Desperate for a HB but CS only?

[LittleGoldFrog]

This is my first post on here so I hope it is in the right place and that someone can help.

I have a 9 month old dd. She was born in hospital after I was classed a high risk for a water birth, which I desperately wanted. She was posterior and, after a long labour, was delivered using rotational forceps. I suffered a 3rd degree tear. This was classified and repaired as a 3a (part of external anal sphincter) but, following problems with faecal and flatus incontinence, it was discovered I had suffered a 3c (both internal and external sphincters torn).

My internal sphincter cannot be repaired so I am likely to suffer long-term problems (although I have recently had surgery to help, it is only a temporary measure).

So after all that, my question is does anyone know if I will be able to have the waterbirth I had hoped for if we decide to have more dc? My surgeon has said that I can only have a c-section in future but I am heartbroken at the thought of not being able to give birth naturally.

I know no one can give me a guarantee but if anyone has any experience of natural birth with a previous unrepaired injury I would be very grateful for your thoughts.

[AngeliqueW]

I don't know the answer to your question.
Maybe you could ask this question on the birth professionals thread. They might have experience with this.
I'm sending you a hug. It sounds like your docs were negligent.
Best wishes on your dream of water birth.

[Nutter]

One of the first things you'll need to do, is get a copy of your medical records from your current doctor.

Once you 'know the facts', you'll have a better chance of finding a midwife or doctor who is comfortable with your personal/medical history, and whom you trust to help you make the best decisions possible for you and your family.

Whether or not you get risked out of waterbirth again will depend largely on what risked you out the first time, and if any major factors in your life have changed since then. Just because one careprovider isn't comfortable with a scenario, doesn't necessarily mean ALL caregivers are.

Good luck.

[LittleGoldFrog]

Thank you both so much for replying. The reason I suddenly became "high risk" was because I had an unexplained bleed when I was 39+4. My waters broke a week later and they had no beds in delivery suite so I had to stay on the antenatal ward. They decided to put me on a drip to speed up contractions about 18hrs after my waters broke so waterbirth was out.

I have requested my notes, they should here next month. I'll try re-posting on the professionals thread.

Thanks again both of you.

[kltroy]

If you check the guidelines on the "birth professionals" thread, it's NOT meant to be an "ask a professional" forum. So you'll probably get nixed there.

Anyway, yes get a copy of your records and see what the story is. Really, it's up to you whether you birth vaginally or not a second time, assuming you don't end up risking out. The benefits of vaginal birth are: no major surgery, birth experience you want, better for your baby

The risks of a vaginal birth in your case are associated with possible birth-related additional trauma to your bladder/sphincter.

Ultimately, you cannot predict whether this will occur or to what degree a vaginal birth would change things. For example I have been diagnosed w/ cystocele and it was suggested to me about a year ago by a uro-gyn that if I have a third child a c-section would avoid aggravating the condition. After a few months of physical therapy and 16 months postpartum, I have *no* intention of having a c-section if I have a third child (dang - I just had a VBAC!!) - my POP is asymptomatic and for me the benefits of avoiding birth trauma do not outweigh the risks, since I'm not convinced birth would make it worse anyway.

Anyway, I think you'd need to get more information about what your diagnosis is and what the risks are before you make a decision for yourself.

[LittleGoldFrog]

Thanks kltroy. Its hard to know where to get an impartial opinion. I have never met anyone who has experience of this so I guess I might just have to take the hospitals word for it and go for a CS.

Oops, best go and apologise to the professionals thread!

Thanks everyone

[mwherbs]

so what do you want to do?
the risk benefit is that c-section is Major surgery and moves your internal organs around - there is considered to be a standard blood loss of 1000cc of blood (considered to be a hemorrhage if you were to have a vaginal birth) has an increased risk of death to you and or your baby ( still small numbers but something like 3-4 times the risk of a vaginal birth) - long term things having to do with risk of uterine rupture in a future pregnancy- fertility problems, increased chance of having a retained or partially retained placenta leading to emergency hysterectomy ...
or vaginal birth has the potential to re-open the areas that have already been torn- repair may hard to do or you may not heal together right- potential to have ongoing infections and bowel incontenence - sexual dysfunctions...

not easy to decide - I am pretty sure you could have a vaginal birth but don't know about tissue health and what may happen there- I would say that the combo of infant position and instrumental delivery had a great deal to do with the tearing you had--

something you might consider is to find a doc or docs in your region who do reconstructive surgery/repair and see if they wouldn't do any needed repair right after birth if you need it -

[mamasunflwr]

Check out these threads...
http://www.mothering.com/discussions...d.php?t=266955

http://www.mothering.com/discussions...d.php?t=126850

http://www.mothering.com/discussions...920&highlight=


You need lots of time for healing.
I know how difficult the decision is. Hugs Mama, I've been there.

[LittleGoldFrog]

Thank you so much for those links mamasunflwr. They are a great help and very inspiring. I have spoken to the independent midwife we had before dd was birn and she has agreed to go through my notes with me and show them to an obstetrician friend if hers for his opinion.

I'll update this thread for anyone who finds it looking for similar information.

[smeep]

I have some questions that may help give you some insight. Were you on your back for most/all of your labour? I'm assuming you were for the actual birthing since forceps were used, am I correct? Did they allow you to try different positions (squatting, all fours, etc.) before resorting to forceps? If so, which ones and for how long and was it prior to and/or during pushing? Did you have an epidural?

All of those can affect unassisted vaginal birth vs. forceps use. Being on your back hinders a woman's ability to push her baby out without additional assistance dramatically. It is quite possible that, assuming you were on your back (or not given enough time to try other positions), mechanical assistance could have been avoided. The pitocin could have also made things worse (how many cm were you when they augmented with pit?).

Also, using a chiropractor, along with various at-home techniqes (visualization, talking to baby, positions/exercises), can significantly improve a baby's positioning and therefore lead to a much easier, unassisted birth.

Good luck, mama!!! It's a wonderful thing that you are questioning their advice because while they may be right sometimes, they are so often wrong. It's just impossible to yay or nay something without knowing all the details. Remember, always weigh the risks of one thing against the risks of another...NEVER benefits against risks, it automatically sets it on uneven ground and skews our perception.

[AlexisT]

Is this in the UK? (I'm asking because of your phrasing... i'm good at spotting the phrasing)

Ask to speak to another consultant, and a midwife if you can. The NHS is much more pro-NCB than the US, but consultants can vary. Was it an OB consultant or the urogynaecologist who advised against vaginal birth?

A 3rd degree tear places you outside the criteria for midwife led birth. You should be referred to a consultant automatically.

[LittleGoldFrog]

I am in the UK, well spotted AlexisT! I have an appointment with my colorectal surgeon next week so I am going to ask very specific questions this time (not quite made the list yet though). It was he who said only cs. The OB said I am "favourable" for vaginal delivery (but didnt mention the fact that my internal sphincter was still torn).

smeep, I was in slow labour for quite a while (days) but if I go from when my waters broke 24hrs or so before dd was born, I was very active. I walked, I rocked, I got on all fours - this got me to 5cm. Then I was given an epidural, pitocin, and flat on my back until dd was born. I can see how this all led to my tear. I should have refused pitocin but I was desperately tired by then.

If my next baby was in a good position then I would probably labour faster (not 6 days) and I think my risk of tearing will be reduced if I labour in water and breathe the baby out (lots of breath-holding and pushing with dd).

I have never looked at it as risks v risks only, like you say, risks v benefits. I spoke with dh and he is completely supportive. I have also spoken with my hypnobirthing tutor (ex-midwife) who has agreed to look at my notes and give her opinion.

The other thing I was thinking is that if my internal sphincter is torn then how much worse can it get? From what I have read, incontinence is pretty much guaranteed now anyway and if I did tear again at least they'd have access to repair my internal sphincter!

I feel a bit more positive.

[LittleGoldFrog]

I meant to say "I feel more positive since reading your replies and the links from mamasunflwr"

[LittleGoldFrog]

Just to update. My IAS is so damaged that future pregnancies alone will adversely affect my continence regardless of delivery. So I may not have anymore children. Its a hard, horrible decision to make.

I did not realise my muscle was as damaged as it is (a gap of almost 50% of my sphincter). I am looking at two further operations in the next few months.

I hope I am a worst case scenario & a rarity. I would not wish this on another woman.