Hi girls
Almost a little scared to post as i am only 9 weeks pregnant, but i think i have to prepare myself. I had 3rd degree tear with my son (tore through my bowel) and was told when it happened that next time i would have to have a CS. Well its taken me a long time to get preg again and i knda thought that maybe i woould give a vb another go, but saw my ob yesterday who initally said i cant see why not, but on further discussion and examination said there is just not enough room and that the same will definately happen again. Exactly same thing happened my mum and she now has prolapse bowel, therefore CS is really the only option. So im just wondering when are CS generally done do you go to full term (40 weeks) or is it done earlier and is recovery as bad as everyone says ? would love some advise. thanks
Last edited by scooby; June 24th, 2008 at 03:52 PM.
Normally elective c/s are done approx 10 days earlier (not sure why?). I had an emergency c/s with DD and I recovered really well. I was walking around really well by the time I got home from hospital, and was doing everything normally, just no lifting or over exertion, and I was even given the ok to drive at 3 weeks post c/s. Everyone is different though and I know some women have a harder recovery. I think I was just v lucky. Even now, I dont have no trouble, never had an infection etc etc..
Scooby,
I assume you mean VB (Vaginal Birth), not VBaC (Vaginal Birth after Cesarean)? It sounds like you've only had one bub so far and that was a vaginal birth... Sorry, I don't mean to be a know-it-all, jut trying to clarify...
C/S are usually done before your due date, at 38-39 weeks. This is so that you don't go into labour. They prefer being able to plan for the operation, I think, rather than having to do an "emergency" C/S.
If I was you, I would see whether I could get a second opinion about the neccesity of a C/S this time around. Your tear sounds pretty full on, your mother's even more so. But there are lots of reasons women tear, and some ways to manage/prevent it or reduce the severity.
Also, there is a case for going into labour before having a C/S. Some health professionals are of the opinion that it is better for both mother and baby if labour has started before the C/S was performed so that it is as close as possible to the physiological process of a natural birth. So this might be worth exploring, too.
Oh, and as Lisa said, some women find recovery from a C/S very easy, others don't. There is an increased chance of infection (along with other possible complications). You are also usally not advised to lift your baby in the first week or so after the birth. Some women find BFing more difficult, partly because the usual hormonal upheaval of a natural birth hasn't happened, partly because the scar might be painful and they find it more difficult to find a comfortable position for BFing. Having said that, some women find recovery from a vaginal birth difficult, too, especially if it was a difficult, long, drawn out labour.
Good on you for trying to get lots of info before making your decision!
Sasa
Last edited by sunshine_sieben; June 24th, 2008 at 02:46 PM.
Thanks girls for the info
SS yes i mean VB not VB been in LTTTC too long!!!
OB was very keen on the idea of letting me have a vb as she said as long as i would have an episiotomy it should be fine as they will cut away from my back passage but when she examined me she said the perineum is just so short that its bound to happen again and really i see the embarrasement and pain my mum has gone through for years because of her prolapse, not fun and something i dont think i want to risk. I like that idea of going into labour first that makes total sense must check that out.
Lisa hope my recovery is as good as yours i think the most important thing to me is being able to feed and cuddle nothing else matters Again thanks soo much for taking the time to reply
I had a CS whith my DS and the recovery was OK. It took probably about 6-8 weeks to feel norma again. However, I had a VBAC with my DD and have had ongoing issues with an anal tear and nasty hemmoroids (sp?). It's been 7 months since she was born and I'm still suffering.
The reason they do electives a week or so early is because STATISTICALLY elective sections are less risky than emergency sections, but that is probably something to do with all the genuine emergencies in there - if bubs or mum is already in trouble when you operate the outcomes might be worsened by that, rather than the surgery. They also prefer to be able to schedule electives during the day for the hospital's convenience.
Talk to your ob about labouring for a bit first. In general it is MUCH better for baby to choose the birthday, as dates and scans can be out and many elective babies are premmie because of this. Even if you know the EXACT day you ovulated - sperm can live inside you for 5-7 days, so you've no way of knowing for sure what day it all happened. Some obs are very open to the idea of the baby picking the day and others are not, so asking is the only way to find out really.
As an aside, i know of a woman (friend of a friend) who had a 4th degree tear with #1 (7lbs9oz, 35cm head) (when she had an epidural and coached pushing and then ventouse) - she tore right through into her bowel for the last 4 inches of her vaginal wall and had 2 severe anal fissures too. She had #2 (9lbs1oz, 36.5cm head) at home without epidural or coached pushing, and though her pushing stage was longer (100mins) because she only pushed a tiny bit with each contraction, she didn't need a single stitch, got away with just a graze. In addition i now know 2 women who had c-sections who have now prolapsed. It can reduce the risk for some women, but please don't see it as a get out of jail free card - i would HATE for you to have the section to avoid prolapse and have one anyway.
In general women's perineal anatomy (barring actual abnormalities/birth defects) makes little difference to who will tear, as does scar tissue (which contrary to oft-told belief IS stretchy).
Things that make a difference are epidural or spinal anaesthesia (because you can't feel what you're doing), coached pushing (because you're not listening to what your body tells you), reclining pushing stage (because the weight of the baby is resting on the preineum as you push - on your hands and knees the baby's weight comes down evenly on the opening of your vagina, rather than more onto the perineum), fast pushing stage (because you don't have time to stretch), forceps or ventouse delivery (because the Ob is inclined to pull harder than you could push, which increases the stress on the whole area) and episiotomy. Your ob saying the episiotomy would be done rang alarm bells for me - episiotomies INCREASE the risk of tearing. Imagine trying to tear a towel in two, pulling on the edge. Now imagine you cut a nick in it with scissors first...! MUCH easier to tear. In addition, the kind of cut she was talking about is a particularly painful one - they cut sideways, towards the buttock, and if you tear at the epi site you can tear right into your glute, which makes sitting and walking painful for sometimes months. Emergency situations (vaginal birth of a baby with a prolapsed cord, birth of a breech whose head has become stuck and compressed the cord, forceps delivery of a baby who is in serious distress) warrant episiotomy, in general slow, gentle, delivery makes a FAR bigger difference.
If i were you (and i'm not so do feel free to ignore me!) i'd seek a second opinion before booking anything. You have time to research your options and strategies, which is a big bonus.
I had an emergency c/section due to failure to progress, the bubba was just in the wrong place & too big for me. He arrived @ 9.30pm. I had a spinal epi. I was up the next day & he is fully BF. He was in the nursery the first night because he had to be in the humidi crib but otherwise he was with me. I was able to pick him up the next day & he has been full BF since birth, there was some pain when I BF a bit like a contraction but nothing too severe. The only painkillers I had beside the epi was 1 shot of pethadine at 4 am followed by ponstan & panadine forte/panadol regularly. I have had no problems with scar or infections etc... When I got home after day 5 (my milk took a little long to come in but I think that was because of the pethadine) I wasn't on any painkillers. I didn't overdo it of course as I had major surgery but that gave the time to be fully focused on DS.
If you have an option they do say that even some labour is good for the baby but from your experience I would want to have a c/section as being a real option.
My sister tore & her stiches got infected soI think there are risks no matter what we choose so try and be as well informed as possible & choose the right option for you.
GL & with your pregnancy.
NJD: thank you so much for that info and im so glad that you were able to BF, it really is my biggest concern! I have been desperatly trying to get information on C/S but unfortunately all the literature is on how to avoid one, which is great, unless you are having one Ive had 3 obs and a midwife tell me its really not a good idea to have a vb including my family and friends who remember well the monthes of agony afterwards so i think cs is really the best option. WOuld really appreciate if anyone knew of some factual CS information for best recovery etc.
Once again thank you so much njd for sharing your story with me
Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study (Villar, et al., British Medical Journal, 2007;335:1025, 17 November)
Study Design: Researchers assessed the risks and benefits of cesarean delivery vs. vaginal delivery.
Bottom line: Cesarean carries twice the risk of injury and death for both mother and baby. Women with cesarean experience double the rate of hysterectomy, blood transfusion, admission to intensive care, prolonged hospital stay and death, compared to mother who delivered vaginally. Babies born by cesarean were 45 percent more likely to be in the neonatal intensive care unit for 7 days and 41-82 percent more likely to die than babies born vaginally.
Risk of Uterine Rupture and Adverse Perinatal Outcome at Term After Cesarean Delivery (Spong, et al., Obstetrics and Gynecology 2007; 110: 801-7)
Study Design: Researchers examined the risk of uterine rupture after cesarean and what harms it may have for mothers and babies.
Bottom line: Regardless of how the baby was delivered, the rate of uterine rupture was low and complications from rupture were also low for both mother and baby.
Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. (Declercq, et al. American Journal of Obstetrics and Gynecology. 2007 Mar; 109(3):669-77.)
Study Design: Researcher divided mothers into two groups: women with a planned cesarean after no labor and women who labored and had either a cesarean or vaginal birth and then compared rehospitalization rates.
Bottom Line: Rehospitalizations in the first 30 days after giving birth were 2.3 times more likely in planned cesarean than with planned vaginal births. The leading causes of rehospitalization after a planned cesarean were wound complications and infection. Hospital costs were 76 percent higher for women with planned cesarean, and hospital stays were 77 percent longer.
Previous caesarean or vaginal delivery: Which mode is a greater risk of perinatal death at the second delivery?
(Richter, et al., European Journal of Obstetrics & Gynecology and Reproductive Biology 2007; 132: 51-7)
Study Design: Researchers compared mothers who had delivered previously by cesarean vs. vaginally, and examined the number of babies who died in the subsequent pregnancy.
Bottom line: A previous cesarean delivery was associated with a 40 percent increase in perinatal death (the first week after birth) and a 52 percent increase risk of stillbirth. A vaginal or cesarean delivery in the current pregnancy did not impact the death rate.
Postcesarean delivery adhesions associated with delayed delivery of infant (Morales, et al., American Journal of Obstetrics and Gynecology 2007; 196: 461.e1-e6
Study Design: A common complication of any surgery is overgrowth of scar tissue, called “adhesions.” Researchers examined the frequency of adhesions with successive cesareans and whether adhesions caused by cesareans could slow down the delivery of a baby in the next pregnancy.
Bottom line: Researchers concluded that each successive cesarean significantly increases the incidence of adhesions and can slow down the delivery of a baby. One prior cesarean adds 5.6 minutes to the time it takes to deliver the baby, 2 prior cesareans 8.5 minutes, and 3 prior cesareans 18.1 minutes. This delay can compromise the health of the baby, researchers concluded.
Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. (Yang, et al., British Journal of Obstetrics and Gynecology: 2007 May;114(5):609-13.)
Study Design: Researchers examined the incidence of placenta previa (placenta blocking the cervical opening) and placental abruption (placenta separating from the wall of the uterus prematurely) in women who have had a prior cesarean vs. a prior vaginal delivery.
Bottom line: Compared to vaginal birth, cesarean increased the risk of placenta previa by 47 percent and placental abruption by 40 percent. Both complications carry the risk of death for both mother and baby. Researchers indicated that complications may be due to the cesarean scar on the uterus.
Risks of adverse outcomes in the next birth after a first cesarean delivery. (Kennare, et al. American Journal of Obstetrics and Gynecology. 2007 Feb; 109(2 Pt 1):270-6.)
Study Design: Researchers examined the complication rate of women who delivered their first baby by cesarean vs. vaginally.
Bottom line: Women who had a prior cesarean delivery were more likely to have complications than women who had a prior vaginal delivery. Women with a prior cesarean were more likely to have a placenta previa (odds ratio [OR] = 1.66), placenta acreta (OR = 18.79), and bleeding during pregnancy (OR = 1.23). During delivery, women with a prior cesarean were also more likely to have a prolonged labor (OR = 5.89), uterine rupture (OR = 84.42), and need an emergency cesarean (OR = 9.37). Babies born to women with a prior cesarean were more likely to be small for their gestational age (OR = 1.12), have a low birth weight (OR = 1.30), and to be still born (OR = 1.56).
Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. (Coassolo, et al., Obstet Gynecol. 2006 Jan;107(1):205)
Study Design: Women who attempted VBAC before the estimated due date (EDD) were compared with those at or beyond 40 weeks of gestation. Researchers assessed the relationship between delivery after the EDD and VBAC failure or complication rate.
Bottom Line: The risk of uterine rupture (1.1 percent compared with 1.0 percent) or overall morbidity (2.7 percent compared with 2.1 percent) was not significantly increased in the women attempting VBAC beyond the EDD. Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.
Incisional endometriomas after Cesarean section: a case series. (Minaglia, et al., J Reprod Med. 2007 Jul;52(7):630-4.)
Study Design: Patients were identified who were diagnosed with incisional endometriomas (functional endometrial tissue outside the uterine cavity, within the incision) after undergoing cesarean section.
Bottom Line: The overall incidence of incisional endometriomas following cesarean section was 0.08 percent. Optimal treatment is by surgical excision.
Predicting Failure of a Vaginal Birth Attempt After Cesarean Delivery. (Srinivas, et al., Journal of Obstetrics and Gynecology. 2007 Apr;109(4):800-5)
Study Design: Researchers analyzed the records of women offered VBAC in 17 community and university hospitals, to identify any factors that could be used to predict failure in attempting VBAC.
Bottom Line: Prelabor and labor factors cannot reliably predict VBAC failure.
Caesarean delivery and risk of stillbirth in subsequent pregnancy: a retrospective cohort study in an English population. (Gray, et al., BJOG:2007 March 114(3) 264-270)
Study Design: Researchers compared the incidence of stillbirth following a previous cesarean section with stillbirths following no previous cesarean section.
Bottom Line: Pregnancies in women following a pregnancy delivered by cesarean section are at an increased risk of stillbirth.
Predicting placental abruption and previa in women with a previous cesarean delivery. (Odibo, et al., Am J Perinatol. 2007 May;24(5):299-305.)
Study Design: In women with a previous cesarean section, researchers compared those who had a placental abruption and/or previa with those who did not.
Bottom Line: Three or more previous cesarean sections was a significant risk factor for placental abruption and previa.
Hi Alan
Thanks for that, it is very similar to info i have already assessed, i actually titled this wrong as i havent had a previous cs my son was born by VB but i had 3rd degree tear, he popped his lung and i went on to almost a year of infection and rehabilitaion and things are still not 100% almost 5 years later. I have been told this is an anatomical problem ( very short perineum) like i said by 3 obs and 1 midwife. I have had to have 18 monthes of fertility treatment to fall pregnant again and also had an ectopic at the end of last year. This will be my last pregnancy as 2 children is all i ever wanted. All this said i have pondered over VB and CS for the whole time i have been trying to concieve and i study natural medicine so medical intervention is just not something that i wanted, but the 5 % chance of ending up with a coloscopy bag is really swaying my decision. All that said i know CS has a bad rep i know all the risks and i feel i have done my home work on this, i really want info that can help me get in the best possible shape before the cs and how to get better as quickly afterwards and as i have said to be able to BF my baby is the biggest issue !!! i even down loaded a copy of the The cesarean booklet and its full of the info you gave me. i really do feel i need support in my "choice" and unfortunately there is none out there except from the women who have been through it.
Hi Scooby,
I can understand why you would be inclined to have a c/s given your circumstances. When I go for round 2 I would like to try for VBAC but as I have already had a c-section the chances are I may need another c/section therefore there are things I would do before the birth to prepare for that option. The thing I remember the doctor saying is that I was healthy & that would go a long way to helping with the recovery.
I would express the colostrum so that there is some for when I am in recovery (they give it to the bubs via a syringe generally to avoid the nipple confusion that can occur with a bub). This would also have to help with bringing in the milk. I would do some searches on BB there seems to be some natural things like alkivite & Fenugreek & flaxseed oil that you can have on hand if you need do to boost your milk supply. Be fit, now this doesn't mean doing marathons but do some gentle exercises & be active, I tried to walk most days - this includes incidental walking eg to the shops, around the shops etc... I did tummy excercises where you pull your belly into you to help the muscels. I mostly got my inspiration from the pregnancy books I got in the hospital showbag you get when you book into the hospital & from the antenatal classes. I wasn't obsessive or anything but tried to do some every few days for about 10 - 20 mins, it wasn't always all at once either I would do 1 set of exercises & then some later.
Be prepared - which is what you are trying to do, read up on some pain managment. Check your hospital policy to see if DH can stay with you overnight if that is an option if you have someone to watch your DS especially for the first night or 2. My DP didn't stay overnight but he was there for as long as possible & a great help.
Remember - take your pain medication when it should be taken to keep on top of the pain, as my dr explained that way you can recover quickly. Try to get up as quick as possible after the op. Always breath. If you are having difficulties picking up bub the midwives are there to help you, don't be afraid to buzz them to come & get your bub for you that is their job afterall.
Anyway GL with whatever you decide & I hope this helps. If you have any questions don't hesitate to ask.
NJD: Thanks so much that is all the type of info i am after and it all makes total sense. Im actually abit of a gym junky and stopped for a little while because i got hyperstimulation from the ivf meds i started back for about 4 weeks but my 12 week scan showed my placenta was lying very low and i have had some spotting, so my ob has banned the gym in the meantime but hopefully they will let me back soon, BUT i will keep walking. Sorry to keep buggin you but what pregnancy books did you have i just cant seem to get any info, i think i must be looking in the wrong place!? Once again thank you.
Scooby, first of all sorry you had such a difficult birth with #1.
Just wanted to say my stepmother had 3 c/sections for reasons I won't go into, always recovered amazingly well - I was surprised to find out that recovery is 6 weeks as she always bounced straight back and after a week in the hospital was at home looking after her kids and showed no ill effects at all. All three were fully breastfed from Day 1. So I think it just depends on the person, and you can have a swift and full recovery and establish BFing after a c/section. If you have decided this is right for you (and to be honest, in your shoes I would do the same) then go ahead and be confident that you will recover quickly.
My hospy want to take my baby at 38 weeks, but this is because of risk of uterine rupture (pffft)
So they want me to avoid labour completely.
Do you need to avoid labour?
Pixie: thanks for that, yes i think a psitive outlook and getting back into things (slowly of course) may be the best way, i aprreciate your support thanks. Good luck too not long to go
MTT: yes its on my list of things to ask my ob at next appointment, it definately sounds good if you can go that way it makes total sense, thanks and good luck to you.
My ob has actually said that if the baby comes early 37 weeks i may be able to try a VB not sure how i feel about that as im not sure how great it is for bubs to come that early, DS was 2 weeks over ! but would love to go a VB.
Scooby, I have just realised you are in Perth & the books I am referring to are done by the NSW hospitals. I would be happy to photocopy the pages about exercises & post them to you if you would like??
Scooby - I am sorry that you suffered so much pain with your first birth. I had an elective c-section for DS, and my doctor took him out at 39 +1 weeks. But most hospitals/OB's have their own sort of preferred time line, as well as what actually happens ie, recovery.
My section was fine, I healed great (can't really even see my scar 18 months later) and I was up and walking the next morning (albeit very slowly!!!).
Unfortunately BFing didn't work for us, but I doubt that had anything to do with the c-section, more just bad advice from midwives, and poor attachment, and the fact that DS had neck issues which did not help him attach at all without pain.
My sister has also had 4 c-sections, and she said that she heals better each time, and she has BF 3 of her children successfully (one of her c-sections was a stillborn).
If I can help with any other information from either my experience, or my sister's, please feel free to ask away!!
I'm curious though, as I am going for my VBAC - when you say that your perineum is short - how short is "short"? Cos I have always thought that mine was quite close to my girlie bits and would be interested (if you are willing to share) as to what they consider short to be. (I've never thought to ask my OB, I'm a little shy.. )
What you "see" as the perineum is only about 1/3rd of it, the rest of what becomes perineum during birth is inside the vagina most of the time - that's why perineal massage is done with the thumbs inside the vagina. At the end of pregnancy the whole area "relaxes" so the distance front to back gets much longer. And if, like me, you tore and were not stitched the perineum can look a lot shorter afterwards.
I just measured (hilarious and strangely scientific) and mine (from bottom of vagina to edge of anus) is 1.5cm stood up and 2cm if i lie down. I'm not pregnant though.
CS after VBAC
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been in LTTTC too long!!! 
Again thanks soo much for taking the time to reply
with your pregnancy.
- I hope things improve for you soon
Ive had 3 obs and a midwife tell me its really not a good idea to have a vb including my family and friends who remember well the monthes of agony afterwards so i think cs is really the best option. WOuld really appreciate if anyone knew of some factual CS information for best recovery etc. 
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