Terrified of birthing again

[EmilyVorpe]

I had a bad first birth experience in July 2004. I was mutilated with several epis. and then had an infection spread from them (I took care of them, not that I wasn't unclean). My 2nd birthing experience (may 2007) was my first natural birth, with barely a labor (no pain til pushing). I tore twice. I got an infection with those also. It had spread to my uterus by 10 days ppd. Also, with my 2004 delivery, I tore my rectum. The doctors I saw for 2 YEARS afterwards told me it was in my head and that there was nothing wrong with my bum. For 2 YEARS I cried every time I had a bowel movement. With the 2nd pregnancy, I had my new midwife check me out and she said there was a fissure. We tried MANY treatments for 3 months, only to have it partially heal. During delivery, though, it tore again. I'm told there isn't anything to do other than have a surgery to repair this.
SO ANYWAY, my experiences have left me absolutely terrified of birthing again. I have an IUD but became pregnant. I am due to deliver June 2008, just over a year after my last birth. I'm so terrified of this that I'm actually considering seeking out a section-happy OB. How can I get over this fear? I'm terrified of the agony. It's been 3.5 years since I've been able to go to the bathroom without pain, my perineum is still swollen and sore (6 months ppd) and I'm a mess. How can I get over this? Or is a csection my best chance?

[DoomaYula]

I have no advice but big

I'm so sorry for your experience.

[nancynance]

You also might want to post this concern on the Midwifery Today forum. A lot of those midwives have knowledge in these kinds of areas. I totally understand your fear and wish you all the best.

[leila1213]

I am not a birth professional but just came across your post. I used hypnobirthing and I'm wondering if it might help you (or hypnobabies or something more customized). If you find a very experienced practitioner you may have success in "fear release" exercises to help you confront your fears and deal with them, then let them go.

Also, a very gentle calm approach to birthing, such as hypnobirthing, might help you avoid any sort of forceful "pushing" at all. I know there are many progressive midwives who do not advocate for pushing; just let the uterus do its amazing thing. I did not do any conscious pushing - only "birth breathing" - with a little grunting thrown in there.

I'm sure that there are measures that could be taken to help avoid/minimize tearing, knowing what you know now about what has been causing your pain. For example, my hypnobirthing class advised perineal massage to help stretch out the tissues prior to labor. Then, if it is needed during labor, hot compresses could be applied. Did you do anything like this?

ETA: I had an episiotomy with my first birth, which should have made tearing during the second more likely. I had some superficial mini-tears, but nothing that required stitches.

Maybe this is all stuff you know and I'm being presumptuous. If so, I'm sorry. Like I said, I'm not a professional. I hope you are able to have a wonderful birth experience on your own terms.

[leila1213]

Great info in this thread too: http://www.mothering.com/discussions...d.php?t=793920

[Jane]

I wonder if a consulation with an infectious diseases expert would benefit you. It seems that many of your complications are from bacteria. It's possible that there is a more invasive type of bacteria on your body that gets into your wounds - similar to the way that some people have more acidic bacteria in their mouths and get more cavities. There might be something they can do now...
While I almost don't want to suggest this, is it possible that you have an underlying problem with healing - like celiac disease or something that is putting stress onto your system? Many women have episiotomies or tears and heal well even with "poor" care. Your average (or, I'm assuming, way better than average after your first experience) should have done the trick.

You wouldn't have to find a "section happy" OB - perineal trauma, especially incontinence of stool is an indication to offer a section anyway. Just about any doc would do one with your symptoms. It is a real option. But I believe that vaginal birth is also a good option. Only you can decide.

Have you had a consult with a reconstructive surgeon? Are you planning that for after you wean?

One last thought - can you see a pelvic floor physical therapist? They can often do wonders for things that you wouldn't think were fixable with PT.

[EmilyVorpe]

After my first birth, I did have pelvic floor therapy. I was unable to have sex for more than a year from the pain. The physical therapist told me I reached my peak at recovery. With my 2nd birth, I gained a rectocyle and cyctocele (sp) and was told to get surgery to fix these. I'm only 23--surgery on my vagina is scary. The rectal fissure will have to be fixed surgically--I plan on it as soon as I can, after this last pregnancy. I was told, though, that if I tore more, even surgery may not work too well and I may be left without control. Lovely, huh?
Also, during recent delivery, I did receive peri message and warm compresses. Midwife did what she could to prevent the tears--but I did end up with 2 stitches.
I guess my questioning is more of a "what would you do".... I'm all for natural birthing, because it was a lot easier to recover from, and there weren't side effects for my daughter. But I'm really scared to damage my body so badly it will ruin me...being 23 years old, I've gotta lot of years ahead of me.

[leila1213]

. It sounds like a lot of pain and worry to be going through. The other thread I linked to had some accounts and opinions from women who have been through somewhat similar experiences. I haven't, so I can't really say what I would do. The gist of what a lot of them are saying, and I tend to agree (although not really knowing since I'm not in your shoes) is that a C-section is a guarantee for major surgery with all the attendant risks and potential complications. However, an attempt at vaginal birth has many benefits in and of itself. There is only a certain percentage chance that it would lead to more tearing, major surgery and/or incontinence. I don't feel like I'm explaining it well. It made sense when they said it on the other thread. Sorry I can't be more helpful. Good luck to you.

[DanishMom]

In your situation I would have a c-section. The risk of serious rupture does increase with each birth. I'm really sorry you are faced with such a difficult choice.

Good luck and hugs!

Anne

[babycatcher01]

First and for most Iam sorry that you have this in your life. No doubt that this is hard for you. You need to heal this in your innerself first. Emotionaly and mentaly. Talk to someone you trust a good midwife will always listen with out judgement. YOu have and inner conflick that I feel if its not resloved will hinder your birthing, but worst of all may hinder the way you look at yourself as a mother and a wife. There are lots of things we have no controle over, but that being so we have just as many that we do have controle over.

What do you have controle over? Your body, and were you birth. YOu need to feel safe were you are going to birth and trust the people who are attending you. Most of all you need to trust yourself. Every pregnancy, birth, and baby is different. The more you are in controle listening to your body, have no fear, fear = pain = tention in tissues = an unsafe birth. Just desided to have a section without working through these things arnt going to help you full circle. I been avoided. You have time to become the birthing woman you really want to be. Trust your body and listen to your baby. Peace be with you.

[Carolinamidwife]

{{{hugs}}}

I, in no way, mean for this to sound dismissive but if I were in your shoes I would have a surgical delivery and I would make sure that even though it was taking place in an OR it was the birth of my dreams.

Your issues go beyond my scope of practice but anytime you are risking fecal incontinence I get hesitant to push for a vaginal delivery. After everything you have been through, you have experienced natural childbirth, maybe a surgical delivery would be a more peaceful experience. Even the most conscientious OB (despite being a trained surgeon) would offer you that option with your history.

[shellbell]

I am not a birth professional, but another thing I was thinking about as I was reading these responses is that if you do decide to have a vaginal birth this time around, you should probably (if you don't already) get heavily into probiotics (they are good at preventing bacterial infections)... in order to possibly prevent more infections from possible tears. I also would be tempted to request antibiotics after giving birth in a situation like yours... because of the infections that have taken place in your pospartum history.

Shell

[pigpokey]

If you do a c-section, try to make sure you can keep contact with the baby. You may need to choose among your hospitals, for whatever one does not separate the mom and baby in a c-section. You may also be able to have the area between your vagina and rectum opened up after the c-section and repaired, while your spinal is still working, which you might find one of the more convenient of your inconvenient repair choices. You will want to consult a urogynecologist -- I'd look for the best -- to repair your perineal structures & near the rectum. Meanwhile, I took large doses of vitamin C daily during my second pregnancy to keep my stools soft and IMO there wasn't any compelling evidence against that, but please decide for yourself.

I think some of the downsides to the baby can be minimized if you wait until the baby initiates labor to go in for a section; but that would pretty much rule out getting any repairs done at the same time.

[Diva Mama]

If there are major issues with infection from the tearing, I wouldn't feel safer facing a major surgery. There's already a higher risk of infection there.

I think you ran into a few bad doctors. Assemble the birth team you need for the level of support you'll need. ITA with having your system checked in general and working on keeping healthy and, well, not germ-free, but germ neutral?


Good Luck!

[Carolinamidwife]

The infections could be stemming from the fistula, in which case surgery would avoid reopening that area.