Pelvic floor damage = recommended C-section...help! - Mothering Forums

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#1 of 17 Old 09-06-2007, 09:33 PM - Thread Starter
 
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Hello...
I would love some input and help with this!!

I'm 9 weeks pregnant with my second child. My ds is 19 months old. I had an unmedicated, wonderful birth with him. I pushed for 3 hours, he crowned for 25 minutes, and I ended up having a 2nd degree episiotomy which I feel okay about because at that point it felt necessary...or as close to necessary as it was going to be. Since his birth I've been diagnosed with pelvic floor dysfunction (tone is too high, always contracting) and small defects in my external sphincter (they think due to the amount of time pushing and the positioning of his head). This has caused me some issues regarding bowel urgency, though nothing totally major.

I was seeing an ob/gyn for these issues (that my midwife referred me to) and after finding out I am pregnant again she recommended that I have a c-section for this baby. She said that I could have a wonderful vaginal birth with no recurring problems or I could make this pelvic floor issue even worse -the major problem being that there is no way to successfully fix it and could result in bad things like fecal incontinence.

For all the obvious reasons I do not want to have a c-section BUT another part of me is having a hard time with the "what if" aspect of a vaginal birth...my quality of life (and my children's quality of life) could be greatly affected by making this issue worse - I've heard stories of friends of friends who have to wear pads and more because they can't control their bowels.

My midwife is referring me to another ob for a second opinion and feels that this isn't a decision that needs to be made for months. However, it is consuming my thoughts! I'd love to hear experiences or thoughts from anyone who is kind enough to have read this far!!!

Thanks
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#2 of 17 Old 09-06-2007, 10:44 PM
 
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I saw one study that pelvic floor problems are no less common in women who have cesareans. What positions did you try when you were trying to push out your 1st? Did you have any directed pushing (i.e. doc telling you when to push, how, how hard, etc.)? Did you have an urge or did you start because you were complete? I'd be inclined to dump the OB and find a good midwife who understands instinctive birth. A cesarean is major abdominal surgery, with a long list of potential complications and a guaranteed cut to your skin and your uterus. All to avoid the *possibility* that you *might* sustain some pelvic floor damage? Not me. I'd go for a homebirth, personally. I'd love to hear details about your birth if you're willing to share.

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#3 of 17 Old 09-07-2007, 12:09 AM
 
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I'd have a homebirth with a midwife who won't cut. I expect that that was the real problem.

-Angela
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#4 of 17 Old 09-07-2007, 09:51 AM
 
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Yes, because episiotomy has definitely been linked to pelvic floor damage.

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#5 of 17 Old 09-07-2007, 09:57 AM
 
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I would get a second opinion. Fecal incontinence is nothing to mess around with. And be aware that pregnancy alone has an effect on the pelvic floor, so your condition could worsen regardless of what kind of birth you have. It's a personal decision and I would want to make sure I had no regrets. Good luck. If you do decide to go vaginal, try to avoid directed pushing. No pushing at all - breathing the baby out - would be the best option.
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#6 of 17 Old 09-07-2007, 12:00 PM
 
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My SIL had a c-section with her third because she was told she might end up with a colostomy bag if she had another vaginal birth (lots of tearing in the first two, and I think episiotomies). At first she thought it was great, but she has developed endometriosis (I have seen research that has linked c-sections to an increase in endometriosis). The doctor has told her that she always had endo, but it was masked by the pill, and since she also had a tubal and was off the pill it is just happens to be showing up after her c-section (yeah, right). Anyway, I think that the endo has ruined her life as much as fecal incontinence could (constant pain and bleeding).
I had a scheduled c-section for fetal macrosomia. Recovering from a c-section is no picnic either. It was at least six months of recovery, and I think I have finally stopped having twinges of pain here and there (dd is almost 2) in the last few months.
There is also a recent report (in December of 2006, in Birth) that babies born by elective c-section are three times more likely to die in their first month of life than babies born vaginally.

At least you have plenty of time to research this. There is lots of information on c-sections out there:
www.ican-online.org
www.childbirthconnection.org

I would also look at Henci Goers books (Obstetric Myths vs. Research Reality and The Thinking Women's Guide to a Better Birth). She may have reviewed the research that deals with this topic.

Also, a book I have seen recommended :"Getting through Birth in One Piece" about how to avoid an episiotomy.

Good luck with whatever you decide.
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#7 of 17 Old 09-07-2007, 12:34 PM - Thread Starter
 
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Thank you so much for your input, ladies.

SublimeBirthGirl - I just read last night after I posted the study that you were talking about.

I would be happy to share my birth details.....I started pushing about 13 hours after labor started. I was complete but did not feel the urge to push. My midwife didn't push me either way but I was so tired of being in labor that I said I wanted to push. I wish now that I would have waited for my body to be at the same place my mind was because I believe that made it more difficult. I got out of the tub that I spent most of my labor in and started pushing while seated in bed (semi-reclined). I didn't make much progress so used a squat bar - wow, the difference was amazing! In about 20 minutes(?) he was close to crowning. My legs were exhausted so I returned to the previous position in the bed (I know, it sounds ridiculous considering that didn't work previously) and attempted to push him out. The midwife and nurses were directing my pushing somewhat - I would tell them when I wanted to start, they would tell me how hard to push, and I would tell them when I wanted to stop. He crowned for about 25 minutes. I believe the midwife tried to help my perineum stretch but I'm not sure exactly what she did. She eventually did an episiotomy because he seemed truly stuck and I was exhausted. He came out a few pushes later with his little hand by his face.

I know that the episiotomy is definitely a major part of the problem. The midwife felt terrible about having to do it, but at the time I really felt okay about it.

I will check out the books and websites everyone recommended. In my heart, I do not want a c-section and am struggling with the risks vs. benefits either way. Thank you all so much for your wise words and input. It helps greatly!!
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#8 of 17 Old 09-07-2007, 12:43 PM
 
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There was no reason for the episiotomy. None. No rush, no fetal distress, no change in position, no need. It should not have been done.

FWIW I pushed with dd for around 6 hours. If I'd been in a hospital I would have been cut.

-Angela
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#9 of 17 Old 09-07-2007, 01:18 PM - Thread Starter
 
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Alegna - Wow! What did you do to help keep up your energy levels pushing so long? What did you do for perineum support? Did you tear at all?
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#10 of 17 Old 09-07-2007, 02:24 PM
 
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This is a tough question that I've thought about myself in the last few weeks. I had my 4th baby 7 weeks ago and I'm pretty certain I have a prolapsed bladder now. Whether it was from pushing too early or just years of pregnancy and 3 vaginal births I don't know. But if we ever decided to have another child I don't know how I would feel about this. I had an emergency c/s with #2 for previa and thinking back to it the whole thing was nightmarish even though it was a pretty standard surgery and recovery. I don't know if I could choose that for myself. On the other hand my quality of life is effected right now by the prolapse and I don't want to make that worse. I'm pretty sure I would choose another homebirth and just do my best to breathe the baby out but on bad days where it feels like my insides are about to fall out I wonder what I would choose.

If I do become pregnant again I will be doing a lot of research and getting 2nd/3rd/4th opinions. Have you looked at the Pelvic Organ Prolapse thread? Maybe there are things you could be doing to strengthen your pelvic floor during this pregnancy in preparation for a vaginal birth?
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#11 of 17 Old 09-07-2007, 02:31 PM - Thread Starter
 
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Goatriffic - Congrats on your new baby! I hope that your recovery improves and you are able to find the help and care you need for your bladder. Thank you for your experience and insight. I will definitely check out the other board - I had no idea there was a Prolapse thread, thanks for the suggestion.
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#12 of 17 Old 09-07-2007, 03:14 PM
 
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Originally Posted by Jak's Mom View Post
Alegna - Wow! What did you do to help keep up your energy levels pushing so long? What did you do for perineum support? Did you tear at all?
Ate whatever I could stomach... peanut butter, honey, gatorade, etc.

Didn't do any perineum support- couldn't stand anything touching me down there.

I had an odd tear inside, but my perineum was intact.

I declined stitches and it healed fine.

-Angela
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#13 of 17 Old 09-07-2007, 03:29 PM
 
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Thanks!
http://http://www.mothering.com/disc...d.php?t=713732
Here's a link for you. There is a lot of great info there, hopefully some of it will help you. I just wanted to say that normally I'm very passionate about avoiding csections since I had a really tough fight getting my first VBAC 5 years ago. And my most recent birth at home was amazing. So it's really hard for me to consider a future elective csection. I understand that this will be a hard decision to make and I hope you find the best option for you and your family.
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#14 of 17 Old 09-07-2007, 11:26 PM
 
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This isn't directly related to prolapse, but I had my third c-section two years ago. I can still barely feel my bladder - the sensation is minimal and comes and goes. I have no idea when I need to pee (it can feel like I have to go right now, and 30 seconds later, there's no feeling of fullness at all) and have come close to peeing my pants several times since the surgery. I'm also largely unable to do Kegels...can tense the muscles, but can't isolate them. This is after doing them daily for almost 25 years.

I don't have true fecal incontinence, but things aren't as tight and/or under control there as they were before the surgery, either. I have a lot of problems with my digestive system, and totally unpredictable and uncontrollable attacks of gas. I don't really want to get into it, as I'm a bit uptight about body fluids, honestly.

Anyway - these things are all related directly to nerve damage in my pelvis from the surgery. Despite the spin the medpros put on it, getting cut open doesn't preserve the pelvice area...not at all.

As far as symptoms that aren't related to bladder/bowels...I had an infected incision (probably not related to the numbness, as the infection was at the other end of the incision from the huge numb area) that took two months of daily treatment to clear up...the incision didn't close for that period. Before getting pregnant with baby-under-construction, I felt burning, stinging pain in my scar at irregular intervals - from what I've been able to find, I think it's caused by endometrial tissue that was caught up in the incision at the time of surgery - but I don't know for sure, and doubt I ever will.

So - I guess I'm just saying that a c-section really isn't protective of your pelvic region. While I don't think I've experienced any actual damage to my pelvic floor, the effects are largely the same as if I had.

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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#15 of 17 Old 09-08-2007, 12:51 AM
 
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I had a 2nd degree tear and episiotomy with my first child. Thankfully I do not have damage, but I was scared of tearing with my second child. My midwife was fantastic with doing perineal support. She used hot water on rags and massaged my perineum, even vigorously for a few minutes with olive oil. I had no tearing, and it really made pushing more comfortable for me. I would go that route.

As for the risk of further damage or fecal incontinence, medicine has come a long way and in many cases you can be surgically repaired. Personally I would take the risk of going vaginal because the risks involved in a C-section are far greater, in my totally uneducated opinion.
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#16 of 17 Old 09-08-2007, 01:02 AM
 
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I had a horrible episiotomy with my first child. The OB/Gyn cut me and then I tore through my anal sphincter. TMI sorry. I ended up with close to 200 stitches.

I had severe pelvic floor dysfunction with weakness, spasms, pain, etc for the first year after he was born. I found out when he was 12 months old that I was pregnant with my daughter.

I saw a midwife for my second pregnancy. She didn't do perineal support and there was no guided pushing. I just pushed when I was ready. I tore only the smallest little tear. It required one stitch to repair.

My pelvic floor has actually improved greatly since my second birth. I am not having any of the same problems I was before.

Perhaps my story can give you a bit of hope?
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#17 of 17 Old 09-08-2007, 09:18 AM - Thread Starter
 
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CalenandEllasmomma - Thank you for your story! It gives me more hope than you know. I am terrified of making things worse and am so happy to hear that isn't always the case!

MamaPoot - I thought the same thing - the risks of a major abdominal surgery like c-section are so much more than a sphincter repair, unfortunately, the ob said that those types of surgeries rarely work. Thanks for the tips of how your midwife did perineal support - I will definitely be talking with my midwives in detail about what they would plan to do!

Storm Bride - Wow! I'm sorry you have had such a rough time with your c-section. It is good information to have when considering both sides....thanks!

I really do thank you all so much for your sharing. I didn't expect so many to respond and am so grateful that you have. I feel that this decision is totally overshadowing the joy of being pregnant, and with this being possibly our last baby I'm trying to enjoy it and not let that happen.

Thanks so much for your stories and insights.....
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