34 weeks with twins and risk of rectal prolapse (sorry if TMI!)- should I go for C-section?

[marlus]

Hi there,

I am 34 weeks pregnant with boy/girl twins, and was all set for a vaginal delivery (both head down at 32 week scan). However, over the last weeks I have noticed that when I have a bowel movement, my bum kind of turns inside out (along with producing a nice bunch of piles). Went to the GP today who said that, while not a prolapse yet, I was on my way towards one. She couldn't give me any definite answer about the effect of pushing two babies out, but thought I was at increased risk of developing a rectal prolapse if I went for a vaginal birth and that this might require surgery later.

Other considerations are that, while I delivered my DS (4) vaginally, he needed high-up forceps (Haig-Ferguson maneuver I think it was called). The other thing is that Twin 1 at the last scan had a head circumference of >98%. The consultant kind of pooh-poohed this as scans are apparently not that accurate, but my GP pointed out that this measurement makes it likely that he has a bigger than average head.

I prefer the idea of 'natural' labour, but with the constant monitoring, the epidural etc that the hospital insists on with twins, how likely is it going to be that it is 'natural' anyway? That said, I was induced with DS1 after my waters breaking and two days of not-quite-effective-enough contractions (and no sleep), had an epidural, was induced, forced to stay on my back because his heart rate kept dipping, ended up having the forceps and it was still one of the best experiences of my life

I'm seeing my midwife on Monday and have been told I should tell her if I want to change my plans. Any advice?

hi,
My twins are 7 weeks old. Both of mine were head down and we were on course for a natural delivery. However, I had LOTS of fluid retention in my lower half, and this also made my back swollen too. Basically I had THREE epidurals and not one of them worked. They induced me at 37+6 and I had 7 hours of full-on labour after they broke my waters, then they lost Baby A's heartbeat (after putting two clips on his wee head), so I ended up with an emergency section to get them out safely. (7lbs5oz, and 6lbs4oz) Long and short, if I had my way again not happening I would opt for an elective section, much less stress and pain. 7 weeks on, I'm fully back to normal, just can't lift the double pram yet!!
Good luck, but watch out for the fluid retention. I've since heard that it's quite normal for epidurals not to work in multiple pregnancies.

Thanks ninja,

That's my worry, really. In the best case scenario, I'd have as 'normal' a labour as it is possible to have with twins and no prolapse. If I choose an elective c-section I'd give up that possibility. But the worst case scenario looks pretty bad - c-section and then also having to have prolapse operation... Maybe best to play it safe? I wish someone could just decide for me... for your tough labour!

I would not make this decision without a second opinion on the rectal issue from a colorectal consultant (or other relevant specialist) if a vaginal birth is what you really want. Piles are very common in pregnancy and I reckon there's a decent chance your GP is over egging it.
All that said, I would prefer a cs for twins personally anyway given the risk of complications/emcs, so that would be decision made for me.
Good luck!

Thanks Roseotto, TBH I think I am more concerned about the rectal prolapse than my doctor, because I know how little 'straining' I have done to get to this early stage (which I saw myself in the mirror - not nice). Logically, I can almost not believe that the amount of pushing in childbirth would not make things much worse. ButI hadn't thought of getting a second opinion - any idea how I would go about that with so little time left? I got the good GP at the practice today (lucky - last minute appointment!) but many of them are a bit useless and in the past referals have always taken months....

I have had a rectal prolapse (way before I had babies) and fear I am now going to have another now after my second DC.

Have an ELCS. Just isn't worth it. My pain now from the piles/possible prolapse is far far worse than the pain from the birth.

Ask for referral through your MW/consultant

Thanks littleturkish, I will take your advice! Would like to not have the recovery time after the c-section (am already housebound now and looking forward to getting out and about again) but much rather that than prolapse, eventual surgery and recovery from that. Have a midwife apt today - hope she's not going to give me a hard time... Are you going for the ELC with DC2? Did you have a vaginal birth last time? If so, did that make it worse?

Thanks again, I will see if I can get a referral today...

Yup, it was a vaginal birth. If I'm right and I'm going to prolapse again, I most definitely would request a ELCS for any future DC, and for twins I wouldn't even hesitate!

Recovery from elective tends to be better- much better than if you end up having an emergency OR prolapsing and having to recover from CB AND the prolapse surgery.

I desperately wanted a natural birth but had to be induced with high blood pressure so strongly urged to have epidural ( though looking back- not sure why i fought that one) started pushing then they realised I was not fully dilated and baby was in distress (and I had insanely high blood pressure) so had an emergency c section- like you it was still a great experience and crucially the c section recovery was no where near as bad as I imagined. However, recovery would have been so much better from an elective section as I would not have been so exausted from three days of induction. So I would say If there is a really risk of c section just get that done. It will still be a wonderful experience. You will have your babies and you will be healthy.

Thanks cookiefiend, that's what I am hoping...

Littleturkish my midwife has now spoken to the consultant on the phone, who sounds like she is not convinced, saying that is doesn't matter how you give birth for a rectal prolapse. I am unconvinced, though, have looked up some of the studies and might well just insist on a c-section. Even if the chance of a prolapse is only 15% or so, I'd still rather have the section. They both said it is now too late for a referral to a colorectal (sp?) consultant... Won't see her until next Monday, so hopefully these twins will stay put until then.

From your thread title alone - yes.

In fact, I'd go straight to ELCS with twins, let alone with a prolapse. I would absolutely not want to jeapardise my health and risk faecal incontinence issues at all.

I have had colorectal surgery in the past. My surgeon said that if you have anything going on there have an ELCS. So I did last time and Will this time too. The recovery from that was nothing compared to the rectal surgery. That was weeks out of action and hideous and messy and never properly healed. If you have even the slightest increased risk then insist on ELCS. There is a risk anyway so if it's increased I'd just not go there.

Bean I'm sorry you had to go through that! I get the feeling that it's pretty rare and that obstetricians and midwives have not necessarily come across it and therefore don't acknowledge the risk. I think I will be insisting, though (though not very good at that in the face of (presumed) medical expertise)..

seaoflove I'm starting to think that's what I should have done... Not really sure why it was my choice to begin with and now not so much anymore....

Marlus it very much IS your choice- NICE guidelines are there, print them off and take them with you if it will give you more conviction.

Best of luck.

Thanks again for all your feedback. I saw the consultant today and, despite what the midwife had said, she recommended a c section. I'm now booked in for 9/4 so not long at all to go

So pleased for you! Great result!

Chances are you already had a prolapse but weren't aware.

I have a rectocele and cystocele from first pregancy. I wouldn't know if I didn't know anatomy very well.

It's genre ally the prolonged pressure that caused strain on pelvic floor not nec delivery.

You're better having a vaginal birth and keeping the very important abdo muscles in cut than having a c section.

Look up Hab-It and start the pregnancy exercises now and get the pelvic floor DVD for after the births.

Good luck

Sorry read all comments now. ??

If you're happier with ECS do it.

Still get the hab it DVD though.