Continence and baby 2

[BunloafAndCrumpets]

Hi all. I'm thinking about a second baby, DD is now 2. I had induction and forceps (baby facing the wrong way and had head circumference over 100th centile) with episiotomy, tears and urinary incontinence for a few days. Two years on and a lot of physio and use of a kegel8 it's heaps better but I still leak from time to time and need to wee frequently. I also have to go as soon as I need a poo or I wouldn't be able to hold that in either (sorry TMI). Sex isn't great as sensation is reduced.

If I try for a second baby, and assuming (big assumption I know) I manage a non instrumental delivery next time, how likely is it that a vaginal birth will make all this worse or cause permanent incontinence? Should I ask for a referral to obs if I get pregnant to discuss an ELCS?

The idea of the labour itself doesn't terrify me but permanent damage is something I would like to avoid. I know recovery from CS is very hard and it's not an easy route at all.

I find it hard to weigh up risks when there seems to be so little evidence in this arena. I also am not sure, because it's not often talked about, whether my symptoms are just normal for anyone who's had a baby. I know lots of people have it far far worse. I am actually a medical doctor but not in this area.

I am looking for any advice, especially from anyone who has been in a similar position. Did things get worse for you after a second delivery and would you have changed your decison with hindsight? Thank you!

I don't know the answer but if I were you I'd speak to your GP. They can talk you through risks and likelihood of further damage, and explain the procedure for requesting an elective section and likelihood of actually getting it in your trust.

Maybe there is a specialist midwife they could refer you to Unfortunately stuff like this varies wildly by postcode so worth getting as much info as possible about procedures/policies in your area in advance.

It sounds like you've been through a really tough time. Good luck x

Your symptoms are not normal for everyone who has had a baby. I know, as I am in almost exactly the same position. Currently having physio. I'm also on medication for urge incontinence, which has helped soooo much with the frequency issue - I'm practically back to normal with that.

I've done a lot of research, and spoken at length to friends, family and my two physios. Some very minor stress incontinence is normal after birth but with correctly completed exercises should resolved in 6 - 12 months. That which doesn't or is not stress related is NOT normal. Fecal incontinence or urgency is also not normal and is a result of damage to the deep rear pelvic floor muscles and nerve damage.

Chances of a second instrumental delivery is 11%. Loss of sensation increases the risk of further damage as you don't know that you are doing damage. Panic about the risks increases the risk of an instrumental delivery!

Personally, the trauma of my first birth, both physically and mentally, will prevent me having another child however if I did miraculously (sex is all but impossible) find myself pregnant I'd be strongly arguing for a c section. Yes, recovery is difficult, but 18months on and I'm not recovered from my vaginal birth so I'm not convinced it can be much worse!

I would definitely be asking for a CS if I were you. I know each birth is different, but if you have slightly twisted pelvis for example, then you could struggle again to give birth without instrumental intervention. With your symptoms I wouldn't be risking it at all. (I had an EMCS first time and lots of intervention for a VBAC second time around. Wished I'd had an ELCS - my symptoms are not as bad as yours but I do have some damage.)

Thank you so much, it really helps to hear some other perspectives. Fan and cake, I'm so sorry to hear that you have damage too and thank you for sharing your experience and thoughts re future. It's hard when you're in a situation to get perspective on it I think. Cake I hope if another pregnancy does ever happen for you the birth can happen on your terms. I will do some investigating re ELCS here and will ask the mw or gp for a referral if i get to a second pregnancy. Thank you.

Hiya.
Urine and faecal urgency are not normal after birth (a forceps delivery is not a "normal" delivery). Stress incontinence is common but the symptoms you describe are beyond that.

Personally I would go for a c-section. The pregnancy itself is a risk factor (the urgency might get worse as your womb grows + relaxin loosens everything) but a c-section would limit the damage.

Thanks tchou