Natural birth with vulvodynia?

[bluemoon2468]

Has anyone out there managed to achieve a natural, vaginal birth without epidural if you have vulvodynia?

After 10 years of misdiagnosis and failure by many medical professionals, I was finally correctly diagnosed with vulvodynia in my mid-20s. I started taking amitriptyline which left me completely pain-free which was such a breakthrough, but I had to stop taking it as soon as I fell pregnant (first baby) as it could be harmful to the baby. Since then my pain has returned and I am no longer able to have sex or tolerate any penetration.

I was really hoping for a natural delivery regardless, but the obstetricians seem dead set against this. I've been told today that I have to deliver on the labour ward (rather than the midwife led unit as I was hoping). They have given me two recommendations - elective c-section or immediate epidural so that they are easily able to examine me routinely. I could cry, my dreams of a natural delivery using hypnobirthing are completely out of the window. I was really hoping that I could either opt out of routine examinations or that there would be some other solution, such as using a local anaesthetic gel or injection to numb the immediate area if an examination is essential. I feel like most of all they're pushing me into an elective c-section, which is the exact opposite of what I want. There doesn't seem to be a particularly good medical reason for this 😕

If there is anyone else on here who has vulvodynia, I would love to hear your experiences of previous deliveries/plans for your upcoming birth!

hi, my diagnosis was vaginismus rather than vulvodynia (& it's improved to an extent in recent years) but maybe my experience is useful?

I just had my first baby 6 days ago, I had a vaginal birth and spent most of the time in the birth pool in the midwife led unit. Had to transfer up to labour ward right at the end, after a long second stage, as the baby was a bit distressed, so the doctor could help him out with forceps. I just had a local anaesthetic for the episiotomy/stitching and a lot of gas & air, no epidural, there wouldn't have been time to do one. Nobody offered me an epi at any point and it didn't even cross my mind to ask, I was knackered & in pain (obviously) but coping with the g&a, and just wanted to do anything I could to help get the baby out quickly.

When I was pregnant I was really worried the vaginismus would impair my ability to give birth so I had one session with a womens health physiotherapist. She was really encouraging & recommended hypnobirthing & water birth. She said that she's supported many women with pelvic pain conditions before & after childbirth; & that it's completely possible to have a vaginal birth.

The midwives, obstetrician & the birth centre manager at my hospital were supportive of me having a natural birth,they all said water birth is great for women with vaginismus as it's easier for the pelvic floor muscles to relax and then push effectively in the pool.

It's concerning that your doctors seem to be pushing you towards epidural or c section just so that they can examine you more easily. Vaginal examinations are only "routine" in the sense that they are routinely OFFERED to you, no one can do an exam on you without your consent and it seems bizarre to me that they're encouraging an epidural just so they can check your cervix more easily or more frequently. I don't see why it's necessary. During labour I only had one vaginal exam, because the midwife wanted to check that I was definitely fully dilated after I'd already been pushing for a while. I point blank refused to get out of the pool and lie on the bed for it so she had to stretch her arm into the water and check me right there, lol. It took a few seconds and I honestly barely even felt it.

Would you be able to get a second opinion, eg from a physio or a vulvodynia specialist? Or get an appointment with the consultant midwife/whoever runs the MLU? Having another medical professional backing you up tends to be the most effective way to argue with doctors in my experience. Good luck

They have given me two recommendations - elective c-section or immediate epidural so that they are easily able to examine me routinely. I could cry, my dreams of a natural delivery using hypnobirthing are completely out of the window.

I can’t help with your specific query, but please remember that birth plans often (maybe even usually) go out of the window for her a whole variety of reasons.

The key object of the exercise is (obviously) to get baby out with you both safe and well, and when you look back that will far and away the most important thing.

If you opt for the early epidural
option that will massively help your ability to go through the whole thing calmly and without pain and will maybe make easier to stick to other aspects of your birth plan (things like music and partner’s specific involvement). Consider that option seriously. Good luck

@goodnightsugarpop thank you so much for sharing your story! This gives me so much hope of being able to have a vaginal birth! Unfortunately they have categorised me as high risk now (due to the vulvodynia alone) and therefore I am seeing obstetricians rather than midwives for my appointments - again this seems over the top to me as they've agreed it will have absolutely no bearing on my pregnancy or baby's development, only on the birth. However I am going to inform myself as much as possible and go to my next appointment armed with evidence and alternative suggestions. I just want more than anything to be allowed to labour in the MLU rather than on the labour ward. I would love to use the birth pool, although unfortunately it's unlikely to be as helpful for vulvodynia as for vaginismus as my pain is unrelated to muscle tension, it's purely nerve pain 🙁 Could be soothing though.

@ArriettyJones thanks for your reply. I know that births often don't go to plan and I'd be more than happy to go down the immediate epidural/caesarean route if my baby was at risk, however it does seem quite an extreme solution to not being able to tolerate internal examinations. Other than this I would definitely be considered a low risk pregnancy.

Watching with interest.

I have vaginismus and did hypnobithing for general childbirth fear and was so up for my natural birth. Due to complicatuons I had to go to labour ward in hospital. I stupidly hadn't mentioned anything about vaginismus and examinations were awful. I wish wish wish I'd pushed back on them. Ended up having a c section. It was emergency technically but not rushed and was wonderful and much wanted by the time I had it. The examinations ruined a lot of labour for me and I don't think I would have got to c section if we hadnt gone through them. I had gas and air for examinations btw, but wish the midwives and doctors had all been pre-warned.

The fact you're already discussing it is ideal!

@goodnightsugarpop did you feel any of the episiotomy and how was your recovery?

I don't have the condition but I can't help but feel they are giving you this advice because they genuinely believe it's what's best for you.
They don't offer our planned sections lightly and although you can refuse to be examined there's a risk things may be missed.
I know it's not your preference but if they think that a planned section is the safest route for you both then I'd be inclined to listen to them:

@strawberry2017 I think what I need to discuss at my next appointment is any potential safety implications that they may be worried about. Today the obstetrician kept coming back to my comfort level and pain threshold, and when I tried to ask several times about safety comparisons between vaginal and caesarean births the closest thing to an answer I got was, "you might want to consider whether a tear is going to improve or worsen your pain afterwards" (from what I've researched it likely makes no difference). If there is a safety implication I'd really like a doctor to be able to explain this to me before considering a planned c-section.

I'm sorry I don't know anything about your condition but I do know that what ever your condition you can absolutely opt out of routine examinations during labour or before.
Have you read The Positive Birth Book? Or actually I am sure your hypnobirthing books will have told you how you are completely within your right to decline any medical contact you like for whatever reason. Good luck

@Wanderer1 I do know that (now, after doing hypnobirthing!), thank you 😊 I was planning to refuse all routine exams anyway due to my condition - mentioning this to the obstetrician made them very unhappy and all of a sudden concerned about me being in the MLU. I do however want to find a way to be examined if there is a medical need, I just feel that an epidural upon admission to hospital is unlikely to be the only solution to this problem.

Update: thankfully they have now agreed for me to be seen by midwives for my routine antenatal appointments as there is no reason for my pregnancy to be considered high risk at the moment. I've been booked in for an appt at 33 weeks with an obstetrician to discuss birth choices and make a birth plan. I need to go in armed and informed up to my eyeballs 💪🏻

Not particularly on-topic, but I was wondering what, if any, treatments any of you have had for either vulvodynia or vaginismus? Preferably anything that doesn't involve dilators?!

I found nothing that helped until I started taking a daily dose of amitryptiline (I settled on a dose of 100mg). Thankfully I saw an amazing GP who knew exactly what my problem was and prescribed it immediately. It honestly changed my life. I was completely pain free and could have a completely normal sex life. I have pure vulvodynia though with no vaginismus (something I only realised after the amitryptiline worked, after years of being misdiagnosed as having vaginismus). If you have this sort of pain I honestly could not recommend trying this treatment highly enough.

@blueskys72 *

Hi OP,
I had vulvodynia but saw an excellent gynaecologist who helped me to sort it - I took nortriptyline and used local anaesthetic gel, also saw a women's health physio regularly and did the exercises she gave me.
Even though I had stopped seeing her, I was able to have an appt with the gynae when I got pregnant and she advised me on birth options.
Everyone is different but I was able to have a vaginal birth, I did have an episiotomy which I was terrified of but it healed fine and once I had recovered from the birth I was able to have sex without pain (and eventually conceive DC2!)
In my opinion, the body mostly just does what it has to do during pregnancy and childbirth - because of all the hormones and the huge physiological changes to your body, the nerves and muscles in your vulva and vagina will behave very differently to how they usually would. You might find that you are physically able to give birth and even tolerate examinations - although you might not be mentally and emotionally comfortable with examinations (for years I would tense up whenever anyone approached the area, whether it was DH or a medical professional. It is a totally normal and natural learned response caused by the pain you have experienced).
You absolutely do not have to consent to vaginal examinations during childbirth so whatever you decide to do please remember that.

PS For OP and anyone else with similar issues, the Vulval Pain Society is an excellent source of advice.

I agree with sugarpop about requesting an appt with the consultant midwife. I don't like the sound of the way the obstetricians have been dictating to you so far

"my pain is unrelated to muscle tension, it's purely nerve pain"
Nerve pain results in muscle tension, you naturally tense up when in pain. My vulvodynia was caused by nerve pain but I had a huge amount of muscle tension and the women's health physio helped me to work on relaxing my muscles as well as desensitising the nerves. They are linked. Google "myofascial trigger points".

Also Helloitsme sorry you had such a negative experience, I think that is a helpful reminder to the OP to make sure you make it clear on your birth plan that you have vulvodynia and do not consent to vaginal examinations - if you need one there has to be a very good medical reason and it has to be explained and discussed with you beforehand to ensure you have consented and they make it as comfortable as possible for you.

Have the recommendations been made purely on the ease of access for vaginal examinations? Sorry that seems quite the question to lead with when I don’t know you, but if it is so, a vaginal examination is NOT a necessary part of having a baby. You do not have to have them. I can understand a want to feel like you are doing everything you can if there is a safety consideration but there are other options. I mention this as someone who has had five pregnancies and no vaginal examinations to date. Does your women’s health physio have any relationship with an independent midwife? It is worthy knowing that you do not have to engage the services of independent midwives for birth in order to use them, they can speak with you about all aspects of pregnancy and birth to offer antenatal, postnatal care or Appointments in many cases, I think you might benefit from speaking in person with someone knowledgeable.

@bluemoon2468 thank you for your reply.

Can I also ask anyone if your DPs/DHs have always been understanding of your condition and associated pain?

Thanks so much everyone. I feel so empowered to go into my next appointment with a clear idea of what I want and to push for it! I would love a natural, unmedicated birth as my Plan A and that doesn't seem unreasonable or medically unjustified.

@NameChange30 I only say no muscle tension because as soon as I started taking amitryptiline my pain went away entirely and I was able to have a completely normal sex life/insert tampons with ease etc. There is potentially some tension but I'm not aware of it 🙂

@ChanklyBore yes it seems to just be because they don't want any trouble examining me. I'm not happy about this and will be letting them know that regardless of how my birth goes I'll be refusing routine exams because there is no medical benefit anyway.

@blueskys72 I have been with my DH for 11 years and I'm so, so lucky to say that he has been very understanding and supportive throughout 💕

Well we are all different so perhaps you managed not to tense up despite the pain. Amazing that the amitriptyline worked so well for you!

@NameChange30 I know, I feel very lucky. Well I could have been luckier and born without a painful condition, but within the realms of vulvodynia my treatment was very straightforward once I was correctly diagnosed.

It is the long path to diagnosis and successful treatment that's such a big issue

@NameChange30 yep, I saw so many medical professionals in my teens and early 20s who made me feel awful and told me it was all in my head. One doctor gave me a very painful and distressing internal exam and then told me I had a low pain threshold and I just needed to "have more sex" because it's painful for everyone losing their virginity (2 years after I'd first started having sex). Another doctor told me that it was likely I'd been sexually assaulted or abused as a child and I couldn't remember it - I was referred for counselling where I sat for 6 months and desperately tried to remember abuse that hadn't happened. When I was finally correctly diagnosed and told my story to the gynaecologist she said it was a terrible story but unfortunately very, very common for women with vulvodynia.

I don’t have your condition but it’s is absolutely no one else’s decision as to how you birth your baby. If you want to try, do it! As for cervical checks, I had my baby 4 weeks ago and had a home VBAC technically due to previous section I wasn’t classed as a home birth candidate but it still didn’t change the fact that I had a choice. I met with the consultant midwife and had an individualised care plan put in place and it went amazingly. I also refused internal checks much to their dismay but they are not needed. My midwife knew exactly were I was in my labour by watching for other signs. Stick to your guns x

Hi blue moon, I’m hoping you still have access to this chat and can see my message. I’m pregnant and also have vulvodynia and am nervous about the birth. I have been considering an elective caesarean because I’m scared that a vaginal birth will make my pain worse. I’m just wondering how your birth went? Whether you had a vaginal birth or a caesarean in the end 😊

Just to give a slightly different view here, I only developed vulvodynia after having an extremely painful vaginal birth with no pain relief (long story). So my story is a bit different but I think perhaps don't dismiss the possibility that a vaginal birth could make your pain worse. I also developed PTSD after the experience.

For my second DD they gave me an epidural as soon as labour started but I ended up with an EMCS in the end.

Personally, after my experiences I would opt for an ELCS.

However, I do feel that the doctors should be listening to you and give you medical reasons why they want to go down a certain route. Make sure you stand up for yourself and ask lots of questions as to WHY they want you to do this. I hope it goes well for you.

Thank you for your reply Kingroo. This information really helps me in my decision. I have been seeing a gynaecologist for a few years now and she has written to my obstetrician requesting an elective caesarean for me. I feel this is the best choice for me. So am hoping they agree to this. I am currently 16 weeks and my midwife has informed me I can speak to the obstetrician at 28 weeks regarding this.