Is this fairly standard or pretty bad as far as birth experiences go?

[sagasleathertrousers]

So probably a bit odd but I'm pregnant with my second and after discussing my first birth with a midwife I've realised there was a lot going on. It was horrendous but at the time I was so out of it I think I thought it was a pretty 'normal' experience but the midwife's referred me to a consultant to discuss it so now I'm thinking maybe it was pretty bad?

Went as follows:

High blood pressure so induced
Five day induction process ending in forceps
strep B so IV antibiotics throughout
Vasovagel reaction to epidural
Third degree tear
Manual extraction of placenta
Blood transfusion 800ml after PPH.

I didn't ask for a c section this time but now I'm wondering whether maybe it would be wise to do so - or was I just super unlucky the first time?

I am a baby doctor and attend all instrumental births when on call. People often ask me if my job makes me more frightened of childbirth - especially as I do not routinely attend straightforward, low risk deliveries. But actually, I would say the things I have seen are more reassuring than the impression I would get from reading accounts of childbirth online. I often wish that mums having instrumentals were less fearful as most of the time, they're pretty okay.

I would say that definitely your experience sounds unusually complicated and horrible. Poor you!

Your midwife is right to book you in to talk it through with an obstetrician who can discuss how likely it is you may have similar problems in future. CS is not without risk, either but whatever you choose I would expect (just statistically) that things are likely to go better than during your first birth.

Mine was similar.

I'd consider it traumatic.

Second time round, I requested a csection. It seems standard practice in my trust to allow women who suffered 3rd degree (or maybe just 3b/3c tears) the opportunity to have a section. My consultant agreed to it with no problem at all. We had a really good chat about the pros and cons of both. I had a think, made my request and ingot my section with no issues.

FWIW recovering from the section was a breeze compared to the recovery from my first VB. An absolute doddle. I think it helps that you can be a bit more prepared and haven't laboured for days first.

@triangulator

Totally agree about the recovery. Wound was a bit uncomfortable at first but otherwise healing was uneventful. With my first, some stitches ruptured and had to be re-done. I also couldn't crap normally for about 8 months afterward!! 💩 Sorry if TMI there.

Wasn't absolutely wrung-out after several nights of labouring either. In at 09:00, baby born at 09:21!

I’m sorry you had a rough ride. I had a similar first labour but ended in cs. Recovery was really easy for me so I never tried for vbac. I got a cs second time with minimal argument (at your hospital). So it might be easier than you think if that’s what you choose.

Anything with forceps is difficult, only a small percentage of births involve this, let alone what else you had to go through.

I have had a section and vaginal birth - for me the section was the harder recovery, as I got an infection and couldn't pick much up for a couple of months - so agree with others that it's not a guaranteed easier option. However I think that in your circumstances anyone would understand why you are hesitant to go through labour again, and I understand that an elcs is usually much calmer and easier than an emcs.

I hope that you are able to discuss your wishes and get what you are comfortable with. If a section is off the table, the only comforting thing is that at least my sister was told that the only upside of an instrumental delivery is that you should be 'pre-stretched' for next time and not have to go through anything similar again. Good luck whichever way it goes!

Following my third degree tear I was offered the choice of CS for my second. The consultant talked me through the risks if I were to tear so badly again and it was a very intimidating list. I asked him what he would advise if it were his wife in my place and he said he’d recommend the c-section, so that’s what I did. I have no regrets. The worst part of tearing for me was leaving my tiny baby straight after birth for over an hour to get stitched up, with the CS at least I was with DH and new baby the entire time.

Yes it’s routine after a third degree tear to be referred. Consultant will want to ask about any ongoing problems and also ask how you feel about vaginal or lscs. You have about a 12-14% chance of another third degree tear.

Well national stats are 12-14%. Your personal stats will probably be lower because one of the biggest risk factors for a third degree tear is an instrumental. So if you avoid the instrumental you’ll probably not get another. If you’d have a third degree tear without an instrumental your risk would be higher.

Your first birth sounds like a whole cascade of intervention starting with the induction.

My first was also similar resulting in third degree tear . Was told after if I was to have another baby they would recommend a c section. Had a section with dc2 and have no regrets compared to the first time it was a breeze

@shrimpi I know you’re trying to help but I would strongly like to suggest that if you were on the receiving end of a traumatic instrumental delivery you would feel very, very differently.

My consultant - who I am still seeing 2 years later because of complications - explained to me that most medical professionals (not nec nursing) have a c section because, although a normal vaginal birth is the ideal, if that fails then the alternatives are significantly worse than a c section. That doesn’t necessarily mean major issues like mine but also more ‘mimor’ things like incontinence which it seems to be suggested should be accepted as normal. Again, I suggest you try it, then come back and tell us if your day to day living is unaffected by someone else’s decision about how you’re goung to deliver your baby after two days of no sleep and no explanation of the risks.

I appreciate that I sound cross about this, and bluntly, I am, so I apologise for the tone of my post but honestly, you only need to read a handful of posts on here to see the misery instrumental deliveries can cause, yet the consent process and conversations remain unchanged. To me, personally, that is utterly wrong.

I don't think it matters how traumatic it was on some average scale but how you have processed it and whether it was medically viewed as within the normal range of events.
DC1's labour & birth was, in retrospect, complicated. I was fine about all of this I thought until I was pregnant with DC2 when I began to get quite anxious. I mentioned this to my MW who booked me in for a session with the "birth reflections counsellor", a service provided by the hospital but which I had never heard of. Due to my notes going missing, the counsellor being on holiday etc I ended up having it over the phone at 41+2 but luckily DC2 wasn't born until 41+4.
It was really helpful. First, it was interesting to learn what actually had happened - I had been oblivious to or forgotten loads of it. Secondly, it was talked about in such a matter of fact, procedural way that it made me realise that, whilst it had seemed chaotic to me, they had known what they were doing. Yes, there were umpteen people in the room but that is what will happen when the emergency bell is pressed and everyone floods in and they sort out the most appropriate people to deal with it. It also gave me a chance to discuss the cascade of intervention and know the terms to raise if things seemed to be going down that route with DC2 so that a c-section might be raised at an earlier stage.
As it was, DC2 was born about 95 minutes after I first considered I might be in labour and 29 minutes after we got to the hospital. Two pushes and that was it not that it stopped me screaming or vomiting. His head circumference was 4cm smaller than DC1's (whose had been off the charts) which might have had something to do with it. I still stroke his head fondly now and it's 6yrs later!
I did tear with DC2 but walked to the shower within an hour of being stitched up, had a shower by myself, was offered the chance of going home there & then but chose to stay in overnight as I was suddenly going "aaahhh, what do I do with a baby" and walked a mile and back to collect DC1 from Nursery when he was about 20 hours old. It was so utterly different it was unbelievable.

It’s not traumatic because you didn’t find it traumatic. Other might have, but you didn’t.
Most births are different, so it’s only ever a rough guide,

Personally I Think pushing a human out of a small hole, or having major surgery always risks becoming traumatic to an individual.

@MisstoMrs

I'm sorry. I did not intend to downplay or deny anyone's experience of any kind of traumatic birth. Only that, because people (rightly) discuss these experiences online, and are perhaps less likely to need to discuss/process less negative experiences online, you get a worse impression.

My mother had a forceps delivery which she found incredibly traumatic and awful. She didn't haemorrhage, tear or suffer incontinence. I think it was so awful because she didn't understand what was happening or feel like she had a choice, and wasn't treated with dignity. Would having had a caesarian section fix that?

It's not so much on mumsnet but there are groups online who are massively against all CS because of their traumatic experiences (I think communication, information and choice remains at the heart of it).

And undoubtedly someone like me will come along to counter anti-intervention by saying something horrifying about natural delivery!

What does this leave for us women trying to contemplate our options? Terror? Latching onto one approach as a saviour, so we are less afraid?

I personally think there is a bit of latching onto CS on mumsnet. Not that it can't be the best option for many. I just also happen to have seen deliveries where an instrumental has taken place, and really turned out to be the best option in those circumstances too.

I'm being a bit incoherent here. I guess my point is that I wish women had more information that permitted them to make flexible choices, guided by an obstetrician or midwife if needed, and overall, with less fear. And better outcomes! Hmm, what a wishlist!

Personally, I agree that there needs to be a much more rigorous process of counselling and discussion re different options antenatally. In some ways, it's great that the internet facilitates discussion, but it isn't enough and has some major downsides.

I think there is sometimes an unfair implication made that obstetricians don't care. Those I have met care a great deal (though I do work in a really lovely place). The system is not set up to help them share decision making with women.

As a side note, I would not assume that the reason doctors have a higher rate of CS is because they are better informed or CS is better. Doctors are really weird when it comes to viewing themselves in the role of the patient (basically they don't want to do it, are unable to relinquish the doctor role). They are notoriously poor at looking at their own health (especially mental health) objectively. They don't view procedures and medicalised environments in the same way as the rest of the public. (In saying all this I'm probably undermining myself massively haha).

Thanks for replying @shrimpi.

I have to be honest that I struggled to follow your reply a bit but I think I got the gist.

I don’t disagree that a c section may not have made any difference to your mum; but for those with long standing consequences of bungled deliveries or deliveries gone wrong a lack of communication is not the only issue.

I completely agree that there needs to be more honest dialogue and that would need to be well managed antenatally to avoid fear. However, I do think there is a tendency in midwifery to stop treating women as intelligent, independent people capable of making choices. It is too often the case, in my experience, and those of friends / colleagues and others, that they are confronted with The Plan as to what will happen next, with no discussion of options, risks etc. Any challenge is met with a ‘what’s best for baby’ comment which will immobilise any woman, in labour, or otherwise.

It is interesting that you say the system doesn’t encourage treating women as partners in their own care. Giving birth is an enormous event in any women’s life but we don’t assist women in doing so by infantalising them through the process. The result is women who often have long lasting mental health issues - related to lack of control or failing their baby - as well as perhaps some physical issues. If medical professionals are not looking to change that system I do not know what hope those on the receiving end (myself included) can have.

I do agree that there can be a tendency to see an opposing birth route as the salvation of your own was poor; I also think that in some cases the potential risks of major abdo surgery are played down. However, I think the profession would do well to ask themselves why that is.

Again, I do really appreciate you taking the time to reply and I’m sorry if my response to your post is firm, particularly as you have made a number of interesting and valid points, but I think this issue needs significantly more debate to try and bring it into the open and onto people’s agendas. The suffering inflicted by blind adherence to natural is best / stick with the cheapest option (I work in the NHS, I know this is a big factor) must stop. What that does to the number of c sections, inductions or natural births frankly I have no interest, provided everyone gets appropriate, agreed, care.

Personally, though, I think forceps belong in the dark ages and should stay here. I have never heard a positive story involving them, although clinically I am sure they would be considered a ‘success’.

If you felt traumatised by the birth, then it was traumatic - as others have said there's no point comparing to others as there will always be worse and that way madness lies. It took a long time for me to accept that my birth was upsetting me, because on paper it was relatively fine (undiagnosed breech so emcs but pretty relaxed and a great recovery). It was the sleep deprivation after 3 days of labour that caused me problems - I'm constantly surprised that there is no research into this linked with trauma. It made the first few weeks so hard. Anyway the reason for my post was - I'm expecting my second, was offered a c section because of already having had one, consultant was very clear it was totally my choice and was supportive when I explained my reasons - primarily that 25% chance of a vbac ending in emcs was for me personally too high. I didn't have to fight.

So I'd say do your research, ask lots of questions, and you don't have to decide until 36 weeks. But once you have decided, make clear your reasons and they should be accepted.

They have said that if I go into labour early I can still choose, you're not rushed off to surgery regardless. So, there are options all the way to let you control the process (which doesn't sound the case for your first birth). Good luck!

I personally think there is a bit of latching onto CS on mumsnet.
I agree with this shrimpi. After my elcs the attitude of an elcs being the answer to any traumatic birth made my reaction to my elcs even more incongruous. I felt like a woman sawn in 2 and absolutely wrecked, and seeing it put forward as the golden answer if previous births had been traumatic made me feel like I had really fucked up somewhere.

Disclaimer: I know they can be great (as can vaginal births) and necessary!

Your birth does sound like it was hard. I was a bit traumatised by mine and yours sounded worse. A day on the induction ward was painful enough for me let alone multiple days. I had a bit of a freak out when the dr produced forceps during my delivery. I had seen them in my Nct class but they seemed massive and scary and in my head I had decided I was going to have a lovely waterbirth. The instruments represented everything I didn’t want and I felt a lack of control.

I’m pregnant again too and had a good birth de-brief with my notes. It was reassuring to see that things seemed much more controlled than I had remembered. I also hadn’t realised they were concerned about fetal heart rate on multiple occasions. I was oblivious to that. They tried to help me get the birth I wanted but ultimately needed to intervene. The debriefing midwife said the chances are the second birth would be more straight forward.