Difficult recovery from VD and PG again, who and when do I ask about CS?

[onehitwonder]

Hi I had my DD just over 3 years ago and had a pretty difficult recovery. DD got stuck crowning (I blame DH's large head which she inherited ). I eventually had an episiotomy, which according to DH at the business end then tore. A small PPH (already had anemia so this just made that worse), don't know how many stiches (too scared to ask). My cocyx was pushed out of alignment (I still can't sit on a hard chair or floor for too long without discomfort). Finally, I believe due to a combination of all the above, I had fecal incontinence for 3 months or so and had to have physio for this.
The pain from my cocyx made BF dd very hard for the first month and I was on paracetamol for about 6 weeks. Had to carry about a cushion with me. The incontinence really restricted me getting out and about with DD, and therefore I was pretty down for the first few months.

Anyhow I am now PG again and have my booking in appointment with the midwife in a week. I would like firstly to try and understand why i had the issues I had with my first delivery and secondly, what can be done to make them less likely this time, including looking at a CS as an option. Am I right in thinking that with a well managed elective CS my recovery could be quicker and easier than it has been from my VB?

Should I just raise it with the midwife? Do I need to ask for a referrel to a consultant to discuss the risk of further damage to cocyx, incontinence etc? Or do I need to talk to my GP about this.

Delighted to be PG and in the grand scheme of things of course I am very lucky, but I just want to look at options this time, now I know what can happen with what seemed like a straight forward VB.
TIA

I would ask for a referral to consultant ASAP to discuss c-section delivery. They will ask you why you want a section. So, be prepared with a list of the facts. (ie. tearing, incontinence, damaged coccyx, and anything else.) Also look at birthchoice.org.uk (or something similar) and research hospitals in your area. See if you can get into one with a high caesarean and low birth defect (the two often go together) rate.

BTW, yes, in my expereinece the recovery from planned section is much better than what you experience after your vaginal birth.

Good luck!

PS Don't let the midwife talk you out of this early referal to consultant. It is never too early to get the fact for your decision. The worst possible thing is to leave you worrying about it until 4 weeks before sue date (which is often the NHS policy).

My community midwife suggested the possibility of an elective section to me at the first appointment - even though I didn't have any continence issues (which is a major factor in choosing an elective). The fact that I had a traumatic delivery and needed counselling and the fact that my scar healed very badly were reason enough. I took DH with me as moral support and made sure that she knew just how difficult the delivery was and just how painful and long the recovery had been (and actually I hadn't fully recovered even then).

I was also concerned about being fobbed off until 36 weeks, but it was fine and I was given the opportunity to talk to the consultant and senior midwife to make a proper informed decison.

Congratulations on the pregnancy, by the way.

Agree, ask to see a consultant to discuss asap. I had a similar story to you with my first delivery, basically I was allergic to the stitches, healed really badly, had to have two repair surgeries and lots of treatment, physio etc and pnd. The gynae consultant said if I had another vd, I would probably need further repair surgery. As soon as I was pg (a miracle!) I asked to see consultant and requested an elective section. They said of course I could have an elective section, it was a very reasonable request, in view of my previous experience. This really put my mind at rest for the rest of my pg.

I definitely made the right decision for me - my section , both the surgery and recovery afterwards was a dream compared to my vd. I think the issue of birth trauma is often overlooked when people start pontificating about section rates (eg in the papers this weekend) - it so is not just about women being unused to pain, as one midwife quoted said, patronisingly.

Good luck.

It sounds as though you must have had a third degree tear if you were left with faecal incontinence. You should ask for consultant led care so that you see a consultant early to go through the options, the guidelines suggest that if you have suffered faecal incontinence you should be offered the option of elective section. Have a look a the recent threads on third degree tear and here are the national guidelines.

guidelines

I am in a similar situation and booked for an elective CS next month following a third degree tear last time, I know others on here have had well managed vaginal deliveries and have been fine second time. I have nothing but praise for the concern and advice that has been given to me by my consultant and midwives, they all have seemed to take on board my worries and helped me work through the options. Good luck.

JJ - on birth trauma. Please remember there are alot of women who suffer birth trauma from csections and its not just from traumatic vb's. I would suspect its a fairly 50/50 split. I myself suffer from PTSD after my csection and I wonder sometimes if everyone forgets or doesn't know the mega downsides to csections sometimes (jmo).

Of course some people have wonderful csections and its everyones individual decision.

Thank you for all the replies. I do realise that surgery is not an easy option, but I had a friend who had an emergency C section give birth a few months after me and she was off pain killers within a week.
No one better try the 'scared of the pain' tack with me. I was induced, (pessaries), sent to the ward over night and left to labour right through the first stage with a paracetamol, and a sleeping tablet, and no-one to support me - told that I couldn't be in labour and that it must be prostin pains and to stop swearing and breath through the pain . Finally got a pethadine injection around midnight and allowed to call DH and go down to labour suite at 3pm. Gas and air made me feel sick, so I did the whole pushing stage with no additional pain relief including DD being stuck crowning for about 20 mins. (Had gas & air for the stiches thought - ouch ).
I would really happily go through all the above again if someone could tell me that there was very little risk of a repeat of the damage. But I really don't want to risk further incontinence. I am in Notts and have 2 choices of hospital - City (where I had DD)and Queens Medical centre, I don't know if anyone had experience of consultant led care at either?

You have had a horrendous experience and I'm sure most women in your position would ask for a c-section. However, the NHS may try and talk you out of it. They have midwife counsellors to do just that. Don't take any shit from them. Be demanding and stick to your guns.

I had a normal vd with dd1 - water birth at midwife led birthing centre - everything exactly how I wished it would be - one on one care, no tearing. The pain however was overwhelming for me so when I had placenta previa with dd2 I was over the moon to have an excuse for a c-section. I opted for one with ds1 afterwards too and will be forever grateful to dd2 for giving me the c-section ticket. The recovery period is longer than for a perfect vd but I'm sure I recovered much much faster than from your vd. Pain only really a problem for 3 days and personally I enjoyed having a few days in hospital to recover post op while older kids were taken care of by dh.

Good luck.

I'd request a visit to your consultant ASAP. As my last obstetrician pointed out, in his experience (nearly 30 years) the biggest influence upon labour and delivery is the state of mind of the mum. Mums who are worried for whatever reason tend to have a more difficult time. I'm sure no-one could hear your story and not understand your concerns about another natural delivery.
FWIW, I had a terrible vaginal delivery with my first which took me a long time to recover from, emotionally as well as physically. With my second, I let myself be persuaded that it would all be fine this time (that whole "your body will know what to do now" etc etc) and went for another vaginal delivery. I ended up having an emergency c-section. With my third, I immediately requested an elective section and had the best, least traumatic delivery.

If you suffered incontinence after your third degree tear last time then I can promise you that you will not get the "scared of pain" or "too posh to push" comments. You have a valid medical reason to have a C section if you want one, and if you don't get a sympathetic consultant (highly unlikely) then you can get a second opinion.

I also went through my birth notes from my first delivery with a senior midwife (the hospital should offer you this if you ask) and both DH and I found it very helpful to have confirmation of what went wrong - the knowledge that there was nothing that I could have done to get her out naturally was very healing for us. I would highly recommend it.

At the moment, I don't know if it was a 3rd degree tear, as I need to request my notes. The physio I saw for the incontinence didn't specifically say what had caused the damage but basically that I had virtually no strength (squeeze) in my muscles. I wondered if the muscles were damaged by the length of time DD's head was crowing for, or just the sheer size of her head (98th centile for head, about 70th for weight/length at birth) But I guess my notes should shed some light.

It shouldn't matter if it was a third degree tear or not - the main thing is that you had continence issues. When I was discussing my birth plans with various midwives and consultants the one question that they all asked first was whether I had problems with continence. And I didn't have a third degree tear, "just" a large episiotomy that was badly repaired.

But like I said, I think that going through the birth notes is a great idea anyway.

Thanks MrsTM

I'd agree with MrsTM, whether you had a 3rd degree tear or not is not the real issue, the incontinence is (sorry if I confused things by suggesting this earlier). From what I have heard and read and personal experience if you have needed physio (or surgery) to improve your symptoms then most consultants would be sympathetic and offer the option of an elective CS to prevent further problems.

Thanks BessMum. Thanks to everyone for sharing your experiences . 3 years after DDs birth, it is easy to forget how difficult the recovery was and also to assume that it was all pretty normal. I remember asking the physio if the misaligned cocyx was common, which I had assumed it was and being told that no, it was quite rare. My booking in is next monday, so fingers crossed for a sympathetic midwife. .

The only piece of advice I would give is this....VERY important....if you give birth a Queens, make sure each visitor arrives with an evening meal as they serve minced lamb and cabbage EVERY night (I kid you not!) This was 8 years ago though!