Giving birth after previous perineum reconstruction - help!

[Lulemon]

Looking for anyone with a similar experience to help with my decision! I’m majorly stressing out.
My first child was extremely big at 10lb5 which ended in episiotomy and forceps. Wasn’t too bad until the stitches completely came apart and then the episiotomy never healed. I ended up having to have surgery privately when she was 4 months old for a complete reconstruction.
Fast forward to now - I’m 38 weeks with my second. I was planning on natural birth all the way through but have been getting increasingly more nervous about damaging the area that’s been reconstructed, particularly since having a birth reflections appointment this week. I also just seem to grow big babies as I tested negative for diabetes. I should also point out that I measured exactly to my dates with my daughter (40cm at 40 weeks) and am measuring the same this time. This was was ‘normal’ at my 34 week growth scan but the higher end of normal.
Normally everyone says that everything is more stretched out after your first but as mine has been completely reconstructed I’m terrified about damaging it again as apparently it would be more difficult to repair the second time around due to existing scar tissue.
I’m also not keen on the idea of a c section as my husband won’t be at home with me after the 2 weeks paternity leave so I’ll be by myself post c section with a 3 year old and a newborn.
Has anyone had a similar experience?
Thank you in advance!

I had a 3a tear plus full reconstruction after 3 months due to gaping stitches. I had an elcs for my second and will be having another elcs for my third in February.

Elcs all the way.

I can see why you would want a c section but you need to act quick to get one!

Caesarian and a doula/ postnatal nanny to help in the immediate aftermath. I wouldn’t risk permanent damage/ long recovery and reconstruction in that zone for a second time.

In your circumstances I would be moving heaven and earth to get someone there with me for the two weeks post birth so I could have the c-section. Is there no way at all he can be with you? Or no way at all you could have other family members of friends there, even if a few of them put in separate shorter shifts?

Thanks everyone :)
I was desperate not to have a c section as I’ve been wanting a much better natural birth than last time but I think that’s me just being a bit ridiculous!
Luckily the hospital have already pre approved me for an elective c section after my birth reflections appt and have even agreed to do one if I go into labour. It’s just a horrible last minute decision after months of thinking I was going to have a natural birth - they kind of forgot about me and my ginormous previous baby until now!

I had the same first time round so had ELCS with my second. I was terrified of messing up my perineum again. ELCS was amazing, so calm and controlled and I felt so much better afterwards. Sore of course, but after two weeks when DH went back to work I felt completely back to normal.

Oh and I breastfed successfully after the section, if that’s a factor for you.

Just to reassure you, I had a CS recently as my second and coped fine when DH went back to work after his 2 weeks. I was driving by then and fine picking up DC1.
I also breast fed fine after both EMCS so don’t worry about that!

Driving after two weeks @Ohshitiveturnedintomymother ? I didn't think you're insured until 6 weeks.

What type of repair have you had OP? Was it a refashion of the perineum or have you had an anterior and/or posterior vaginal wall repair? Or both?

I'm reading this as you will have your husband home for the first 2 weeks, but not after that.
I would choose the ELCS, if your perineum were damaged again to that degree you'd presumably struggle with the toddler anyway.

I realise there's a chance you could have an uneventful vaginal birth but if the baby is so big I would probably not choose to take the chance.

Good luck whatever you decide.

@toadstool32 check with your insurer, mine says you can drive when you feel able to do an emergency stop. Not intending to drive before I feel ready but I know plenty who have felt fine driving after a few weeks.

I had a very similar first birth. Went with vaginal for second and ended up with a whole second round of reconstructive perineal surgery when my second baby was just a few days old because the small number of stitches didn’t heal properly on my previously damaged perineum. Awful. STRONGLY ADVISE ELCS. I had an ELCS with my third and it was lovely. Any healing issues (minor) were much better than the awful perineal stuff with the first two.

I had an ELCS with my second a couple of months ago. I too had a forceps delivery with my first which resulted in numerous surgeries. The section was a dream, I didn't have any pain really and was feeling pretty much fine after 2 weeks.

OP, that sounds like a horrendous experience, I'm sorry that happened to you.

But really, a significant majority of mothers will have partners who return to work two weeks following a CS. Mine had to for all three of my sections - and the third left me with three children under five at home. I coped. By two weeks post section you should be pretty mobile. I wouldn't even consider a VB in the circumstances you describe - the post birth recovery could well be much, much worse than an ELCS.

Oh and the no driving for 6 weeks after a section is a myth that just will not die. I called my insurance company and they said it was entirely down to whether or not I felt fit to drive - just like any other illness or surgery. I was driving again after about two weeks. Getting the children in and out of car seats was probably the hardest bit, but manageable if I took my time and was careful.

I had an ELCS with my second after EMCS with first

It was so much easier and a completely chilled experience

DH was he for 10 days but at that point, apart from driving, I was good to go with everything else

No problem breastfeeding either in case that's a consideration

All the best with your birth, whichever way you choose

That said, what did your surgeon advise following the reconstruction? Surely they discussed recommend birth options/likely outcomes for any subsequent pregnancies?

@Secretsout it was a perineal refashion and posterior repair. It was a disaster down there 🤦🏼‍♀️😂

@cheeseismydownfall she was very back and forth about it so never gave me a definitive answer.

I think it’s a unanimous vote for the ELCS! I definitely will manage after husband back at work, I think I’m just getting myself worked up with the stress of it all. Thanks everyone :)

@toadstool32

Driving after two weeks *@Ohshitiveturnedintomymother* ? I didn't think you're insured until 6 weeks.

This does my head in! I’ve had two sections and checked both times. Insurance companies don’t care. It’s a fallacy about 6 weeks and tbh I think it needs to be said more often. A) it’s isolating to be expected to stay home/so close after a section for 6 weeks B) I’d had done more damage post CS walking with the pram abs a buggy board than I did driving. C) life goes on, how was I expected to do the school run etc?

I think it’s nct who perpetuate this abs it needs to die a death now.

Agree with #ohshit, the six week thing is not true, they just say if you feel able it's fine.

I cannot express strongly enough how much I would go for the cs, after suffering issues after first ( similar but nowhere near as severe as you!) Thanks goodness you've been offered the option. I know it's different for everyone but for what it's worth I was pretty much back to normal after two weeks.

omg OP don't have a vaginal birth.

I had an horrendous first vaginal birth. horrendous. big baby, tear, pph,. Needed help from parents and MIL for weeks after. I had two elcs after that and it was so much easier. I was walking day 1/2, driving day 5/ discharged myself after 1 night for the second one (wish I had done it for my first). back to normal day 3 tbh. First vaginal massive tear birth - took me weeks to get even close to normal.

Go for the CS. I had an elective cs a year ago after 2 vb’s, second was a disaster. I healed quickest out of all the births after the cs, was discharged after a day, gardening after 3, only needed co-codamol once. Still breastfeeding 13 months later. I don't know why we are so hung up about natural births :(
Re car insurance - I rang my insurer a week before the cs to ask directly, spoke to some fancy manager and their position was that if you are happy to put yourself and your child in a car and drive, ie take the risk with your newborn in the car with you, they are happy to insure you. This was Admiral, but then I’ve always found the very good and hassle free. No GP letter/check needed.

@Ohshitiveturnedintomymother it was actually my consultant last week who told me

I have a similar back story, massive baby, 4th degree tear with associated side effects, although thankfully no revision surgery needed. Everyone told me I shouldn't give birth vaginally again, and while I did agree with them, part of me yearned for the natural birth experience to heal the mental wounds from the first time round. The problem was, I wanted a complication and intervention free natural birth, and actually, I wasn't likely to get one. What made the decision for me was that I found childbirth scary and overwhelming the first time (water birth, gas and air, an objectively "lovely" birth until they discovered how badly I'd torn). When I considered that this time it would be scary and overwhelming AND I'd be terrified of tearing, I knew that I really didn't want to labour naturally.

My second baby was born by ELCS and is now 4 days old. I'll be honest, the recovery has been a bit rough so far. But I can tell every day that I'm healing. The surgery itself was incredible, overwhelming at first because I was apprehensive, but within 10 mins or so I'd been handed my baby. My DP was there throughout to hold my hand, we did skin to skin, delayed cord clamping, breastfed straight away in recovery.

My first birth I did 15 mins skin to skin, then I was taken away from my baby. While I was in theatre having the tear repaired, I could hear him screaming and there was nothing I could do to get to him. We had loads of problems with feeding, I was traumatised, couldn't walk, couldn't go to the loo, we spent several days in hospital. I don't remember much at all of the first 2-3 weeks of his life, and I needed counselling to help me move past it (and endless physio for the physical symptoms).

This time, I remember everything. It was calm and controlled, bonding and feeding are going brilliantly and despite the pain from the incison I feel amazing.

I would always recommend a vaginal birth to people who are unlikely to have complications, but for people like us an ELCS is absolutely the right choice and the experience can be wonderful.