Is VBAC safe/possible with three fistula surgeries? Does anyone have any input?

[Inspiremom76]

This is REALLY long, anyone that reads this I am in total gratitude to, I feel so confused!

TMI-I developed an perianal abscess three years ago when pregnant with my first child, I was 7 months pregnant and planning a natural birth. My OB pressured me into a c-section, which was HORRID. Baby and I were both healthy but had attaching and breastfeeding issues, I was very depressed after for a long time, and had a rough recovery. Since then I found Mothering (love it!) and have done a ton of research. The abscess turned into a perianal fistula and I had three surgeries as a result (not fun at all, really hard)

Now I am 32 weeks prg. My OB (a different one) had said she supported a VBAC this whole pregancy, and voiced NOT ONE concern, even when I asked her. 4 weeks ago at a checkup she began asking me "why on earth would I want a VBAC" she said the worst case scenario would probably happen (tearing into scar/ending up with a recto-vaginal fistula, fecal incontinence, tons more surgeries etc

By the time I left the office I was terrified. She was really bullying me and now I realize it is the nature of that practice, of 10 people that I know 8 of them were pushed into csections!  I called my doula to tell her and luckily she gave me lots of ideas on how to really research & make a good decision.

I left that practice, found an awesome group of midwives (that do hospital deliveries) the local homebirth midwife in my area wouldn't take me with past surgeries. They had me consult with the head OB at the hospital and while she was a lot more kind and informative she again brought up all those risks, said there isn't enough research on this to have an idea of percentage of this happening. She said they wish they had a crystal ball so we would know. Said all the dangers of repeat c-sections, saying if we want more than one more child she would caution us not to have a section. She also said that I could end up needing lots of surgeries if the vbac goes badly and I have bad tearing.

Then back to my wonderful, awesome midwife and she said I should call rectal surgeons and ask them how many women they have had with my surgeries and ask how many attempted a vaginal birth and what the outcome. She said she supports us 100% no matter what we decide but did stress the dangers of c-sections. I asked her for ideas on how to prevent tearing and she seemed reluctant to tell me anything worked because I am different because of scar tissue.  I really want a vbac, but I am terriefied of incontinence and more surgeries. My doula is also being amazing and non-judgemental. My husband wants what is best for baby and I.

Anyone know of anyone that went through this? Any input on preventing tearing and what I could do for the last 2 months to prepare for a positive outcome? Any opinions would be awesome on either side, we have 4 weeks to make a decision. Every day after research I go back and forth.I have done prenatal yoga, walking daily, birth ball and squatting to prepare up till now.

HELP!

[SAMarshall]

I'm afraid I'm no help, but you might try posting your question on the ican-online.org forums, also. The more women you can reach, the more chance you have of finding someone in your situation!

[Inspiremom76]

Thank you! I am heading there now.....I appreciate your feedback!!

[MountainMamaGC]

I am in the same boat. I actually have crohns disease with a history of fistulas (none vaginal yet, but almost once), and next time I get pregnant I plan to give birth. Like you I was pressured into having a section because IF I tear a fistula could develop, but that doesnt mean it will. You have to consider if you have crohn's  that you can also get a fistula at the incision site and I didnt. I healed beautifully. It makes me think in the event I did tear, that I would have healed just as wonderfully.

I know a women on a crohns forum that gave birth vaginally while she had a vaginal fistula, and the fistula did not get bigger. She was fine and very happy with her decision. And she got the OK from the surgeon the operated on her fistula the year before. I will find the post on the forum where she talks about her birth experience and PM it to you.

I am in remission now and all my fistulas are healed, and so long as I have no active peri-anal disease at the time of birth I plan to skip the c-section.

I know what you mean about the c-section. I healed alright, but I found recovery rough, and I had a lot of anxiety, and a rough start to breastfeeding. I dont want to go through that again.

[Inspiremom76]

Lydia,

 Thank you so much for the PM info and your post! I meet with my doula this week and she has a bunch of ideas for me to prevent tearing, I can PM you if you want when I get the info. It is so nice to know other people with this issue....

We are going to go for it. I will post again after delivery or PM you with our outcome.....take care and thanks!

[MountainMamaGC]

One thing I did for sure was make peace with the fact that I could possible tear and have a fistula. Its a bit different for me because I have crohns, but what helped make my decision was the fact that I could develop a fistula in the future without ever going through childbirth. Its a reality to me no matter what I do.

Also the fistula was the result of an abcess. So if you tear you should be able to heal just like anybody else.

If you dont have crohns I dont see how you are at any higher risk of developing a fistula than anybody else. You may tear at the scar tissue, but if they stitch you up you should be fine.