Not sure whether to have C Section

[WhatshouldIdo155]

Had a VB couple of years ago, ended up with severe incontinence and prolapse, awful recovery which resulted in PND. It’s a lot better now but still have stress incontinence which really effects me.

Now pregnant with my second, was thinking of having a C Section to avoid any further damage (am aware of some people who have ended up with even worse damage second time around, such as bowel incontinence or fissures). However the obstetrician has really put me off - dismissed my current issues, telling me it’s not that bad. Told me a C Section would result in scar tissue and adhesions which will cause issues later in life.

Now I’m so confused about how to give birth. I feel so anxious, like either way I’m going to ruin my body even more.

Any advice much appreciated.

I heard that if you need a surgical pelvic floor repair later in life it's better not to have lots of abdominal surgery as I think they go through your abdomen?
How many more children do you want?
I'm sorry you've been through such a difficult time!

Thanks for your reply. This is the last child I want - so hopefully wouldn’t cause too many issues later in life..

Do you know how that would be related? I've just never heard of that link between pelvic floor surgery and a c section.

It's a common misconception (I thought this before too) that a c-section cuts through your ab muscles. Actually they cut between and pull them apart, like curtains (sorry it sounds gross).

That's why the recovery, although brutal at first, is surprisingly relatively quick compared to an injury where a muscle is torn or cut.

@WhatshouldIdo155 oh gosh I’m sorry you are going through this!
I have a similar situation myself.
I had my little girl in 2021, ended up with a fourth degree tear and unfortunately now the odd fecal incontinence. I haven’t been so good at keeping up with my excersises and it got worse over time.
when I did see the consultant not long after baby was born she heavily advised me to have a section.
Im almost 12 weeks now and planning on a section.
At a different hospital now and consultants have granted my section but didn’t push for one.
Im anxious about major surgery, but for me I didn’t want to risk my issues getting worse, it’s not worth it. And that’s what’s making me verge on the decision for a c section.

I don’t know about the doctors reasons for dismissing a section, so rude! Plenty of people have sections and not aware of being left with issues in later life?

good luck with your decision OP 😊

Last weekend on R4 there was a whole discussion on how women should be able to get C-sections more easily. The upshot was that due to targets set for mothers to have less C-sections, targets which have since been dropped, there is still a lot of negativity towards them. I think that if you put in your birth plan you would prefer an elective C-section they cannot refuse - hopefully someone who is more up to date with procedure will correct if I am wrong. For many women it is indeed safer.

So this is all anecdotal but I had a horrible labour ending in EMCS for my first birth so I opted for Elective C Section for second birth…best decision I ever made, really quick recovery, went really smoothly and would scarcely know I had a c section now. They even got rid of some of the scar tissue from the first C Section during the op so can hardly notice it now. I never got any pushback for having an elective - it’s your choice, I wonder why the obstetrician is trying to put you off?

The scar is minimal and they don't cut through your abdomen, doctors just don't like c-sections because it's more risky, more expensive, etc. It's your decision but I would probably seek a second opinion. I recovered very quickly with no complications whatsoever, I had mine in the UK but I come from a country where a very high % of births are via c-section, no stigma and no shocking death rates there either.

They will always try to talk you out of them but if it's what you want they have to agree it's in the NICE guidelines (I think that's what they are called)
To dismiss your concerns is wrong. I personally would push for the section.
I had an emergency one with my first and a planned for my second and I have no regrets.
Why would you risk further damage. They can't promise you that worse won't happen.
Then how long would you have to wait for repairs. Coz we all know women's health is not prioritised.
If you want the section, don't ask tell them that's what you want and stand by it.

I had 2 c sections - 1st was an emergency and 2nd was recommended following a stillbirth. Recovery was OK, on a par with a ventouse/forceps delivery.

What I didn't anticipate was the surgical adhesions. That 20 years later are still causing issues, and I am too frightened to have more surgery to remove them. It's more common than you realise and worth researching.

I had a terrible ELCS and I'd still go for a c section in your case, especially if you don't want any more children.

Hello, sorry to hear about your first birth. I also had a difficult first labour but not resulting in the ongoing issues it sounds like you’ve had and I still found it a difficult decision.
Did you have a third or fourth degree tear? Have you had an ultrasound to review your healing?
The RCOG guidance (which your doctor should be working in line with) is clear that following an anal sphincter injury with symptoms (eg incontinence), women should be counselled in elective C section. Definitely ask to see another doctor or just turn up at the day unit and ask to speak to someone if it is causing you distress.
https://www.rcog.org.uk/media/5jeb5hzu/gtg-29.pdf

OP just to add. Please discuss the continence issues with your consultant and beyond. Not trying to scare you, but I’ve had an EMCS, ELCS and DO have pelvic floor and continence issues related to birth. C-sections offer some protection BUT don’t erase all risk and working with physio/women’s health is still important. Even if not VB.

OP please can I ask how you got on? Did you have a c section and was everything ok?

I am in a very similar position, and I am considering a c section for my second birth as I had incontinence issues with my first.

Thanks