c section vs natural birth after 2 nasties!

[WidgetWB]

i have to make a decision tonight and tell the consultant tomorrow and am SO stuck! I am now 36 weeks and have to book in if I am going to have a c section tomorrow. Thats not the important bit. I had 1st ds, horrific labour, ventouse, shock, episiotomy, tearing etc etc. took a week or two to recover. 2nd ds had tearing but can't remember how bad, but then had a huge haematoma in my left labia which took a long time to recover from, remember going to my 6 week check not feeling 100% down there. Consultant this time has requested notes and three months later they still haven't arrived, but has said I could have a c section if I want to to make sure that I don't have such bad tearing or something else which could lead to anal incontinence! Apparently this baby is going to be quite big (8 to 9lbs) my others were (7 to 8lbs) and the two lots of scar tissue plus the huge amount of scar tissue in my left labia aren't going to help my chances of not tearing and badly - and as everyone has pointed out - episiotomies don't necessarily help tearing! My thoughts are that I really really don't want to be incontinent AT ALL, and so to avoid that is quite sexy, however a c section is a huge surgery and not fun afterwards. Please can someone help me with this one and asap as i have to tell them tomorrow! I am leaning towards a c section now having spoken to friends who have done both, and they all say that having poo issues for ever or surgery to correct it can't even be an option worth considering! I am starting to think they are right - are they?

Widget, go with your gut instinct! Trust yourself.

I'm totally pro natural but realise it's easy to say so when I've not experienced all you have.

Could you approach vbirth with confidence? Look to the kind of birth you want rather than the after effects, there could be some either way ~ definitely with a cs, possibly with a vb. FWIW, I have two friends who tore front to back but made full recoveries. It's not nice but birth positions can help immensly in avoiding it.

Good luck with your decision.

I'm not going to lie to you and say it will be easy to give birth to a big baby because it isn't. It really does depend on your pelvis etc. The chances are it won't be easy with the scar tissue you have from your previous deliveries so I understand your concerns. The recovery after a section can be time consuming, the risk of infection is there, as it is with all surgeries but no one can tell you what to do. You know your body better then anyone else. You know what it's capable of and what your limitations are. If it were a friend asking your advice what would you say?

when i had my first baby i tore and had a BIG episiotomy that took months to heal and was painful for ages, with ds2 i tore but in a very 'unusual' way and they had to get the consultant to come and sew me up, which was agony worse than giving birth actually.

BUT i went on to have ds3 who weighed 9lb 5oz and ds4 who weighed 10 and 13oz without so much as a graze and that is despite having bad scar tissue from the first episiotomy, i can still feel it now (eight years later)

i just thought a positive story might help, with ds3 i laboured in the bath (three hour labour) and with ds4 i had him in the birth pool only in labour for an hour and a half an in the pool for less than an hour of that, but i do think it was the water that helped me to 'strech' and avoid tearing etc ds4 head circumference was just over the top of the 99 percentile, so not only was he huge at almost eleven pounds, he has a massive head and i am tiny, size ten and 5 foot 2, its my dp that is big

anyhow no one can decide for you but i thought my story may help, oh i tried perineal massage as well when preg, didnt do it much tbh but its maybe worth a go?

good luck xxxxxxxx

Had a third degree tear with ds. Consultant warned me of risks of future incontinence with another natural birth. For me it was a no brainer. Had planned csection with dd-fantastic experience-healing not as bad as with tear. Don't take risks with your future continence if a csection is acceptable to you

Widget - it's a tough decision. I had a caesarian last time and I have to say it actually wasn't that bad. Had I not had the failed induction and poking by docs beforehand I'd have described both the surgery and the recovery period as quite pleasant.

Conversely I have a friend who is recovering from a second surgery to repair an anal tear (and various other bits) from her first birth and it's still not right.

Planned CSs do give faster recoveries but it is still major surgery. I'm having a VBAC with this one probably but not because of any particular dislike or fear of the caesarian experience.

If this is your last child, I would go with your instinct and book the cs if that is what you think is best for you. If you plan more, remember that how you give birth to this one will influence the next birth.

Good luck with your choice

Having had a rough ride twice with a vb in your position I would opt for an elective.

My reasoning is this will be an operation you can plan for in advance (useful when you have 2dcs) rather than possibly going through a tough labour and then having to have an unplanned emergency repair under GA. You will be also taking preventative steps to avoid further trauma to an area already damaged and it may help protect you from incontinence/worse incontinence when older.

There is a website for cesareans that's worth a look (plus some scary photos) and they recommend taking arnica tablets and a host of other helpful suggestions.

I also felt very pressured by the very pro consultant and very anti mws regarding having an ec with my 2nd because of concerns regarding bad tearing and postpartum complications. Very last minute (I'd gone for my ec pre-op appointment) I was offered the kind of birth I'd been asking for all the way through, a guaranteed epidural to slow the birth and control it, so in the end I had a vb but if I hadn't had that, I would have had an elective.

I had read the stats including 75% of women 2nd time round don't tear again or tear to the same degree - but obviously not in your case. I also read data regarding vaginal repair so felt I was making an informed decision. The only aspect I am still worried about of course is future continence when I'm older & if I had a third baby an elective would still be very much under consideration for this reason.

What they should have done is sent you to a specialist to examine the friability of the tissue, to see how thin it is or likely to tear under pressure.

Widget, it's probably too late to give you advice as you'll have seen the consultant by now, but you don't lose anything by booking the c-section now, and you can always change your mind later. Do as much research as you can in the interim and go with whatever makes you feel most comfortable.

I have heard medical professionals say a planned c-section can give a better recovery than a difficult vaginal birth. I've had 2 c-sections, and while my emergency one was horrible (but even so, the operation was miles better than the labour that preceded it), the planned one was completely pain-free and actually enjoyable. My recovery from the planned cs was quick and easy, but everyone's experience is different.

Let us know what happens at your meeting with the consultant!

The recovery you describe from your vaginal births sounds a whole lot worse than my sections. And I never I really understand what exactly people mena about sections being "major" surgery. Seems pretty straight forward to me. I mean, brains and hearts are major surgery.

Could you book a section today and then change your mind in a week or two? Is today really the deadline?

AtheneNoctua - Can I just clarify that caesarean sections are classified as major abdominal surgery because they are. It is major surgery, although some people find the recovery much easier than others. There are quite a few people who speak of being up and about and totally unaware as to what the fuss was about, and others who feel as if they've been hit by a truck. Elective caesareans tend to be 'kinder' on the body, but not by much and people can still find the healing and recovery arduous.

A caesarean section involves incision into the skin, incision and tearing of the abdominal muscles and the abdominal sheath (tearing heals better than an outright cut) followed by incision into the uterus muscle. All of this is held back with large metal clamps. Forceps are often used (caesarean forceps) if the baby is wedged far down into the birth canal. Once the baby is removed you're stitched up. It invoves surgery and trauma to skin muscle and organ so, by definition is major surgery. It certainly felt that way to me. Fantastic if it didn't for you, but I don't think it's 'straightforward' by any means.

However, for the OP, a complicated vaginal delivery can be incredibly traumatic and so I understand the 'temptation' of a (straightforward) elective caesarean. There will still be pain and a recovery period, but it will be of a different kind. And you remove the very real shadow of continence and repair issues that would be incredibly scary. Only you'll know what is best to do. It's a difficult balance as previous difficult births don't necessarily mean that you're guaranteed the same with your next. And a caesarean isn't always straightforward as there can be issues with healing and complications. Rare, but a risk all the same.

Best of luck making your decision and best of luck with the birth - whichever method you decide to go for will be the right choice for you.

"...by definition is major surgery"

I'm sorry, I missed the definition. Can you please define "major surgery" for me.

I just think people hype up caesareans as "major surgery" to scare people out of having them. In my life I have had:

surgery to correct a lazy eye
surgery to replace the ACL in my knee
an crash section
a planned section

I had a GA for all but the planned section so I don't really remember them. But, in terms of recovery, the knee surgery was the worst.

I'm not saying section recovery does not hurt because it does. But all this talk of "major sugery" seems to belittle the experiences of people who have organ transplants or tumors removed from their brains.

Also, I thought that bit about them cutting/tering the abdominal muscles was a myth. I though they pushed the muscles aside and cut into the uterous. I'm no doctor though, so could be worng.

Athene - It is major surgery, although it is performed fairly routinely in many cases. The layers are cut until they get to the abdominal muscles when they are literally pulled apart. As a midwife I have seen many hundreds of c/s and believe me it can be really brutal! Not to mention the potential for damaging the other organs on the way in or out.

However, for most people it is pretty safe and as opposed to a difficult vaginal birth or a difficult forceps, it may well be a much better option.

Widget - I know you have probably made a decision by now, but from your posting, it doesnt sound as if you have had a 3rd degree tear previously, and this is what can lead to incontinence in a small number of people if it is not repaired properly. If you have had very bad tearing in the past and it has not gone near the anal sphincter, I cant really imagine that it is likely to cause you a problem this time - you would have to be incredibly unlucky for that to happen, so the chance of incontinence would probably be a fraction of one percent.

However, with the awful experiences of perineal trauma that you have had, I can fully understand why a c/s sounds appealing!

Good luck with whatever you have decided.

Definition of 'major surgery' from The Free Dictionary -

major surgery - any surgical procedure that involves anesthesia or respiratory assistance

I had a mole removed under anaesthesia - does that count?

I guess that backs up Kittstwins then........

Hi,

I had an emergency C section less than 2 weeks ago - waters broke and baby was 5 weeks early and breech. I have to say that the recovery has been no problem really. Okay I know that I'm not 100% and tire easily etc but I'm not in any pain at all and wasn't ever in any pain because I made sure that I took all my pain medication that was offered.

ok, so a caesarean, just like mole removal, is major surgery.

So, what is minor surgery? A manicure?

i had a c section after having a terrible time with ds1 i tore and had lots of problems afterwards. this time i got told my dd would be at least 10 pound and with complications it may have to be born by c section anyway so opted for it, everything went well but suprising enough my baby only weighed 7 lb 13 oz hardly a bloody ten pounder ha. .
if you had a bad time with last two i would consider it as youll know your in for a bad time

My understanding is that if you've had a 3rd degree tear first time around and are already experiencing problems with continence then a c-section may well be the best option. On the other hand if you've healed well and have no problems on that score then a vaginal birth may well be fine.

I had a forceps birth involving large episiotomy first time around. Second time had a 10lb 12oz baby with minimal tearing, despite shoulder dystocia - no suturing involved.

My feeling is that if you go for a vaginal birth you need to have a very detailed care plan and to think through your second stage issues carefully.

Oh - something I wanted to pass on: there's a piece of research in the the current copy of MIDIRS quarterly (mainstream UK midwifery journal) that suggests using hot towels on your perineum in late second stage (especially during crowning) can have a major effect on rates of 3rd degree tears, pain and incontinence - ie it reduces the chance of this happening quite considerably. Oddly enough it didn't seem to reduce rates of second degree tears, but had a very marked effect on more serious perineal damage.

Good luck, whatever you do!

AtheneNoctua - seems a little pointless to be debating the semantics of major surgery as you don't seem to consider a caesarean one. However, as much as you found it fairly easy going, I know a lot of people who haven't. Far from it.

But that's just my take. More importantly, if you ask any surgeon they will clarify that a caesarean section is major abdominal surgery. That is how it is classified within the medical profession. And that's why they don't hand them out like sweets and make you sign massive disclaimer forms detailing the many risks involved. As far as I'm aware, major surgery involves incisions through muscle skin and organ, so a mole removal, for example, wouldn't really be considered major surgery as it wouldn't inolve muscle incision or organ incision or removal.

Caesarean sections are becoming more commonplace and this is having a knock-on effect in people's attitudes towards them. They are seen as routine, where the reality is for most people they involve a lengthy and painful recovery period.

You feel the way you feel - fantastic for you. I'm glad yours was straightforward. But they ARE major abdominal surgery and are classified as such within the medical profession, however much people outside that profession consider them to be otherwise.

K

Well, having read through the minor disagreements of whether or not a c section is major or minor surgery - which made me laugh hugely so thanks for that anyway - I thought I would tell you what I decided!

I finally, after a huge amount of tears and tooing and froing, decided to have a c section. The final decision came after I spoke to the consultant who 'did' me during ds2. He said it wasn't 3rd degree BUT I had a HUGE amount of tearing and therefore scar tissue, not only from number 2 but also from number 1 which is why it was so bad during number 2. Having the tearing wasn't that bad, but the major haematoma afterwards which burst lead to a huge amount of stitches. He suggested trying to do it naturally and then see what happens, I failed to see though how that would be good having it sore from both ends! So c section - which I am not looking forward to at all, but much better than the other chances. Both the midwife and the consultant told me they were pleased with my choice but they couldn't make it for me!

So thank you all for your help - off to buy big, hugest pants and arnica now!

WidgetWB - good luck with the C-section, I am having one too after 3rd degree tear with DD1, it was a difficult decision but I was not prepared to risk fecal incontinence as a result of another bad tear!!