Delivery options with endometriosis - vaginal or csection?

[squashie34]

Hello,

I'm currently 30 weeks pregnant (have stage 4 endo and had 6 laparoscopies) just wondered if any ladies with endo can share their stories on how they gave birth?

I'm consultant led and at our last appointment I mentioned about a csection due to having severe bowel pain when opening (sorry if tmi) which is the pulling on my bowel adhesions from baby getting bigger, and the consultant said that a vaginal birth (with epidural) would be the safest method due to the likelihood of scar tissue present in my abdomen which would make a csection harder. Then there's also the risk of the endo then forming in csection scar in the future.

I've done a lot of reading however that states research has suggested women with endo are twice as likely to have an EMCS when attempting a vaginal birth, so id really like to avoid an emergency section where time would be of the essence especially if they think scar tissue would be harder to navigate- id rather they do that in a planned section where at least they have lots of time to get baby out.

Just looking for stories of either delivery of any ladies with endo and how it went for them? Not seeing the consultant again until 36 weeks so quite a while and near to the end! Thanks

@Cockodoodledoo thanks so much for all of that info, and I'm sorry to hear you're in so much pain. I already actually have a tentative diagnosis of adenomyosis from my laparoscopy last year - the surgeon cleared a lot of endo from the outside of my uterus but had noticed the thickening inside too and said that is his view on what it is but of course it cannot be diagnosed fully without a sample being tested from on the inside of the uterus once it's been taken out in a hysterectomy. His words to me were 'go and have your babies and then come back to me and we will whip it all out' because my life has been pretty miserable for years with it all, so that's fine by me. I wonder whether already potentially having adenomyosis May affect the risk of csection?

How was your recovery after vaginal delivery with episiotomy and forceps if you don't mind me asking?

At least you're aware of it, I hadn't even heard of it until 6 months ago.

Your specialists advice sounds about right, have your babies and then they'll deal with it afterwards. I'm not ready for a hysterectomy yet, plus my children are too little for me not to be able to pick them up so I'm hoping the endometrial ablation will see me through to menopause...

In regards to my recovery from vaginal birth and forceps/ episiotomy I unfortunately had it go a bit pear shaped and had a third degree tear and major post partim haemorrhage (which the consultant suggested which from the actual tear rather than my uterus?! ) which I didn't mention in my first reply so as not to side track. I don't think it had anything to do with my endo though.

So personally I found recovery from my ELCS to be much easier both times. However when I saw the gyno/ had a scan earlier this year it was confirmed that my endo had regrown and one of my ovaries is now fused. No concerns re my c section scar and endo growth though.

For what it's worth I have only recently realised that my bowel/ colon pain during a PM was endo related - I just thought I was permanently constipated to some extent and that was what was causing the pain.

The lack of research into endo and adenomyosis and similar continues to astound me!

Hi just an update from me (stage 3-4 pelvic and RV endo removed from 2 laps etc). I had a vaginal birth a couple of weeks ago and it went smoothly, no instruments, no EMCS. I have a recto-vaginal nodule which was shaved but not completely removed, which may or may not have contributed to some extremely painful constipation post-birth, but other than that it was fine from an endo perspective.

@RyvitaBrevis thanks so much for updating and letting us know, and congratulations on your little one! 🥰

@squashie34 Thank you! All the very best and I hope things go as smoothly for you! Birth is unpredictable but you've researched and thought carefully about the options and that's the best anyone can do. x

@squashie34 can I ask how your birth went? I am now faced with this dilemma - albeit I’m leaning heavily in favour of an elective C-section. I have stage 4 endo and bowel adhesions. My endometriosis is apparently “everywhere” although I have luckily had zero symptoms and the diagnosis was only made due to investigating fertility issues (it took a while to conceive this baby).

My consultant is arranging for me to have an MRI scan to assess the latest position with my endometriosis but she has recommended a vaginal delivery due to the endo and adhesion complications.

However - I also have ulcerative colitis ! And I suffered from a bad first vaginal birth with an awful recovery (I did not know I had endometriosis at that time) and the thought of further potential incontinence issues is to me, worse than the risks associated with a c-section with endometriosis.

But maybe that’s maybe I have never had any endometriosis symptoms only symptoms from my colitis? I am wary of the C-Section giving me endometriosis symptoms… It’s so hard to know what to do!

@EalingMamaRelocating lovely to hear from you, although sorry to hear you also have this dilemma!

I had my girl safely via elective section, however the surgery did end up being complicated due to my scar tissue from my endo- there was a section of scar tissue/adhesion right on the part of my uterus they needed to cut to get my little girl out, so I lost a lot of blood and haemorrhaged. The surgeon worked really hard to clip it and stop the bleeding and it never felt scary or anything as they always seemed in control and never panicked. I had the blood given back in a Transfusion after surgery. There was a gynae surgeon on call just incase but they never needed to call them.

This did however mean that because I was losing a lot of blood they needed to pull my little girl out super quick so they could get to work on stopping my bleeding, so she came out with some mucus on her lungs and needed a 1 day stay in NICU with a little oxygen help until it shifted. Again whilst writing it sounds like it was a bit traumatic it didn't feel like that at all, it all felt very normal.

If I could go back and repeat id 100% have another elective- my baby was 9lb 3oz when she was born (had no idea she would be big as I'm tiny!) and the surgeon said there was no way I would have delivered her naturally. If the surgeon would have encountered my scar tissue and adhesions opening me up in an emergency C-section where time is critical, I dread to think what might have happened.

Wishing you all the best! X

In case it helps anyone - I went ahead with an elective c-section and it all went very well! Definitely the right decision for me. My hospital were great as well - I had an MRI scan in advance to allow them to assess the status of the endometriosis, location and possible adhesions. My endo is all primarily at the back which allowed the c-section to go ahead smoothly.

Good luck to anyone else in this position!