Long post, sorry.....I’m 16 weeks pregnant and considering my options for this delivery as I had a rough time having my son who was born in 2012. I’m considering an elective c-section, though I know they come with their own risks and issues. Both the consultant midwife and my consultant have agreed I can have one if I choose but equally would support me if I choose vaginal birth.
A bit of background…I had a long labour – 80+ hrs from first contraction until delivery. Despite planning and preparing for a hypno / water birth, and not wanting pain relief other than G&A, I couldn’t use the pool due to a small bleed shortly after getting to hospital and I ended up on the syntocin drip after a while to augment things as they weren’t progressing and I was exhausted from not having slept a few nights already. I stuck with just G&A as per my birth plan until we knew we needed intervention. I ended up with low forceps with episiotomy under spinal in theatre as my son was back-to-back and facing the side, and just wouldn’t come out (though I didn’t know this about him being back-to-back until months later when I was informed at a birth review meeting). Before we moved to theatre, I pushed for well over an hour, including a fair bit of time on my back (not knowing he was back-to-back – gah!!).
After delivery I had a retained placenta which had to be manually removed and then had a PPH of about 1.5l due to uterine atony and became faint a day or two later while still in hospital and so chose a blood transfusion before I was discharged. I had a catheter in for a bit in hospital and shortly after it was removed I remember feeling I needed a wee and I stood up only to then find urine pouring out of me onto the floor. Midwife came to clean up and got the women’s health physio to come and see me and exercises were prescribed. I also struggled to control the passing of wind for a couple of weeks after but was told this is normal. With hindsight I wish I’d taken an epidural so I could have rested more during such a long labour. I ended up with lots of interventions anyway and breastfeeding was very difficult for months!
My episiotomy healed with no issues but a few weeks after my 6 week check (when I wasn’t examined, just asked how I was), I went back to the GP because I was finding it hard to control bowel movements. For example, the first poo of the day was tricky. I’d get the urge and would need to get to the loo asap and sometimes didn’t make it. GP referred me to Women’s health physio who checked me over and gave me exercises for the whole pelvic floor, with instructions to tighten the vagina and anus when doing them. I also got dietary advice to help manage symptoms in the meantime. Physio also queried if I’d had a ‘missed’ tear. I’ve no idea obviously as there’s nothing in my notes if it was missed. I then had weekly physio appointment for the next couple of months and the problem was resolved. I still have less control / time than I used to pre-baby when needing the loo after a spicy meal etc but I no longer poo myself!! I also have no issues with urinary incontinence (can run etc with no issues) and sex is also fine.
So, I’m still considering an elective c-section. I’m worried about needing another epi or tearing and having the same or worse issues. Consultant midwife was supportive of me choosing either c section or vaginal birth. I know subsequent labours are often quicker and easier and tearing and need for forceps is less common etc but equally I feel there’s no guarantee as you do hear of people having difficult second labours too. Midwife said one option would be to try vaginal delivery but rule out forceps / ventouse so if things need help they would move straight to c section. This appeals but I’m worried that it may not play out in practice…? She also said that I could use water pool this time if all normal and so avoid epidural and associated increased chance of interventions. She also said water reduces risk of tearing? But she also said that faeceal continence issues are quite unusual and she understands me not wanting to risk repeating the past situation and can see why a c-section might be the best option for me. A comparatively ‘easy’ vaginal birth appeals and I know I can deal well with the pain. I would love to have a natural birth with no issues and be home later that same day – who wouldn’t?
I am waiting to see the women’s heath physio again to see if they will take a look down there and give their view on whether a c section is best or whether another vaginal birth would be ok. Then going back to see the consultant midwife and the consultant in February, by which time they'll both have had time to look at the full notes from my last birth.
Another consideration is that I also have diastasis recti (separated abdominal muscles) after my first pregnancy and have been working to improve this but I’ve heard that c-section is bad for DR.
I’ve no idea how common faecal incontinence is after childbirth but I know it can re-emerge and worsen during later life so that’s a worry. A few of my friends also needed women’s health physio after their births and some had to have those electronic probe things to use for weeks after, (I didn’t thankfully!) but I don’t know what their issues were e.g. faceal or not. We talk about a lot but not at that level of detail!
Anyone been in a similar position or have any other useful knowledge to share please?