Got "minor" prolapse since birth of DC1. 36+ wks with DC2. Consultant says circa 20% chance of things getting worse from a VB. Been offered ELCS. What would you do?

[MammaCici]

I saw a consultant today and she suggests another vaginal birth but says there is some medical grounds for a c-section, so left it open. She says there's an 80% chance (roughly) I will be either better off or no worse off with a VB. After the VB she could perform a small op/procedure on my perenium that she thinks will improve my overall condition downstairs. But obviously she can't rule out things not going to plan. She based her assessment on a physical examination, my birth notes and a detailed account of my symptoms. Before meeting her I was very wary of what her motives may be but I felt she listened to me and was honest with me. I'm kind of leaning towards a VB as I have a 16kg toddler who I need to be able to look after as well as my new baby. But a 20% risk sounds really scary.

I must decide before tomorrow afternoon. Another vaginal birth or a planned CS.

What would you do?

I had a minor prolapse after dc2, it hasn't got any worse since dc3 although that may have helped that he was slightly smaller. I would always go for a VB unless there was a really good indication for a section as I personally think that there are more and worse risks with a section than a VB. Having said that mine were all easy births and although totally knackered afterwards I felt very well after all 3 straight away.

What!!
If it was me I would go for the vb. if all goes according to plan and you avoid a section then great.
I had prolapse after all mine. Particularly my second. They do settle. After DC3 I bought a sensatone thing, which seems to have sorted it out
Section seems a bit drastic to me, but I like to be in and out ASAP if possible!!
Just my opinion of course. Either way, good luck!

Hi. I had the same dilemma as you. I had a couple of prolapses after DC1 and had to have a pessary in for my pregnancy with DC 2. I saw various obs and birth injury consultants and they all advised no c section unless I was adamant. I did see your other thread and was going to post there. I was told that pregnancy itself is damaging not just the birth so things may already be worse than before. They also said that depending on whether you will need surgery in the future to fix the prolapse (as I know I will), they wanted to minimise scarring and adhesions.

I ended up agreeing to have a managed induction on my due date with the head/consultant midwife present throughout to supervise. Partly this was because the baby was thought to be big and even they admitted that this might be a bit of a problem. After the first drug filled forceps birth from hell the second took about three or four hours with no pain relief even with a nearly 10lb baby. They did say that had it not seemed to progress then they would move to a section sooner rather than later to avoid further instrumental damage. I had no tearing, recovered immediately and my scarring really improved so that I didn't have the minor op that had been mooted before.

I am 26 weeks pregnant with Dc3 (and another pessary to keep things in) and back to wondering if the great result last time was just luck or the easier birth all the consultants kept promising. One rather brutal chap told me that with significant prolapse and not much perineum you would have a much easier birth as there isn't much holding the baby in! The argument seemed to be that a section is protective but if there is already damage that will not naturally improve post birth with time and specialist physio then the benefits of the section are undermined. If you haven't had the hospital type physio it does make a huge difference to minor prolapses I think.

I would be really interested to know what you decide. Good luck either way and sorry for the long post.

I'm in the opposite camp I'm afraid.

I haven't had a prolapse but did have damage from forceps delivery which took a huge time to resolve, and still hasn't fully 3 years on. For this reason I'm having an elective CS this time. I know there is a chance I could be fine with another vaginal birth but I am not wiling to risk it because any further damage would be much worse and more permanent.

I'd rather recover in 6 weeks rather than a few years or worse!

Atrcts , that sounds horrible, you poor thing. But if you don't mind me saying it is a bit different.
The others are right, the pregnancy itself often brings the prolapse. I know with DS2, who was nearly 11 lbs and engaged really early. I could barely walk and was so bruised and tender for weeks before the birth. I was numb for two weeks after, couldn't even tell if I was doing a wee!! Didn't have any stitches or anything. But then realised I had a prolapse.
Like I said it did go back with exercise. It wasn't anywhere bear as bad after DS3. The sensatone has helped amazingly. Nearly back to normal! Abdominal surgery can bring its own problems later too-adhesions etc.

Persoanlly, I would take the CS plus a repair op on top if offered .

IME, ELCS are often very well handled as they are planned, the atmosphere is calm and the surgeons are not working under the more pressurised conditions of a crash or EMCS.

I had a toddler when I had a new baby from a planned CS and didn't have any problems with lifting, if your toddler isn't walking by the time of the CS then that might be different, but if they are walking or at least on their feet the lifting element is minimal, particularly if you have a DP/DH to step in and help.

For me, I reasoned that even if pg caused some or most of the problems, a VB potentially puts some element of strain on an already strained area, whereas CS does not. But every person has a different experience, what's right for someone else might not be right for you.

If only we were given crystal balls in the Bounty packs!

Thanks for your replies. I've decided on a VB. I'm reassured to read that most others would do the same so perhaps I'm not totally bonkers. I have to say, I had no idea how common my complaint (or similar) actually is. I think being given the choice feels good and I don't feel bullied into something. Baby had been back to back until a few days ago and that really had me up the wall because my first birth was ideal, on paper anyway. I plan to say that when labour gets going if things don't go smoothly I would rather go to CS sooner rather than later. I very much want to avoid an instrumental. But I also want to avoid major surgery! I too have been told I will need surgery in the future so I'd like to avoid it now.
It's a relief to have made a decision. I think I'm going to sleep better. Once baby doesn't turn OP again. Right now I can feel baby's butt cheeks at my ribs. I hope to spend the last few weeks thinking about baby, rather the birth process. I can't wait to find out the gender!
Thanks again girls.

I had back to back and it took a long time for down below to feel normal again, I didn't have an elc for any reasons down below at all but am v glad that a wonderful side effect has been wonderfully intact down below.