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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

bowel incontinence/cs or vaginal birth?

18 replies

manitz · 15/09/2006 13:22

Ive seen similar messages before and wondered what decisions people had made or what advice you could give me?

I had a vbac in jan 05, 3rd deg tear and heamatoma. I'm not yet incontinent thankfully but also tear has not completely healed, just been checkd and it seems the outer muscle still has a gap so it's likely i'll need either physio or more surgery.

At the old hospital they recommended I try a waterbirth next time as a speedy labour (and crap mw) contributed to bad tearing etc. However the new hospital and bottom doctor (his name not mine) said have a cs. He says I have a 40-50% chance of tearing in the same place or a 4th degree tear and then likely incontinence either now or in future.

All in all I'm persuaded however after no3 (ttc at present), I'd like another fairly close together. I had a cs for #1 and with more scar tissue it seems you are more prone to placential abruption and previa (which concerns me a lot). Generally I feel that cs is extreme surgery which is also bound to carry risks. What would/did you do?

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Toady · 15/09/2006 13:55

I personally would go for a water birth, but you need to find as much information as you can, and what you can do to prevent tearing again. This link might help.

anniediv · 15/09/2006 14:00

manitz if this helps, I've had a placenta praevia and was told that having a section will NOT increase the chances of it occurring again, it is fairly 'random'.

mears · 15/09/2006 14:08

manitz - why do you think the midwife was 'crap'? What do you thin she did (or didn't do) that contributed to your tear?

There really isn't any particular thing that can be done to prevent tearing completely. Waterbirth is good for encouraging the perineum to stretch but I have known 3rd degree tears in the pool as well.

Sometimes it is recommended that an episiotomy is performed when there has previously been a 3rd degree tear however there are more 3rd degree tears associated with episiotomy than without.

It might be helpful for you to see medical advice here for the management of subsequent births. As with all advice, it is your decision whether you accept it or not. Women who are symptomatic with problems after 3rd degree tear should be offered a C/S. Doesn't mean she should have one if she doesn't want to.

Original poster

manitz · 15/09/2006 14:29

Thanks for advice. Looked at first link and will look at other one when not in work.

Midwife didn't guide me, she put me in stirrups, told me she'd never heard of being upright when I requested a diff position, told me i needed forceps because baby had to get out due to meconium - luckily sho/doctor came in and said I was progressing fine so leave the forceps - later i found out it was v old meconium. All this made me panic and I was shouting give me cs etc but because of the panic. MW told me 'not to be silly', therefore I pushed bloody hard and got baby out in 5. she said stop as tearing and cut me but didn't guide me to pant etc and I thought baby was dying.

following that she didn't notice the 3rd deg tear and when I couldn't sit down to get back to ward again told me not to be silly gave me baby and made me sit/didn't examine me.

presume heamatoma developed whilst i was waiting for wheelchair. 3 hours and 2 attempts at weeing later they told me to have a bath and left me to do it on my own. when emergency cord didn't work i left door open and cleaner found me and got sho to help me out. eventually they examined my 'pile', realised it was heamatoma and rushed me into surgery (7hrs after birth), apparently pelvic floor had seized up and womb hadn't contracted so I was still bleeding. obviously this wasn't my labour mw's fault but I do blame her for panicing me, not supporting me/advising me, and not checking me b4 sending me to ward. I also resent the 'silly' comments which didn't help. Is this where I parp myself????! sorry for banging on.

I'm beginning to consider another vbac... we shall see. Anyone actually gone against cs advice about possible incontinence?

OP posts:

mears · 15/09/2006 14:32

manitz - no wonder you upset with her

Were you stitched at the time? Did she do them?

Original poster

manitz · 15/09/2006 16:11

yeah she did first lot of stitches but as she didn't say anything about degree of tear I'm presuming that she didn't realise it was so deep. In fact it wasnt' until physio on 2nd day following that I found out it was 3rd degree and they said it wasn't important why it had happened just how I deal with it. later was cut open again and restitched by consultant.

Generally I feel there is quite a lot of room for improvement in postnatal care from my experience. mw was agency and older and it was middle of night. other mums in area agree that you try and give birth during the day! next time if not ecs will get a doula.

OP posts:

mears · 15/09/2006 20:45

manitz - did you write to complain at all? You really have grounds to sue.

Original poster

manitz · 20/09/2006 09:11

No. I've asked NCT for advice about how to go about it but haven't heard anything back yet. Need to chase them really...

OP posts:

Uwila · 20/09/2006 09:38

Have a look on the NHS site for the address of your PCT and write them a very stern letter. You can bet that if I were you, I would never ever set foot in that hospital again.

I would probably also ask for a section just to avoid the possibility of another equally neglectful midwife experience.

If I were you I'd look at birthchoice.co.uk and see what other hospitals might be an option. You can refuse (but you have to be very determined) to go to that hospital again.

Where are you? Are there many hospitals nearby?

monkeychambers · 20/09/2006 10:21

I had my dd 4 and half months ago. I also had third degree tear. My midwife was great. I had a water birth but she arrived really quickly (also weighed 9ld 11oz) so the consultant who fixed me up the next day advised me that with the speed of labour and size of baby is was pretty inevitable.
When I saw him for the 6 week check up he said next time I should definately go for c/s so as not to risk incontinence.
Just wanted you to know I had water and still ended up in a bad way really - although the birth itself was fab, the aftermath wasn't too good. Will stop rambling now....

Toady · 20/09/2006 11:24

Just to say I really wouldn't go for an elective section on the basis that you MIGHT get a crap midwife, what if you got a crap surgeon.

Have you thought about having a homebirth?

Uwila · 20/09/2006 12:29

Yes, but statistically there seem to be an awful lot of crap midwives. So, I think the chances of crap midwife are greater. Just in case there is any doubt, Mears does not belong in this category. I think she gives very good sound advice. In fact she has explained a thing or two to me that no one before her ever bothered to enlighten me on.

Still, the only way to guarantee the undivided attention of a team of doctors in this country is to have a section. So that's my preference.

However, the OP may have a different view, in which case I think that preference should be supported.

Original poster

manitz · 20/09/2006 12:46

I didn't twig that mears was a midwife. Generally every one I have met was v good. Monkeychambers thanks for your experience, I have always wanted a waterbirth and I was very tempted by it when the other consultant suggested it. Would you now go for cs?

Uwila Ive moved out of the area (homerton) and would now automatically be Northwick park . Although ironically I loved my cs at homerton and would be very keen on being seen there for anotehr cs.

Toady I completely understand your pov and your link was extremely interesting and may yet persuade me. I've seen some really bad cs recoveries and agree that it is a certain op rather than a possible one. That does concern me but the thought of bowel incontinence is really hideous and I'm not sure I can get over that. My cs was so calm and recovery was much easier than after the vbac, I actually liked it (are we allowed to say that?). My plan was cs, vbac, vbac, cs and now it looks like I can't stick to my plan which I hate.

tbh I think I still need as much info as poss so I can consider all the options and pros and cons. I'm only ttc at present so i've got at least nine months to make up my mind.

OP posts:

Uwila · 20/09/2006 13:17

I don't think you have 9 months. If you want to change hospitals or refuse one they want to send you to, you need to do this the second you find out you are pregnant. I was refused treatment at two hospitals when I was 6 weeks pregnant. They said they were full. They were lying.

Toady · 20/09/2006 15:24

Glad to be of help, sounds like you are getting as much information as you can. This forum may help too.

spudballoo · 21/09/2006 15:31

I suffered a 4th degree tear at the Homerton, and now have a colostomy bag as a result. I was due to have te colostomy reversed about now, as there are conflicting views from physiological tests as to my level of continence - only one way to find out!

But I got pregnant again by mistake. I am having a c/s on the very very very clear advice of my colorectal consultant AND obstetrician. An elective c/s will protect what is left of my pelvic floor, but not the pudendal nerves. But it is my best chance of ever being continent again.

The risk of further damage to my pelvic floor is considered such that I am being delivered at 38 weeks as even a few hours of labour could do irreperable damage.

Personally I wouldn't risk it. I would take the elective section.

SoupDragon · 21/09/2006 15:40

I had a 3rd degree tear with DS1 (10lb 1oz, ventouse delivery) and was giventhe go ahed to have a natural birth for any subsequent children at a check up 10 weeks later. With DS2 I did have an episiotomy when the tear looked vulnerable to direct any tearing away from the oringinal. All was fine. Then I had DD at home in a pool. No episiotomy, no "monio=toring" the old tear and I got a 2nd deg tear. All has healed fine and I've had no problems at all after any of my births.

However, I think that had I had any trouble, I would have opted for a cs and if I'd already had a prior cs I'd probably go for that as it has a more predictable outcome than risking further damage.

Original poster

manitz · 22/09/2006 10:59

spud sorry to hear aobut your 4th degree. I had my cs at homerton and thought they were excellent, in fact I enjoyed the whole experience. I think I'm going to wait until I'm pg (hoping for a positive this month) and then will wait for a 3m check up and carry on gathering advice. I guess it's not just the 3rd deg tear but the heamatoma which has increased the scarring, plus the fact that at my recent scan it looks like the outer muscle has not properly healed. I'll go for feedback next month and know more about it.

I'm veering towards a cs but then find the next day I'm thinking about a vaginal birth. I'm considering hiring a doula/indy mw just to have someone i trust to bounce ideas off and who could then support me in my decision whatever it is. Money bit of an issue obv.

Not sure spud how many children you have but i had dd1 at about 38 weeks by cs and she slept for 24hrs. feeding and latching on were a big issue, I think she would have gone over and was a bit more prem than just 10 or so days - more like 3 weeks. hth. As she was number one it was quite an issue fo rme prob be easier if you've successfully fed other kids.

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