ELCS or Vaginal? PF dysfunction & other stuff

[dustpan]

Can you give me thoughts on what to do please?

I'm 30 wks pg & consultant has scheduled me for an ELCS but also offered I can do a trial of vaginal Labour (induced, with epidural) if I want to.

Reasons are: pelvic floor dysfunction after my previous birth 3 yrs ago. Only had a 1st deg tear but also nerve damage. Had bowel incontinence, physio helped, however muscles still v weak & have had urinary incontinence during this pg, despite doing the exercises. Family history of prolapse & hysterectomy. Also got painful varicose veins in vulva & legs this pg, which apparently are linked to weak collagen & increase risk of prolapse. Great.

So...... my head absolutely tells me to go with the ELCS & be grateful for it. Minimise risk of any more muscle damage / incontinence/prolapse.

But - I hate thought of c-section recovery & would much rather be up & about with baby as much as needed straight after birth. Hate thought of relying on DH to help me out of bed, pass me baby etc.

Just waiting for labour to start naturally has not been suggested an option as my prev birth was v fast & I was unattended, even though on a hospital ward :( Had PTSD afterwards as dreadful experience birthing so fast without support from a MW.

What would you do??

Thanks!

It's really tough - sounds like you've had a lot to deal with. I ended up with an EMCS after long labour so no experience with pelvic injury, but have known people who had it.

I understand the not wanting to be restricted after birth - but in my experience it doesn't last that long (of course everyone is different, and there are risks with both courses of action). I was fairly mobile by the end of the first week, and felt virtually back to normal by about 4 weeks.

I would personally balance that with how long it might take to recover from further pelvic injury and see what you feel. For me it would be ELCS next time as everyone I know who's had one seemed to love the calm, planned birth.

Hope you reach a decision you're happy with - still plenty of time to decide

Oh darling go for the ELCS, don't risk ruining your pelvic floor for life.

Go for the ELCS my situation is similar in a way. I suffered a bad 3rd degree tear and a lot of emotional trauma from DS1. I'm now at 25 weeks starting to really struggle with holding in wee etc. There is NO way I want to put any more pressure on my poor pelvic floor than absolutely necessary.

Also worth considering that induced labour's are riskier and there is a higher chance of needing intervention which is in turn more likely to cause damage.

When I was deciding, I did for a while consider trying for a natural labour but I said to my consultant that I would not agree to an induction under ANY circumstances. She told me that was sensible..

The decider for me was that they offered it to me at my first appt with the consultant within minutes, no seconds of discussion. I suspect that to some extent the consultant believes it is the sensible choice for me. I totally trust her and so the speed and ease to which it was agreed upon was a key factor. I think if you have been advised to have one, then I would!

Recovery will be hard, but I doubt it will be as hard as recovery from a bad vaginal birth.... My recovery the first time round was absolutely horrific.

Thank you for these kind responses- I was worried I'd get slammed for an ELCS!

Helly that is a v good point - weighing up recovery from c sec against further pf damage.

What were the limitations of the 1st week recovery like for you? Were you able to BF/ bond with baby?

Thanks Stormy :)

OhNo - that's interesting that you wouldn't risk an induction- do you know why induction increases risk of tricky birth & more damage?

I suppose the other option is I could wait to go into labour naturally & then head into hospital to try for vaginal birth .... but I'm pretty scared about being left alone again. Consultant really seemed to understand that, & has scheduled me for a day when she is there so someone who knows my history is at the helm.

No problem - glad it was helpful!

I had a 60 hour labour so was shattered going into my section, however despite that I was up and had a shower (slowly!) 12 hours later. Breastfeeding was fine - fed him for 18 months, and I think besides luck that he took to it, having a couple of days in hospital with breastfeeding support really helped. He was given to dh in theatre and I got my first cuddle in recovery, though you can ask for immediate skin to skin (which I will do next time).

I needed regular painkillers for the first week - paracetamol and ibuprofen, but with them I was comfortable so long as I went slowly. Dh did any heavy lifting but I could do most things myself eg feeding /changing. Managed to get out for some short slow walks after about 6 days - needed some sunlight! Out and about on the bus at 2 weeks with the sling.

I'd recommend a litter-picker/grabber thing - so useful! Elective recovery is supposed to be better than emergency too.

I had an induction with my first and had I known what I know now, I would definitely have refused it. I don't know any official statistics or anything but I have been told you are more likely to require an epidural and intervention if you are induced.

I suspect a bit of research or a chat with your midwife could shed some light on this?

If you have had one baby vaginally already, then the statistics suggest you are less likely to need intervention second time around (I think!!). That said, second births are usually quicker, which given your previous birth might not be a good thing.

I've weighed up the pros and cons based on the statistics available to me. EG, 7% of women who suffer from a 3rd degree tear will tear badly again. For me, that's almost 10% or 1 in 10. I have also considered WHY I required intervention with my son, he was very big with a large head and I am small. He was also back to back. Consultant told me that I was likely to have another bigger baby, especially if I go past 40 weeks. All things considered I have decided I'll take the more calculate led risks of an ELCS.

Do bear in mind you can mentally prepare for a section slightly better than the unknowns of a vaginal birth. Which may help you avoid PND again. I know for me, the trauma and the whole escalation of events was what made it particularly difficult to cope with. Vaginal birth is just so unpredictable.

Go for the CS. I promise you the recovery will be ok. Just do as you are told re taking lactulose and please accept all help you are given x

I laboured for 75 hours before my emcs (back to back and well and truly stuck baby). I was up and dressed by myself 5 hours afterwards. By 23 hours afterwards I was walking from one end of the hospital to the other to see my ds in NICU.

My sil had a lot of issues with her first (fast and natural), declined the offered section with the second and tore badly again.

3 months post my emcs, she and I and our respective kids were shopping. She ended up pushing ds in his pram whilst I chased her kids across the car park because she can't run or walk fast without weeing herself.

Personally, I'd take the section.

I know everyone's experience is difference but I had a horrendous forceps birth with my first and ended up with a recrocele and cystocele. I had my second at home (with the prolapses and the pelvic floor damage) and it didn't make it worse. And I have since had it all repaired (and failed but that's a whole other story!)

But one word of warning I would say is elcs or vaginal you shouldn't be doing stuff after the baby is born anyway. You really need to rest the pelvic floor if you already have problems, I too have a connective tissue disorder (hEDS) and no one told me that advice. I look back and wince at the fact I was lifting car seats and pushing prams within days and doing even more damage!

I know its not the same as all but I am also having an ELCS for other reasons. Knowing the process and having very little chance of any damage after is definitely so reassuring.

Think of having life long permanent pelvic floor problems/urinary (or possibly faetal inconsistence) VS having a few weeks where you must rest and recover from an ELCS.. no brainier!

Good luck d