C sections vs natural birth - with pelvic floor issues

[Willow4987]

I’m just after some advice/real life experiences of c section vs natural birth when you’ve got exciting pelvic floor issues from a difficult, forceps first birth.

I’ve been left with fecal urgency issues which I’m now terrified are going to get worse with this pregnancy/birth

I’ve booked to see a private physio to try and help but wondering which birth option is best for me

Midwife said to speak to the consultant about it but can’t do that until 28 weeks and I’m just getting really anxious and thinking about it all of the time so I’m hoping someone will be along with their stories or advice so it gives me other ways of looking at it etc

Hi,
I'm in a similar-ish situation...
First birth was forceps/ 3a tear - I had consultant app at 20 weeks (in second/ current pregnancy) and they were very forthcoming with suggesting c-section, as I'd had some issues with bowel incontinence.
However, as I had only experienced this when out running, and it stopped after about 7 month post-child birth, I decided I still wanted to try for a vaginal delivery for this pregnancy.
The general advice is if you've had an ongoing bowel or bladder incontinence issue go for the c-section - roughly the chances are about 10% that you'll experience it again, and of those women 10% will have long lasting issues. For the nhs (and for me!) that is high enough to choose section delivery that removes that risk.
For me, it was only because it was directly connected with running that I was willing to overlook it.

Even so, fast forward 18 weeks I am now 38+3 and have a breech baby!! So after all that unless this little one shifts head down over the weekend looks like I will be having a section next week.

I am terrified at the prospect of section, but am measuring at the 110th centile from growth scan and have a head up baby so have to follow medical advice and accept it looks like I might need a section!!

Good luck, as I said be honest with your problems if they are on-going (bladder or bowel) discuss your options...physio is amazing I've heard, I am convinced daily pelvic floor exercising after ds1 preventing me having any bladder incontinence, however I never did exercises for the anal pelvic floor and had never had it explained that it had been damaged by the forceps.

No one wants a life of Tena pads, or anal leaking (which was my problem!) so don't be a martyr and make sure you make any issues known to midwife and consultant.

My consultant told me a planned c-section is always better if you have existing pelvic issues.

I had a very difficult first birth resulting in forceps and a 3b tear. I had a pro-longed second stage too due to a not great midwife which can damage the pelvic floor. I've been lucky that any issues I had cleared up quickly after birth but I found the tear and idea of faecal incontinence extremely traumatic and upsetting.
I've opted for a c-section this time round with good support from my hospital. I have read that pelvic floor can become weaker post-menopause too so the fact that I don't have issues now doesn't mean I won't face them later in life.
Given my previous birth experience I would also find it quite difficult psychologically to deal with an emergency c-section so this was a further rationale behind my choice.
There is internal scanning that can be done to see how the muscles are below which night help you make a decision?

Following this thread as I also had pelvic floor issues after a 3rd degree tear, episiotomy and forceps birth for DD1.

I'm only in first trimester but am considering my options already. Good to know they can be supportive with elective caesareans but I guess it depends on which hospital and consultant you get assigned.

Thanks everyone! I just don’t know what to do for the best and worried if I don’t go into the meeting with a clear plan they will persuade me to go vaginal when I might regret it

I was adamant I wanted a c section with the next but this is a surprise post IVF baby and my DS will only be 18ms so I’m not sure how I will cope with 2 so small after a c section

Hi OP, it's not uncommon for women who would like a "maternal request" (in your case, I'm not sure it falls in that category) CS to be left hanging until the last minute before the planned CS is approved. Don't be fobbed off. If you feel a planned CS is better for you (in your situation, personally I'd say it is), listen to what they say but ultimately the decision is yours and yours only. If first consultant refuses, they have to refer you to another consultant who will support your choice. Good luck!

Definitely echo what Flyingfox 2 said. If you have any leaking or suffered a previous third degree tear the RCOG guidelines recommend that you are informed you have a higher risk of tearing (although this is admittedly low, 5-10 per cent I think) and are counselled on birth options incl a c-section.

I recovered a lot faster from a c section than I did from forceps. I had forceps and episiotomy for my first and elective c section for my second. I would do it again in a heartbeat!
The consultant didnt book it until quite late on (36 weeks in my case!) But they just need to hear why you want it and that you understand the risks.

Ps I had a 16 month old at the time of my second birth

This is the info, it's a few years old but complete up to date as far as I'm aware, I bought it into my consultant appointment ready for a struggle but he said he was totally fine with signing me off for the section. Not looking forward to the recovery but it wasn't exactly a walk in the park after my third degree anyway.
www.rcog.org.uk/en/patients/patient-leaflets/third--or-fourth-degree-tear-during-childbirth?source=gtg29

@mintich how did you find having such a young first one after a c section? I’m just concerned about him feeling even more unsettled as I won’t be able to pick him up etc

@IrishMamaMia and @mintich thank you for sharing your experiences. I am leaning towards c section too due to the risk of permanent life changing damage. DD1 will be 3.5 by the time I'm due so I'm so worried about having to stay longer after and elective. How many nights did you have to stay before being discharged?

I was discharged 24 hours after the section so stayed in 1 night. I felt back to normal after 2 weeks. My husband had those 2 weeks off so I didn't lift my daughter at all during that time. I was picking her up but trying to lift her like you would lift a box ha! Using my thighs to lift rather than bending over.

Thanks @mintich - that's good to know thanks! I would dread a 3 night stay in a post-natal ward esp with DD1 waiting at home!

Why can't you see the consultant until so late in the pregnancy? Is it just the midwife saying that? I am seeing one at 15 weeks to discuss a c section. Had a ventouse delivery last time, it was done against my wishes and without my consent, so I will not consent to a vaginal birth again. I dont have pelvic floor issues but did get severe ptsd from the incident which took a very long time and a lot of psychotherapy appointments to (mostly) recover from.

@chikitiki it’s because I’ve already got an appointment booked to see them at 28 weeks and my midwife said to wait until then

Tbh I wasn’t that reassured by the midwife

@mintich how did you find explaining to your first they couldn’t jump all over you etc?

I just don’t know how I’m going to make this decisions. Every professional I ask basically tells me to google c section risks vs natural birth but it’s so overwhelming and I can’t find anything specific to my case - just quite general facts and figures

If I saw her coming towards me I kept telling her "Be careful, mummy has a sore tummy" she got used to it, so it was fine.

@chikitiki I had the first consultant appointment at 16 weeks but no decision was made until an appointment at 36 weeks. They basically asked why at the first appointment then went through the risks. Then I was left to think about it until my appointment at 36 weeks where I had to say I understood all the risks, had read about it etc and my c section was then booked.
They didnt ever say no, I think I they just like to know that you have researched it etc.
Although your hospital may be different and book it earlier.

Thanks @mintich for sharing your experience. I plan to go to the meeting with print outs of all my research and showing I fully understand and accept the risks. Along with a summary of my first birth, info on the NMC and GMC referrals and complaints process. I will also be writing what I will and will not consent to in my green book. I hope and pray they agree early on to a c section without leaving me in limbo for months unnecessarily.

@chikitiki hopefully all will be ok! I went in ready to be all guns blazing but they were actually really nice.

Thanks @mintich

@Willow4987 Have you tried the Birth Tear Support group on Facebook? Lots of women have gone through the same decision process you're going through.
Otherwise the appendix to NICE guidelines on caesarean section (www.nice.org.uk/guidance/cg132/chapter/1-Guidance) gives risks of planned CS v vaginal delivery for women who have not had any CS before and whose pregnancy is low risk.
This is the appendix
www.nice.org.uk/guidance/cg132/chapter/appendix-planned-cs-compared-with-planned-vaginal-birth#appendix-planned-cs-compared-with-planned-vaginal-birth
Hope it helps.

Thanks for the links and lasvic @Flyingfox2. I’ll take a look at all of that