C section - issues with prolapse, bladder incontinence

[Teetotal2018]

Hi ladies,

I’m just tying to make the right decision for my body regarding wether to have a c section or a VB. I’m terrified of having to have cuts down below and the increased risk of prolapse, bladder weakness and frankly crappy sex after a VB. but just wondering if ladies that have had C sections have these issues anyway?

I know I might sound vain but it’s my body and I’m just trying to find the right thing to do for me. (Paying privately btw) I know that there is no nice way to give birth!

I had a straightforward, easy birth and most of my pelvic floor muscles were torn off the bone as my daughter crowned. I have a minor prolapse and am at very high risk for developing significant prolapse later in life. There is currently no surgery which can fix this. I will be having a section for my second.
The book ‘Choosing Caesarean’ is a really great, unbiased look at both options.

Whilst my vaginal birth was fine (induction for 3 days, waters broken and epidural) I would deffo in retrospect have c section due to tears, failed stitches, infections, prolapse, constipation. My recovery is ongoing at 7 months, much longer than straightforward c section.

It's v hard - straightforward VB much preferred over c section, straight forward c section over complicated VB.

My mum had prolapse and needed surgery so was always likely it would happen to me. Sadly she didn't make that clear. If your Mum and sisters if you have any delivered fine you would most likely be fine too.

3cs here. All for specific reasons not out of choice. I’ve got the pouch, but no issues at all with continence. Had a pile and a fissure, but related to pregnancy not childbirth. I think ideally I’d want to attempt a non-assisted VB, with A very low threshold for progression to a CS. It seems that there are many factors, that when they all come together, add up to a high likelihood of a straightforward VB. And the more of them that are missing the greater the likelihood of poorer long term outcomes.

I had an EMCS and have had no issues with bladder weakness or prolapse. Some of my friends who gave birth naturally still have issues.

C section recovery will take time and is painful, but the long term risks of c sections are small compared with the risks of urinary incontinence of vaginal birth. There was a recent study done which shows that the risks of incontinence from vaginal birth are much higher than the risks of future placenta issues from c section (although those risks can be more serious eg hysterectomy as mentioned by a PP)

The study itself is here: journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002494

^"Conclusions
When compared with vaginal delivery, caesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse, but this should be weighed against the association with increased risks for fertility, future pregnancy, and long-term childhood outcomes. This information could be valuable in counselling women on mode of delivery."^

An opinion piece on the paper is here which includes a useful graphic on the relative risks of vaginal birth vs c section:
www.skepticalob.com/2018/01/stop-mansplainin-womens-incontinence-and-sexual-dysfunction.html

Looking at the relative risks :
The principal finding of the paper is that the long term risks of vaginal birth (pelvic organ prolapse and urinary incontinence) dwarf the potentially deadly long term risks of C-section. For example, the risk of pelvic organ prolapse is 10,000% (yes 10,000%) higher than the risk of placenta accreta in a subsequent pregnancy

So neither are without risk, but there is no doubt that the risks of urinary incontinence are significantly higher with vaginal birth.

I would also say, I have 'the apron' following my vaginal birth, it's caused by adhesions under the skin that can occur as a result ofpregnancy, as well as a result of surgery.

And I was physically unable to have sex for months after birth, and it was very painful for about 12 months, now (2 years on) its ok, but certainly not as good as before - things have moved and I also have nerve damage and a loss of sensation.

The vagina is made to stretch and if you have a nice normal vb then chances are with some pelvic floor exercises you’ll be right as rain. I’m expecting my 3rd and apart from having to cross my legs when I sneeze during pregnancy and some piles then I have no issues. This fear of your lady bits not going back to normal women seem to have is getting out of hand, they’d rather put themselves through major surgery.

I had a Vb with DS1 with no tearing then an ELCS with DS2

ELCS every time

Steeley113 lucky you, good to hear you’ve had no issues x

Gave birth a year ago. Laboured 36hrs, baby got stuck so ended up with episiotomy and ventouse (and prepped for emergency section due to distress). Got some pretty spectacular piles pushing him out. They were gone by 10weeks pp. sex fine once bleeding had stopped (in fact, FAR better than before). Absolutely no continence issues. And a flat tummy. Lots and lots of kegels early on really helped I’m sure (midwife told me to start hours after birth. I thought she was mad but I’m glad I listened to her). A horrific vb doesn’t automatically mean your nether regions are destroyed.

Myheartisbeating Great to hear you had a positive experience. You’re certainly the first woman who has told me sex is better after childbirth - all the woman I know have said the complete opposite 😊

My worry is the increased risk of prolapse in later life because of VB. I’ve read it’s a 60% chance if you’ve had a VB. The long term effects of VB are often not talked about.

You’re at risk of prolapses just from carrying a baby. A minor prolapse won’t cause many issues, and they can be fixed if they happen. You’re body changes during pregnancy and birth, it’s something we all have to deal with.

Steeley113 I meant that prolapse often happens in later life because of VB when women are younger and there is a massive risk of it if you had a VB. it’s terrible that this isn’t something that women are told about. You may be okay now but who knows how this will affect your body later in life. I don’t know any women who have had a Caesarian who have had then had a prolapse

Steeley113 why should woman have to put up with this and deal with it? That is incredibly sexist and misogynistic. We should have a choice over our bodies and what goes in and out of our vaginas.

I think maternal age can play a part too, i.e. the older you are, the likelihood of adverse consequences (pretty sure I've read multiple studies to that effect). That said, I laboured for 75 hours with ds, had a 6'3 bloke try and yank him out of me with forceps and then an emcs aged 37 and so far, have no physical issues whatsoever from any of that.

I have had 4 pregnancies, 3 births. All births were by c section. I haven't had any bladder weakness or anything whatsoever in terms of physical effects. Not really much of an overhang either.

@teetotal2018 I fully agree it's sexist and misogynistic to dismiss women's legitimate concerns about adverse side effects of childbirth.

You should have full bodily autonomy to choose what is right for you and your baby ( within safe medical limits obvs). And in fact c section is safer for baby with majority of risks on the mother.

You only have to look at some of the suffering of women who have undergone vaginal mesh surgery to fix these very issues to know that you wouldn't want to trade places with them. I watched a documentary on it recently (panorama I think?) And it was awful. Dismissing women's fears with "oh this is all getting a bit out of hand" and "if it's bad just do some kegels or have suegery" is truly shocking.

If this is something you are concerned about (and I was too and now count myself "lucky" to have had to undergo an EMCS ) then you are right to find out the risks and make a decision with all the facts in hand. I for one will be choosing ELCS if/when I next give birth.

1stTimeRounder thank you so much for not dismissing my fears. Us woman should stick together and not perpetuate the misogynistic society that we have to deal with on a daily basis xx

I'm another who had no issues recovering from VB. No bladder issues, and despite a 2nd degree tear/stitches I felt back to normal within a week. Sex took a while to feel comfortable again, but two years on it's better than ever.

It's just unfortunate that there's no way to know how well your VB will go. I'd definitely choose VB again. For me, the fact that within hours I could get myself in and out of bed (where CS ladies on the ward needed help to do so, or even to lift their baby), deal comfortably with baby, drive again within days, were huge positives.

I know I've been lucky, but I'd still rather take the risk.

I was very pro VB but had a horrific experience. I have had surgery and ongoing continence issues. I am not able to have sex. I have been guaranteed a c-section next time. Except if course I’d need to have sex for that!

This is a really tough topic because we’re all coloured by our experiences. I’m surprised there aren’t more people advocating VB but perhaps that’s a sign of some of the unspoken consequences we are just expected to live with. A very sad and quite sobering thought.

I think a PP was right the issue is that you don’t know how your VB will go until you try it and they don’t tend to want to swap to a c section mid labour unless it’s critical and even then you’re more likely to be pushed into Ventose or forceps - I would genuinely assault anyone that ever came near me with forceps. Ever. Again.

@frostiesmum I'm so sorry about your experience. That must be very difficult to deal with, everyone should be able to expect to have their continence and their sex life intact post birth and currently it's simply not the case :( . I know a few friends and family who have had forceps and it genuinely sounds like an awful experience.

@teetotal2018 you should also have a look at this article in New Scientist... it links to further studies on risks of vaginal birth and how age is a factor too

www.newscientist.com/article/mg23130813-000-uk-doctors-may-starting-warning-women-of-childbirth-risks/