C-Section or Vaginal Delivery with bowel incontinence

[CreedBratton]

Hi, hoping to get some advice and views from anyone who's been through similar. I'm 32 weeks with baby 2. I've suffered from bowel incontinence ever since the delivery of my first child (some bowel leakage and inability to control gas). I met with the consultant earlier on in my pregnancy and they advised it's up to me ultimately but it's probably best to go for an elective c-section to minimise the risk of a potential tear again which could cause further damage. I'm meeting with them again at 36 weeks to discuss my decision but I'm not sure what to do.
My first birth was amazing and very smooth (just the unfortunate after effects) and I didn't find recovery too bad. I'm concerned about having the major surgery of a c-section and the recovery whilst looking after a newborn and a toddler.
Has anyone had similar issues, how did you deliver in subsequent pregnancies and are you happy with your choice?

If my consultant advised against a natural delivery for the reasons you’ve outlined I wouldn’t go against it. I wouldn’t risk worsening what is already a difficult thing to deal with

I went through a similar experience with my last (second birth). I had been told I’d had a second degree tear with my first but I had two bouts of bowel incontinence in the subsequent 3 years and after seeing a specialist perineal care midwife she said it had probably been a third degree tear.
She examined me and gave me some tips to birth naturally but warned it was almost certain I would tear again.

I booked in for a caesarean but even after hypnotherapy was too scared to go ahead with it.

I decided to go for a vaginal birth.
This was the advice she gave me which I put on my birth plan.

Second Stage:
It is a priority for me to minimize perineal trauma.
I would like to deliver on my left lateral.
I would like a warm compress on my perineum during second stage.
I would like a “hands on” delivery of the head and shoulders by an experienced midwife.
I would like to pant out the head.
I would like to use spontaneous pushing.
If an episiotomy is required, please adopt a wider angle >60 degrees.
I would like a SLOW delivery.

The birth went really well. I laboured in water and delivered on land (apparently water is worse for tearing). I had someone hold my right leg up and the midwife kept a compress on my perineum. The slow delivery was more intense than the speedy standing delivery I had with my first (which caused the tear!).

I had a second degree tear but this healed quickly and caused me no further problems.
I haven’t had any incontinence since.

It’s a really tough decision. It sounds as though your incontinence issues are maybe a bit worse than mine were. The problem is that the doctors can’t promise you anything with a vaginal birth, whereas they can control the c-section for you.

Best of luck, it’s not an easy but I’m sure you’ll make the right decision for you.

I think if it was 100% certain things would be made worse then I'd definitely go for the c-section but it isn't and a c-section doesn't cone without risks either. Plus the recovery and just surgery in general scares me

That's amazing you had a much smoother labour and no incontinence since @Awaitingnumber3
I had quite a fast delivery too which I'm sure didn't help matters! I'll have to discuss those precautions with my midwife and see if she thinks it's something we could realistically do

Similar position to you except I suffered bladder prolapse following my second birth. I had 2nd degree tear and episiotomy after first, second was 3rd degree and was advised not to have vaginal birth again.
My prolapse improved massively over time, with exercise and loosing weight, I don't suffer from it anymore.
I am now pregnant with my third and will have c-section.
The risk is just too big to take imo.
I don't want to have potential complications for life. The thing is you don't know what will happen and how will the vaginal birth go. I know recovery from c-section will be long and painful plus with two kids already here and third baby. But I rather not risk any more damage to what has been done previously plus I would not go against the medical advise. C-section will be the safest option.

Hello. Congrats on baby number two! Also sorry to hear about your physical issues since your first birth.
I had severe tearing and urge incontinence after my first, It turns out I had a 3 degree tear but they didn’t realise and by the time I had the scan to show this my baby was 5 months and it was too late to repair. I was distraught and thought I would be incontinent for life. I also suffered prolapse.
When I became pregnant again I was advised to have a c section but also was told the choice was mine if I very much wanted to go natural. So I did lots of research and just felt that I would never forgive myself if I tore again and was left worse off. Fair enough with first birth I was naive and didn’t know the risks (still blamed myself for it all that time too!) but knowing what I knew about the realities of bowel incontinence (it did improve massively by the way and i don’t suffer at all now 5 years later ) I just couldn’t risk it. I had a wonderful planned section with no issues whatsoever. Within 2 weeks it was like I had never even had surgery and I would 100% have another section. I had a wobble the day before but just kept reminding myself that it was best for me and it really was!
Glad to see some positive Natural birth stories here too!!

I would follow doctor's advice and have a c section. If it was me, I wouldn't want to take the risk with a VB in case it worsened the incontinence, I would never forgive myself. Even with detailed notes in your birth plan regarding how to take more precaution, you're at midwife's mercy nonetheless on the day... the team might be rushed, tired etc and not everything might be adhered to unfortunately. This is out of your control.

I'm currently recovering from birth number 2. It was my 2nd c section and like with any birth, as long as it goes well, a c section really isn't as bad as we may think. I would say the first 4 days you really can't and shouldn't do much. Yes it's painful but the painkillers really, really help. You'd need a strong support network around you, either a partner or relative off work to help with cooking, cleaning, general house bits, looking after toddler, passing the baby for feeding etc but as long as you have that, the recovery can be quite nice as you can just sit, cuddle, rest and feed for the first handful of days. Around day 5 I find mobility returns and you can do a bit more but still take it easy. The op itself is major surgery - yes, but you would be well looked after by a competent team. Think about the long term and the potential set back if a VB made things worse, it's not just about the delivery on the day, it's also about protecting your womanhood and personal well-being for the future.

Also, to add in case you're wondering - the c section scar is cut within your pubic hair line so you can barely see it! I looked in the wardrobe mirror and couldn't find it until I got close up with a pocket mirror... it's amazing how discrete they are.

The c section was definitely the right choice for me. Hope this helps, best of luck with everything!

I had to have an emergency c on Weds morning last week OP. I won’t lie that it’s been easy because it’s been sore and I’ve been quite laid up. I’m doing so much better now though and wondering if I’d even attempt a vaginal birth if I was going to have another baby. I would say you need a really good support network and as a PP says, the painkillers make the world of difference.

Thank you for all of the replies, some very good points and experiences and sounds like the majority think a c-section is the way to go. I am starting to sway more towards this now and DH also thinks it's the sensible option.

Hi OP, I’m in a similar-ish position. Pregnant for the second time after a third degree tear that didn’t heal properly and required further surgery 3 months after birth. I haven’t had any incontinence issues, but I saw the specialist perineal care midwife yesterday and she really urged me to consider a c-section. She talked about the risks associated with tearing again which were quite scary.

In many ways I don’t really want a c section as like you my first birth was fairly straightforward and I have an insane toddler around the place. But I have to weigh up the tough recovery from a caesarean against the worst case outcome of a vaginal birth. Which is far from a guarantee but it is a real possibility.

I also discussed the possibility of a vaginal birth (because obviously I could still have one even if I book in for a section) with the specialist midwife and she made all the same points that @Awaitingnumber3 has made - no water birth, hands on, warm compress, left lateral position, and in my case avoiding lithotomy position (which is what caused my tear with my first).

Best of luck - I think we’re at almost identical places in our pregnancies!

I was in your position, and went for the elective c section. In the end I went into labour early, so it wasn’t ‘planned’ as such, but I still had a c section, and, compared to my previous birth (which had been traumatic), it was a dream. I know you said your first birth was smooth, but my recovery, also, was so easy. Everyone recovers differently, I know, but I was up and about almost immediately, discharged the day after, held a birthday party for my eldest a week post c section. Don’t get me wrong, I’m not super woman, and I was sore - but it didn’t stop me doing much at all with my toddler.

Sorry to hear your in a similar position @Chasingaftermidnight do you think you're going to go ahead with a vaginal birth?
I watched a really good seminar the other day from the MASIC foundation about childbirth after OASI which threw out some interesting questions but I still think I'm going to go with the c-section.

Thank you for sharing your experience too @OhPleaseJustLast the unknown is always scary but it's reassuring to hear from other women who have been through it and survived!

Hey @CreedBratton

I’ve got an appointment with the consultant next week to discuss it, so I’ll see what he recommends, but I too am strongly leaning towards the CS. I know CSs aren’t risk free but I just feel I can’t take the risk of tearing again more severely and the consequences that may come with that. Also, I had a big baby and a fast labour last time, both of which are risk factors for tears.

The only frustrating thing is the difference in medical opinion. The gynae who repaired me after my first birth told me she didn’t think I should attempt any more natural births. Then I saw a registrar earlier in this pregnancy who who was all ‘there’s no reason at all why you can’t have a vaginal birth, the only reason to have one would be for your mental health’, etc. So I thought for a while I’d attempt a vaginal birth. Then I saw the specialist midwife who urged me to strongly consider a caesarean on the basis of my particular history. So I’m going to see what the consultant says but at the moment it’s two against one!

I was in your position after a traumatic first birth (3rd degree tear with episiotomy, and urge incontinence). I saw consultants and gynaecology physio who recommended c-section as couldn’t guarantee issues wouldn’t get worse following another vaginal delivery. Recovery from section was ok, (I found it a lot easier than recovery from first traumatic birth) but you do have to take it easy for first 3 weeks.

The only compelling reason against section that I was given was if you want multiple future children, as then have risks from scar during future pregnancy, and risk of adhesions to internal organs following multiple c-sections.

I've met with the consultant this morning and booked in for a c-section at 39 weeks. DH and I discussed it all through again last night and agreed the safest thing for me and baby is a planned c-section as I would really struggle to cope both physically and mentally if my incontinence issues were to become worse.
Feels a bit weird knowing when baby is coming (assuming they're not early!).
Thanks for sharing your experience @Namechange357 because baby is coming over the Christmas holidays DH can postpone his paternity until the office reopens in Jan so he'll luckily be off for about 4 weeks to help me and toddler!
Hope your appointment goes well this week @Chasingaftermidnight go with your gut!

Hey @CreedBratton, just wanted to pop back and update. I was seen in antenatal clinic (still didn’t see the consultant which was frustrating) but I saw a registrar who just asked ‘how do you want to have this baby?’ I talked it through with her and opted for a section.

The only compelling reason against section that I was given was if you want multiple future children, as then have risks from scar during future pregnancy, and risk of adhesions to internal organs following multiple c-sections.

Yeah I agree, these are the risks of a c-section that scare me the most (that and heavy bleeding leading to an emergency hysterectomy).