Advised to consider a CS because of bladder/rectal/uterine prolapse - thoughts?

[Soul-O]

Hi Mamas:

I am 9w2d pregnant with (hopefully!) my 6th child.  I've had all relatively uncomplicated vaginal births.  However, my last birth in Nov. 2010 resulted in a fairly serious prolapse of all three structures (uterus, rectum, bladder).  I was initially advised to consider surgery to repair the structures, but instead I decided to try a pessary.  Now that I'm expecting again, I've received some conflicting information about the best means of delivering the baby.  Some OBs believe that a c/s would at least keep the prolapses from worsening.  My midwife seems to think I will do fine with another vaginal delivery and specialized physical therapy after the birth.  As much as I'd like to deliver vaginally again, my gut tells me that the prolapse will probably worsen to the point of no return after pushing out another large baby, and that maybe I should consider the section.  Has anyone else ever been advised to consider c/s because of prolapse?  If so, what did you decide and why?

TIA!

Edited by Soul-O - 2/3/12 at 5:41pm

[Red Pajama]

I do not have experience here. However, you know what your recovery was like last time with the prolapse. Would you prefer that to sugical birth? are there other complications of the prolapse to consider? Do you plan on having more children?

It seems to me that as your last birth was so recent, taking the suggestion of a c-section might not be a bad plan. Best of luck making your choice.

[Soul-O]

Originally Posted by Red Pajama 

I do not have experience here. However, you know what your recovery was like last time with the prolapse. Would you prefer that to sugical birth? are there other complications of the prolapse to consider? Do you plan on having more children?

It seems to me that as your last birth was so recent, taking the suggestion of a c-section might not be a bad plan. Best of luck making your choice.

Thanks so much for your reply.  You bring up points I hadn't really considered with regard to prolapse recovery vs. surgical birth.  My main worry is that I will have such a severe uterine prolapse from the vaginal birth that I will need a hysterectomy (rare, but it does happen) because the tendons holding that structure are very weak.  Taking the risk factors into consideration, I think it might be safer to have a c-section vs. a vaginal birth, especially because I am unsure of whether or not I want to have more children.  Given that a vaginal birth could result in a complication that renders me permanently infertile, I don't want to close the door on the possibility of more kids.  Hmm.. so much to think about!

[Monkey Keeper]

I think the close spacing between this and your previous pregnancy--and therefore the injury--would play into my decision as well. We all know that some degree of pelvic floor weakness is pretty normal with any pregnancy and vaginal delivery, and they resolve with time. Your body has not had the luxury of that time to grow strong again, and it was injured beyond what is typical. Given time and appropriate attention, yes, the weaknesses could be improved with therapy and such. But since you conceived so quickly after a significant issue, I would worry that the likelihood of reinjury or further injury would be much, much higher because your body did not have that time.

Having had a c/s and 2 vaginal births, I personally would lean toward a c/s if I felt that my fertility and continence were at risk.

[Soul-O]

Oops.. I just realized that I wrote Nov. 2011 instead of 2010 for my last delivery date - don't know if that makes a difference!  Anyhow, there will be less than 2 yrs between deliveries, and that does play into my decision making process.  I have done some work to get my pelvic floor muscles back in place (i.e. kegels, lots of pilates and yoga etc.), but I don't feel like things are where they should be, and added pregnancy weight pressing down on those structures won't help.  So... at this point, I'm still leaning more towards the c/s.  Thanks so much for your advice and information!