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'm in a similar situation OP. DC2 due in October; DD (2.4yo) delivered with ventouse after prolonged 2nd stage due to her being back to back. Episiotomy/3rd degree tear wasn't pleasant, but no long-term complications after it all healed.

It's so hard to know what to do as you have no idea how it will go if you opt for a vaginal birth. It might be completely straightforward with no tearing, or you might tear a bit, or you might tear badly. And if you do tear badly you might be left with continence problems. Or you might not.

As Fliss said upthread, you're comparing 100% chance of an operation (CS) with a much smaller chance of tearing. Personally, at this stage, I feel I'd rather not have a CS unless I absolutely need one, and I'm keeping my fingers crossed for a straightforward vaginal birth. But if this baby decides to get into the back to back position nearer the time, or I go overdue and need induction, I may rethink.

I had a traumatic birth for dd1 and saw a consultant before getting pg with dc2 who agreed to cs. I wasn't certain but I wanted to know I had the option. In the end pg was twins and both were breech so decision was made for me.

Everyone is different so I can only talk for myself. My cs was a wonderful experience although dtd1 was rushed to SCBU that wasn't due to cs. I felt so much better emotionally afterwards not to have had my vagina ripped (I had 32 stitches with dd1).

I only knew the decision was right afterwards with hindsight, but was terrified or both vb and cs. Go with what you feel is right and what makes you breath easily. Good luck whatever your choice. x

I had a horrendous birth with dd and had a Emcs with ds( breech , per eclampsia ) and I would take cs anyday . Yea the recovery is awful but I wouldn't risk being fecally incontinent .

I had similar to you OP, DS1 overdue 2 weeks, waters broke as I was in hospital waiting to be induced. Epidural, episiotomy, failed venteuse, forceps delivery, 3rd degree tear, haemorrhage, blood transfusion. Very traumatic.

When I got pregnant with DS2, I went to see consultant midwife to insist on ELCS as I was afraid of tearing and incontinence. The consultant assured me she didn't think that would happen, but left it to me to think about. I decided that I would try to deliver vaginally, but would be shouting for a cs at the first sign of trouble (ie, being made to push for over 3 hours with head crowning but just not coming out! )

My experience delivering DS2 was very different. It was just under 3 hours from start to finish. I got in the birthing pool, had a bit of gas and air in the beginning, but nothing as I pushed. He had shoulder dystocia so I had to be helped out of the pool with just his head out, but he was delivered immediately after. He weighed 11 pounds, 2 ounces, and I had a tiny tear that didn't even need stitching, and did lose a fair amount of blood but didn't need a transfusion. I felt elated for weeks.

OP, I know it's not an easy decision to make. If you go for the vaginal delivery, I'd definitely recommend labouring in water. I also think listening to the natal hypnotherapy cd leading up to the birth helped. I will just say (in favour of an ELCS) that the old grey mare, she ain't what she used to be. As you can imagine, pushing out 2 babies with 38 cm heads ... chuff like a wizard's sleeve!

Lets not get carried away and scare anyone, I don't think anyone said there was a 17-20% chance of faecal incontinence!
An induced labour, presumably with little moving around, epidural and forceps delivery is not going to be comparable to a normal spontaneous delivery.
There's every chance you will go into labour spontaneously this time and have a completely different experience. Induction often leads to a cascade of interventions and leaves you feeling as if your body is incapable but really it never had a chance to show you what it can do!
I think I'd be inclined to see the initial intervention (induction) as the beginning of the sequence of events - you can either choose to avoid that (you can choose daily monitoring if you are worried about going over - tho you're not technically overdue until after 42 weeks). In my experience (3 babies) doctors are very quick to warn about the risks of natural chilbirth but skirt over the risks of things like induction.
Read some stuff from a more positive perspective. I had two fairly straightforward hospital births and then opted for a homebirth for #3 which was just the best thing I could have done. My reason for choosing it in the first place was that I felt the hospital was terribly understaffed and I had felt half-cared-for but after reading loads while pregnant and having such a positive experience I would choose it every time. I'm not saying hb should be your choice tho - just so you know where I'm coming from.

Best of luck bringing your baby into the world!

Umm (and definitely not intended to scare anyone)... as I set out in my previous post, according to the Royal College of Obstetricians and Gynaecologists Guidelines, if you have a previous 3rd or 4th degree tear, there is a 17-24% chance of worsening symptoms of faecal incontinence, regardless of whether you tear in your subsequent delivery.

It is, of course, for each individual to look at this risk and make their own assessment of it.

Like your DH and DM, after what the consultant said to you I find it hard to understand why you would consider taking that risk. Obviously you need to decide for yourself, but I wanted to address a couple of points that you raised....

You say you feel guilty for taking the CS due to risks to you rather than risks to the baby - but don't the two go hand in hand? Isn't your well being also vital to the baby? Does the child want to have his / her mother left incontinent and the resulting restraint on your ability to function, not to mention the effect it might have on your happiness - and let's face it your happiness has a HUGE knock on effect to your child's happiness. What if the worst happens and you subconsciously find yourself blaming this child for the damage done to you (i know - you think you wouldn't but sometimes we can't help these sorts of irrational thoughts manifesting).

Re looking after the older child after CS - I have had 3 sections (first was emergency after long and horrendous labour), 2 yrs between each so I had a toddler each time. Electives were wonderful happy occasions. Also v nice to be able to have childcare arranged in advance for toddler. I had no issues at all dealing with toddler afterwards - I do think that people imagine that it is going to be much harder than it actually is. You have help and support available anyway, so the small additional difficulties due to CS recovery are unlikely to have a big impact.

Thank you so much to you all. It's so good to get balanced views from other people who have been there. I had my 20 week scan and they think (I know it can be wrong) that's he's going to be very big. This has sealed the deal and I'm going to go for an Elcs (that's what I think today though).

I would have loved a natural birth and although I know the chances of things going wrong are slim but if they did I would spend forever regretting the decision.

Once again thank you

I had a ELCS 2nd time.

I see you have made your decision but I also suspect that as you get closer to the end it will probably reinforce that decision.

I ummed and ahhhed right up to about 32 weeks getting more and more scared when my consultant finally said I had a 40% chance of the same thing happening as first time - signed up for section there and then. I could not have gone through that again.

nelly is right, elcs are very calm relaxed occasions!!

I had almost exactly the same experience as you OP. wrung inside out! And a long recovery time . The second time I went for an ELC, I have to say it was an absolute pleasure, the recovery was no problem, and it was fine even with another toddler.

For me I was terrified of the same happening again and being permanently damaged. The Caesarian was by far the best experience.

I had an emergency section first time after 35 hour labour. Baby 9lb 10oz, back to back and got stuck in my pelvis while I was pushing for 2 hours. Took 2 surgeons better part of two hours to get her out, had to have a t-incision in the end. With my next two I didn't have a choice, the risk of the vertical incision rupturing was too high - had elective sections both times and had excellent deliveries, no ongoing issues. I think you've made the right choice.

I have had problems after my first baby and incontinence is life wrecking. Luckily mine was treatable but at the clinic I met women whose lives, jobs, confidence and relationships had been ruined by it. If they were wanting to go out, they were having to pump thenselvesl with water every morning to flush out their lower bowel to give them 5 hours or so where they could be confident they would not soil themselves.

Sorry to be graphic but rectum tissue is elastic and it is actually cannot be repaired easily.

The probability is that even if you do go for a vaginal delivery you will not end up with the worst kind of tear but personally having seen the effects first hand I would need a lot more than a probability.

Why don't you talk to DM and SP about your concerns about not being able to manage your toddler? I bet they will bend offer backwards to help.

Good luck but please please thing about this very carefully. The probability is you'll be ok with vaginal birth but if you are wrong it could be the worst mistake of your life.

I know this isn't a very 'balanced' view but it is from the heart. Good luck whatever you decide.

Phew! Sorry I missed your earlier post that you had changed your mind.

I'm very relieved. Good luck.

4/5 chance awful, this means you have a 20% chance of having problems again. Personally I'd have the section if it was a 2% chance.