labour and it really inspired me. I so didn't want to feel the lack of control I experienced the first time.

Went into labour naturally with ds2 and gave birth 3 days after his due date. No pain relief during dilation (mw didn't believe I was in labour as I was 'too calm' - they discovered I was 10cms when they did an internal to see if I was able to be induced as waters had broken a couple of days earlier) Had g and a at pushing stage as a) I felt I flippin deserved it!! and b) I was scared.

It was the most amazing experience - I was on a high for weeks after. It really helped me heal emotionally after the feelings of failure with ds1. I had a great mw too.

I guess you just have to gather as much info as poss and do whatever feels right. I really hope it all goes well for you whatever you decide!

Sorry this has to be a quick reply as ds 12 days old is stirring lol but I had exactly the same experience as you with my dd (although she is now 9 yrs old so it was a longer time between births) and I was so traumatised I opted for an elcs with my ds.

I found the recovery from the elcs a hundred time better than the vaginal birth... Yes I had some pain the very first day but that was well managed with pain killers and by day 3 when I was discharged I was walking about and managing to care for ds with no probs at all. By day 4/5 I was back to my old self.

Been fine for days now, no painkillers, feel "normal"!!!

Just wanted to say don't rule out elcs on pain - it really isn't as bad as people make out... Unless I was lucky!!

"the consultant who basically said that if I was to do similar damage (tear-wise) as last time they wouldn't be able to repair me as well and I might be left feacally incontinent, possibly forever, and basically advised me that I should have an Elcs"

What are you still thinking about? Take the ElCS!

I pushed for an elCS after traumatic first birth, and there wasn't even any horrid probability as irreparable faecal incontinence. It was one of the best decisions of my life. Relaxed, easy, quick birth. Calm and perfectly intact baby (especially compared to DD's bruised, squeezed, cone-shaped head with overlapping skull plates as a newborn ). Much less pain, in fact pretty much pain-free and completely off pain meds (even paracetamol) on Day 3 following ElCS.

First - induction, syntocinon, epidural, forceps, 3a tear, 750ml PPH and manual removal of placenta.

Second - Didn't consider CS. Declined consultant care. I planned a homebirth, water and G&A, sadly was transferred in for prolonged second stage and DS was born via forceps. Episiotomy. 1500ml PPH. A trillion times better than first time round. I'd do it again in a heartbeat.

The Supervisor of MWs told me there's no way of knowing who will tear badly and who won't. Stats I found (can't remember where) said there was a 17-25% chance of another bad tear, meaning 75-83% chance of NOT having a bad tear.

Forceps with both were due to crap positioning.

I wouldn't find the 17-25% probability of lifetime faecal incontinence as particularly comforting odds. They are quite terrifying, in fact.

I had an Elcs with dd after a third/ fourth degree tear with ds. It was bliss. The consultant was v pro cs, my midwife was quite sniffy, I ignored her.

Whereas I did find them reassuring.

Certainly it was a risk I was willing to take over a 100% chance of an operation.

What suits one doesn't suit another.

You find an average of 20% probability of lifelong faecal incontinence "reassuring"? That is 1/5!

How about if you were told to roll a die for it. If you get a 3, you will forever be shitting your pants in public. Would you find that reassuring, too?

20% is worse than the odds of rolling a die (less than 17%).

How about if you had a serious disease and were given a 20% chance of imminent death unless you had abdominal surgery. Would you do the operation?

Just wondering how far you would go not to have an operation.

I had an operation. It was fine. Cs are mostly fine. All the risk was loaded onto me, which suited me fine.

I had a terrible time with my first DC - 33 hours from first contraction to birth (and the contractions were strong from the word go). Failed ventouse (twice), and they ended up cutting me & using forceps. Couldn't sit down without a rubber ring for weeks!

Second baby - 20 hours from start to finish, but the contractions were pretty mild (even managed to go to bed and sleep as normal). Woke up at 7am thinking 'ow!!', went to hospital at 8, baby popped out - and I mean 'popped' - at 9:25am. No drugs, no ventouse/forceps, nothing. It was great! I had torn but the midwife stitched me up and 'down there' I'm better than I was before! Good luck x

My friend had 2 third degree tears (10 years apart). After the second, she has been in immense pain for years and years. She has to have general anaesthetic injected into her which relieves the pain for a few weeks, but she can't have it very often. It's pretty awful for her. She's had loads of ops, but they can't seem to fix whatever it is that went wrong.

I had a third degree tear the first time around. The second time I was very anxious about the birth. In the end, I had twins and a c-section. I have to say, the section was fabulous! I do kind of envy people who have a lovely, natural birth, but there's nothing to say I would have had that second time round. I healed well from the section. It was pretty painfree. The joy of having my babies made any pain afterwards totally bearable (I think it was a lot better than the third degree pain and certainly went a LOT more quickly).

Sorry to scaremonger, but this is just my immediate experience.

Okay - you are weighing up the option of surgery to bring your baby into the world which, although not as safe and physically beneficial as a straightforward vaginal birth, is really a very safe surgery to have. You are aware of the limitations you might face after the birth.

On the other hand, you have the risk of a serious tear, which (because you mention 'repair') presumably means some kind of (at least) small surgery. Possibly major surgery if you were to tear in the same manner as before. Also, any kind of incontinence does not a happy mother make - physically and emotionally.

FWIW, I had very similar, quick births - first resulting in a horrible tear, proper crochet affair and the 2nd resulting in a graze (and a temporary rectocele which was really traumatic). I was terrified of tearing again and it stopped me from pushing effectively 2nd time round (luckinly DS2 was eager to appear!).

There are lots of people on here who have had CS for 2nd/3rd/more children and coped. Maybe visit the prolapse/rectocele threads too to properly weigh up what you are potentially offestting the risks of.

All the best.

Cote in those circumstances, to me, a 4/5 chance of not having a problem is bloody good.

Doesn't mean I think that the decision someone else makes to have a CS is any less right though - we all weigh up the risks for ourselves. I wouldn't discourage anyone who had a similar first birth from having an ELCS if they wanted, not would I discourage anyone who chose to have another VB.

I was simply offering my story.

"I don't know why I feel so guilty going for a section for the risks for me rather than the baby? "

you should think about why you do feel guilty, but its not surprising really...there is a whole feeling out there being radiated from all areas that c sections are bad, drugs are bad etc etc....

so many people have come on these boads and said how wonderful they are....

as somone else said - can you really be a happy functioning mum of two with bowl issues? is it worth the risk- for your childrens sake isnt it worth cutting down that risk?

isnt the consultant the ultimate expert on your privates? can a MW do the same kind of extensive stiching that would have to be done?
I would be interested to hear what ladies who are living with incontinese issues think of this...good luck!