SHOULD I opt for a section...opinions really needed please??

[pucca]

Ok, i am 17 weeks pg with no 2, i am going to discuss mode of delivery with my consultant in a few weeks and i need some opinions please?

My dd was 9 lb, and i suffered a top of the scale 3rd degree tear, the pain of the tear wasn't so bad but it did take me 4/5 months to be able to control my bowels again (sorry TMI) andi am quite frightened of ending up with no bowel control at all or a 4th degree tear if i go vaginal again, even i really don't like the thought of a section.

Now obviously no one can predict if i will get a severe tear again so i am in limbo...

I will go with what ever the consultant thinks best, but i will also have a say too, i am quite likely to go over EDD as i did with dd, and obviously the weight of dd, and possible weight of no 2 is also a factor.

What do you all think?

TIA

Pucca thank you so so much for starting this thread... I am only 11 weeks pg and midwife has just recommended elective to me. After DS I ended up doubly incontinent for 2 months and then just incontinent for another 3, had to wire myself up with electrodes three times a day to give myself electric shocks where the sun don't shine, and had weekly physio as well (don't even try to imagine).... I had been asking myself if I was being selfish taking the easy way out of an elective but seeing all this advice makes me feel so much better about making that decision.

The only thing I'm not sure about is whether all the damage was done with the first anyway and what the likelihood is of this repeating itself or not if I went for a normal again? ('this' being pelvic floor damage due to first stage too long, second stage too short, had done all the pelvic exercises in advance but apparantly nothing could have prevented it).I have no idea what likely outcome would be and strangely enough (hahaha) this kind of stuff doesn't get mentioned in the baby books.. Even the midwife had no idea of chances of it happening again...

If you have a lot of scar tissue there, then scar tissue isn't as elastic, which may put you at increased risk. Also, babies tend to get bigger. I personally would go for the section. Haven't read allt he thread so sorry if I'm reapeating anyone. Don't you have a consultant you could speak to?

Have to be honest, I would go for the section. I had an elective section at term (compromise with consultant, trial of labour if anything had happened before 40 weeks) and it was really good, very quick recovery. Had the section at 5pm, was moving around in the bed that night and out of bed and in the shower lunchtime the next day. I know every experience is different but I am very happy how things worked out for me. And have to say your experience sounds pretty awful!

you'll (hopefully!) have a far better idea of things once you've seen the consultant, but I would be inclined to go for an elective section, to avoid risking continence problems. Even if the continence problems are temporary, I still think it's worth risking a possible longer recovery time in terms of lifting/physical aspect if that would avoid continence problems.

Thanks you all so much for all the replies and experiences given,

I see the consultant in a few weeks and all will be discussed then, but i was told to try and work out which i would feel happier with.

Whiffy....All i can do is > at what you went through, sounds horrific i did have the 3 months of "accidents" and if i am truthful i am still not back to normal really, and run for the toilet when i need a no 2 {sorry! lol)but nothing like what you had to go through.

pucca - are you having any treatment/physio etc for your bowels? just it sounds rotten for you having to put up with dashes to the loo etc. when you see the consultant, explain that you still aren't 100% back to normal.

Actually, very good point TBB. Pucca, you should go to a chemist and ask for vaginal pelvic strengthening cones (or get DP to do it for you). They are basically metal tampax shaped things that you use to exercise your muscles. Easy to use and should help you heaps.
I'd phone up the chemist beforehand in case they have to order them (bet you can also buy online)..

Waswondering, I was quite uneasy about the idea of having to lie there while I could feel them pulling and tuging but wouldn't be able to feel my legs enough to move them. So much so that the day before the operation, I enquires with the anaesthetist about getting a general. He talked me out of it. In the end I remember lying there on the table and feeling them "rummaging around". It felt a bit like a nice back massage, only on my front insteadof back. And I recall thinking how strange it was that I seemed to ectually be enjoying it. So it wasn't so bad after all.

Good luck to you!

I'm 45 and have had three sections at full-term (one emergency under general, one after the water bath made no difference to my inelastic cervix with a spinal, and the last an elective one with a spinal). Having my fourth (and definitely last!) by spinal on Monday - am feeling a little apprehensive now but mainly because of my age and the fact that the risks increase with age and number of ops. But my consultant was very supportive and quite happy for me to go ahead with what was an entirely unplanned fourth pregnancy. Don't be afraid of a section - as far as I can see its easier than the
horrendous labours I and my two sisters had - with my first they left me for hours having to not push when my body was doing its level best to push that baby out! The last two were remarkably pleasant experiences all things considered and I have always recovered quickly and been mobile quickly. The main thing is the health of you and your baby. Get one of those banana shaped nursing pillows to cover your tummy when you feed the baby and dont wear bikini briefs for a while!

Wow..more replies

Tbh i just got on with it after having my dd, i wasn't offered any other appointments to check everything except the usual 6 weeks postnatal one where a physio "checked me" kind of and said everything felt ok, i know i should have gone to G.P but i just thought it would be normal not to have control for a few month's, i think it is in my head why i run to the loo now, because i had so many accidents in them 4/5 months after having dd.

WasWondering...Please let me know how you get on, sounds like we are very similar

Thanks again for all the very helpful replies. xxx

yeah. a few things I found with my ecs.

I must say dh and i loved my ecs. He held dd1 for 20 mins as I got stitched up whereas he felt useless during vbac and didn't bond with dd2 as well initially. also he got to wear scrubs. I had no fear (apart from the spinal needle) just wanted to see her and I was quite high which was nice. didn't get any baby blues (not liek vbac) and ws high for about 4 months - drove everyone else mad.

I found sleeping difficult in hosp as didn't know - or get told how to sit up to deal with baby so slept sitting up (you can imagine how much sleep i got). heard that you roll onto side and lower legs down to floor and push self up with arms. Best pants are tesco value (1.50 for two pairs) can also be mistaken for pillow case. took my biggest pair in and they were agony now have different definition of big pants.

also get up and walking as soon as you can, less frustrating and better for recovery. As with natural birth you want easy poos and no constipation so eat fruit and fibre etc. is that tmi? going upstairs was a mare but found that with vbac too, just got two of everything. Personally i believe the early delivery of dd1 (10 days b4 due but wld have gone over) caused bfeeding probs so be prepared if you want to bfeed.

was told wld be about noon so ate nothing night b4 and arrived at 7am. didn't get cs until 5pm so was gasping for food and drink. missed hosp tea as didn't fit with their timing. so be aware. Also noone told me to shave muff so had mw do with dry razor, nice, I'd ask these sorts of questions if I were you.

Finally the scar is in my pubic area and you can't see it at all now. It's not like old days wher eyou cldn't wear bikini. Although i can't for other reasons now!

Hi

Don't think I can add much, but I'm in similar position to you. I had em c/s with ds1, then vbac and third degree tear with ds2 - very long stage 2 and then he emerged in a rush if that makes sense.

I too didn't quite realise what problems I had (also thought faecal 'urgency' was just one of those things after vaginal delivery) until my 6 month check up - gynae and bum consultants just said that they wouldn't advise another vaginal delivery - but like boris09 says, there haven't actually been any studies of the incidence of tears after tears... In the end, it was dh who 'made the decision' - he wasn't absolutely sure about having another baby so our deal was that I could have another one if I didn't put my health at risk.

By the way, my c/s was fine really - worst bit was that ds was stuck so there was a heck of a lot of pulling and they had to call in for reinforcements he was stuck so well! But I felt that recovery was pretty good, dh kept commenting on how well I seemed/moved etc given that I'd just had major surgery! Good luck with decision, and pg.

oh, interesting question for us to ask consultants (I'm 8 weeks pg with no 3 ) - how close to due date can your c/s be? Bf established well with both my ds's, but then with ds1 I'd been in established labour for 12 hours, so all the hormones in place to aid milk etc? Does worry me slightly that this might not be the case with c/s where timing not related to how well cooked baby is.

yes, think cookedness was prob with me and bf. My ecs was due to breech. other breech mums asked for ecs to be at time of labour. Prob not a good idea in this case though? also it was my first baby and both of mine have had failure to thrive even though no 2 was a natural birth.

my bowels are different since the tear, i kind of dont need to go then do and it feels like it doesn't stay in teh first chamber like it used to. does that make sense and is that what you are talking about?

Why not good idea to go close to dates? In case quick labour? Hmm

Happily for me, have really appalling memory, so can't quite remember what urgency was like - perhaps just one of the reasons dh worried that I wasn't being realistic at wanting another vaginal delivery. I think my problems were two fold - stage 2 was nearly 4 hours and I think this caused general nerve damage, then 3rd degree tear caused muscle weakness/ nerve damage/ whatever..

I'm in the same boat, and can tell you what my consultant told me.

Had nasty third degree tearing from forceps, and temporary numbness (so couldn't empty bowels as couldn't 'push') and lasting urinary urgency (now on bloody brilliant drug treatment - god bless my urogynae consultant). Also was 'remodelled' in day surgery due to rubbish repair of the vaginal tearing.

My obs consultant was quite clear. He felt it was hard to estimate the chances of extensive tearing second time around, although they would be greater now that the tissue was weakened, but he said ANY chance of double incontinence was unacceptable in his opinion. He also said that repairing tissues second time around was generally less successful. He would support my decision if I wanted to deliver vaginally, but he would question why I would take such a risk.

My first delivery was fast - 3 hours first stage, hard to say after that due to complications/rush to theatre/forceps etc. I was on date. According to the consultant, he would plan a section one week before date. As I live minutes from the hospital, he was confident that if I went into labour earlier than that, a section could still be performed despite the likely speed of my labour.

By the way, don't live with continence/tear repair problems - I am SO glad I asked my GP for referrals. Well on the way to sorting the urinary problems now, and exactly the same 'down there' as before the delivery, which is marvellous when you consider that the original repair was so bad my GP couldn't even do a smear test.

jamiesam, the other breech mums i knew (also all first babies) opted to have ecs at the time they went into labour. I just thought as everyone here is on post first baby and has quick labours and is concerned about tearing again (whereas breech births are likely to get stuck and often end up as emergcs anyway so they know how to deal with it) waiting for labour so baby is cooked might be just as risky as not having ecs.

did any of you have constipation during labour? i didn't go for about 4 days but had been told that the runs is one of first signs of labour. I had lots of regular pain in my lowerback/bum from sun-thurs. went in thurs eve and was in agony as tho baby posterior but it wasn't. I wasn't any more than 1.5cm dilated at this point. then waters brok and went up to 8cm in 10 mins and i'll have to check but was about 20 mins - something like 5 pushes. Also were you on your back? again, have blamed that myself.

With my labour with my dd, i had a very long 1st stage (27 hrs) and almost an hour pushing then my dd popped out like a cork! infact the MW was lucky to catch her! but i remember the crowning of the head and them telling me the head was crowning (the burning) and the MW's didn't tell me to pant, so i pushed extremely hard so blame on the MW's part as well i feel.

When i saw the MW last week, she said while looking through my notes that i did have the best registrar to sew me back up, so luckily i had no problems with the repair as such (didn't have to go back)...it is just so hard to make a decision...because no one can say what will happen if i went for another vaginal birth.

I've also had both. By far the best was my emergency c-sec over my 5hr vbac. Recovery was quicker in my c-sec, I was home faster. I was an 'extreme' case so they told me. Sounds to me that you are likely to heal far faster from a c-sec than another vaginal.