I should just "demand" an ELCS, shouldn't I? Any advice? (existing prolapse, tendency to tear/PPH)

[Roonerspism]

Hi there - really grateful for advice as I think I'm going to have to become pushy on this issue.

Brief summary. Hellish first birth (mismanaged) resulting in bad 3rd degree tear, large PPH, retained products needing later D and C. Recovery remarkably OK but minor prolapse developed. Second birth - much better experience but still a second degree tear and then prolapse much worse. Also developed awful anal fissure that took 6 months to heal. And of course, incontinence issues when running. Things have never been quite right but I can live with them for now.

I'm now pregnant with number 3. Thus far, I've been advised that it is pregnancy that causes the prolapse, not the delivery. My prolapse has, however, actually improved during this pregnancy. I have a fissure again though and other issues - I think a new rectal prolapse.

Consultant is very laid back and thinks natural delivery is the way to go - didn't even examine me - and that I'd need a repair at age 50 anyway so should have a natural delivery and not a CS.

I'm now 32 weeks and I have just had a private scan that showed this baby has a very large head - 96th centile and looks generally very big (my other children were large, but not this big).

All in all, I can't help but think I'd be crazy not to ask for an ELCS. My prolapse is actually so much better now, but if it worsened beyond what it was like in the 18 months after DD2, it would be very hard to deal with. I have other issues that I don't want to worsen. I definitely don't want another tear. I also asked for pain relief (epidural) in the next delivery (as it's flipping sore badly tearing without any pain relief) and of course it can't be guaranteed if they are busy. So I feel I am going to be anxious generally about it, and I wasn't about my previous deliveries.

I know that a CS is hard to recover from, but I can't help but think I'm being fobbed off by consultant in the interests of keeping their ELCS numbers down.

I'd be really grateful for any experience/advice. Thanks so much.

Yes. Previous third degree tear is reason enough. Don't risk incontinence just because they are being unhelpful

I'd request an ELCS.

I've delivered vaginally (dd1) and damages my tailbone, so o requested an ELCS for dd2. Thw consultant was extremely dismissive, but I was insistent. I knew the probable pros and cons for each mode of delivery and took the more predictable risks of ELCS.

For me, the ELCS was fine. All very routine and the pain was managed so well, I couldn't believe I'd just given birth/had surgery. It was uncomfortable, especially for the first few days and couple of weeks ... but no pain. Just discomfort.

Don't be fobbed off.

Thanks so much for responses. Seeing consultant again next week so might need to be firm.... Glad to hear recovery can be OK.

Any other views gratefully received..

I think that a good CS would be easier to recover from than a bad VB. Obviously you can't guarantee either. I'll be taking the known risks or an ELCS over the unknown of another VB as I can't face having the same hideous recovery again.

Definitely go for an elCS. Mine was much easier to recover from than my "normal" vaginal delivery.

FWIW, I remember hobbling up the stairs carrying my then 4mo dd1 (at age 26yo) as I still hadn't recovered from my tailbone injury that I incurred from unsuccessfully pushing for 2 hours.

I had 6 sessions of private physiotherapy to help. It helped massively, but I still get pain, 5.8y on.

In a straightforward ELCS, my experience (and the experience. of 2 others who I know who've had ELCS) is that the first few.days up to the first two weeks are hardest. But the recovery is usually predictable.

IME, the consultant wants to hear you say that, despite the risks, and ELCS is what you want. So, don't let the consultant wear you down with worst-case CS vs. best-case VB. Each have their own merits and demerits.

As someone once said to me "there is no easy way to have a baby". I used to think that those who have had fast births had had it the best, but changed my mind when my friend had to have a culposcosuspension (sp?) at age 36 after two fast deliveries, which shattered her pelvic floor.