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Thread: CS after VBAC

  1. #19

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    Hoobs - I'll have to get DH to measure mine.. obviously I can't even reach that area at the moment... LOL


  2. #20

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    lol - everyone reading this will be sneaking off to measures theirs now too Hoobley!

    I had an elective c.s with DS. And although recovery time for me was a bit slower than others I healed well and didnt suffer much pain or any complications.
    Ds was delivered at 39wks.
    He was put on breast and sucking within half hr or birth.
    I have many friends who had natural vaginal births who were not able to get baby feeding well or as soon - so I think that unless theres some other complication with the delivery, then c.s or V.b, makes little difference to how bf will go.
    Being in fit and healthy state before hand and being aware of the procedure (as it sounds you are) is bound to make a difference to recovery.
    I was fit when I had ds and recovery mentally and physically was good, but I had abdomo surgery last year during a stage when I had gotten quite unfit and recovery emotionally and physically was difficult.

  3. #21

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    Heeee this thread has taken a different sort of turn and hoobley thank you so much for doing that, ive often wondered and actually thought of looking up porn sites just so i can see (very embarrsed) any way as part of science and all i have tried to measure, but it does seem there is no real "flat" bit to measure any way it would be under 10mm but it kinda feels like there is a piece of skin about as thick as my earlope and shaped the same dividing the 2 parts, hope that makes sense?!?!?! i know when ive looked in my anatomy books it seems to be a bit longer and have more of a "flat" bit than what i have.
    To all the replies thank you soo much for your support and advise you dont know how much i appreciate it thank you.
    Njd: thank you so much i would love that info can you PM me your address and i will send a return envelope and money order for the photocopies, or if youd prefer i can deposit it into your bank account what ever is easiest. i really would love that info.

  4. #22

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    Scooby - yes I've looked at the porn girls before too.. pmsl... I don't think it helps that I compare it to a guys and apparently guys poo holes are much further up (well appear to be because of the ball sack..PMSL)
    ahh what a conversation. This is what me and DH were discussing in the bathroom before anyway, but he has agreed to measure mine for me later on.. .LOL

    I'm very curious from your description though....

  5. #23
    paradise lost Guest

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    The gap in men is much bigger, so no go for comparison.

    It sounds like your tear has healed so that the scar tissue sits "tighter" which seems to create the divider?

    If i measure from the end of the tear (which was only first degree but "gaped" because of it nicking into the muscle a little, so there is a visible nick in the skin rather than as you say, a flat bit) it's about 1cm, maybe a little less. But i can't get my finger "in" it, if i try it slides back towards my vagina proper, if that makes sense. It's like the tear left a sort of more sloping vaginal entrance on my perineum in the flesh. Does this make sense?

    Bx

    ETA, actually i realised you might mean the "lobe" bit of skin is sitting across between vagina and bum - mine doesn't sit that way unless i'm standing up and i think of it as just skin, whereas my perineum is the muscle underneath. See that in part is why i don't get how it can be "too short" because it's the muscle that maintains vaginal/rectal integrity and during pregnancy you're SUPPOSED to be able to compress the muscle to paper-thinness - it makes the maximum amount of room in the pelvis for bubs to fit out... I'd love to quiz the Ob on what they actually MEANT. LOL
    Last edited by paradise lost; July 25th, 2008 at 08:54 PM.

  6. #24

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    Hoobley, you are an encyclopedia - better even. Amazing the detail you seem to know about pretty much everything!
    I'm no expert, but I wuld think that the ob is concerened that if the perineum is "short" that any tear, even a tiny one, would be severe... just my interpretation.
    To be honest, it sounds very strange to me. But obviously a few OBs and midwives have come to the same conclusion independently.

    Saša

  7. #25

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    I had a CS for a breech bub, and have previously had a couple of rounds of major pelvic surgery. Here's some of my tips to make it easier - I'll keep adding to them as I remember:
    1) When they say "nothing to eat or drink after midnight" it is worth having a drink and snack at 11.30. Anxiety about surgery is bad enough without adding major hungry and thirsty.
    2) After the surgery drink a little water very often. Start eating gently though - throwing up with a cut tummy aint fun.
    2a) If you feel at all nauseous tell someone - there are meds to stop you chucking and they are worth using
    2b) Take pain meds as suggested initially, and don't wait for the pain to get really bad before taking the next dose - take the next dose as the pain starts to worsen. It's important for you to be mobile as soon as you can after surgery (even if it's just wriggling in bed), and the pain meds will help you do this.
    3) practise rolling from back to side without using your tummy muscles beforehand. I find that if I tense my bottom and pelvic floor I can then pull myself over with my arms and not stress my tummy at all - find what works for you
    3a) similar idea for getting up
    4) Granny undies - several sizes bigger than pre-pregnancy. So nothing rubs or squashes your cut
    4a) big, soft clothes (yoga pants, pj's, trackies, whatever - but nothing with a zip or other stiff material). You don't suddenly shrink after a c-section, so whatever fit late in pregnancy will probably be fine here too.
    4b) avoid long nighties - getting them out from under yourself so that you can bfeed is really awkward.
    5) bfeeding lying down was great for me - but do keep bub's legs wrapped up or put a thick towel over your tummy, 'cause a kick in the tummy (even from a little baby) hurts lots
    6) put a folded up jumper or baby blanket or similar between your tummy and the seatbelt on the way home
    7) pack your stuff for hospital in several little bags. It means that when you pack to go home you can lift the damn things!

    hth a bit
    Kate
    Last edited by Kmn; August 13th, 2008 at 10:45 PM. Reason: adding to list

  8. #26

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    To be honest the obs have always drawn a diagram im not sure if theyve named it as such, but the skin between the anus and vag is the perineum, the perineal muscle is what is underneath, actually found this hope im allowed to transfer this info:
    First degree tear - tear involving the perineal or vaginal skin only
    Second degree tear - perineal skin and muscles torn, but intact anal sphincter
    Third degree perineal tear - perineal skin, muscles and anal sphincter are torn
    a. Less than 50% of the external anal sphincter thickness is torn
    b. More than 50% of the external anal sphincter thickness is torn, but internal anal sphincter intact
    c. Both external and internal anal sphincters are torn, but anal mucosa intact
    Fourth degree perineal tear - perineal skin, muscles, anal sphincter and anal mucosa are torn
    Button-hole tear - anal sphincter is intact but anal mucosa is torn
    i think really they are saying that because the area of skin is so short, next to go would be the muscle and the existing scar tissue would lead straight to the anus, but i will ask the ob ill add it to my never ending list i think i may need 2 appointments back to back
    Yes i do mean that if i put my thumb at my vag opening and fore finger at my rectum it feels the same kinda width as if i do the same to the bottom of my ear lobe. (what a lovely conversation)
    Kate: that was amazing info thank you so much and i would really appreciate anything you have to add thank you

  9. #27

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    Hi Scooby,

    Congratulations on your pregnancy! Good on you for thinking about this so early, the more time you have to research and think the more ready you will be to make your decision.

    I haven't have a c/s so sorry can't give any advice from a personal position, however, I have supported women through c/s as a doula and I have seen that they really can be wonderful and joyful experiences, just as vaginal births can be. I would recommend that you consider maternal assisted c/s and also just have a really good think and write a birth plan for the c/s if you choose to go down that path! Just because you choose to have a c/s certianly doesn't mean you have to hand over all control over about the kind of birth you would like to have.

    I hope you have a happy and healthy pregnancy and good luck making your decision. You are the only one who will know what is best and don't let anyone make you second guess your decision or make you feel bad about it!

  10. #28
    paradise lost Guest

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    Did some pubmed searches, found some studies:

    The perineal body length and injury at delivery.

    Risk factors for perineal injury during delivery.

    Is primiparity, the only risk factor for type 3 and 4 perineal injury, during delivery?

    Basically i found that i have an extremely short perineum. Long is over 6cm, average is 3-6cm, short is less than 3cm. The studies which looked at risk factors concluded forceps, posterior presentation and being a first time mum posed the most risk. In the perineal length study, perineal length was found to have no bearing on damage whatsoever.

    Bx

  11. #29

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    Hoobley they are really interesting studies, and worth a read i have done abit of a scholar search before and i just wish there was studies done on 2nd and 3rd pregnancys, this has been my point all along there just isnt the information and or studies, iget the point of everything thats in those studies i had an episotomy with DS, he was also not lying straight and he was birthed by vacumn extraction, i realise some or all of these could have caused my tear, but i still have no where to go, where are the studies on the chances of it happening again, why even with my history would an ob say yes to a natural birth then examine me and say they wouldnt reccommend a VB, i really want some answers and i guess i need to talk to my ob about the info i have come across and find out her reasoning. i really apprecite your help through this process and man am i glad i started so soon welll im going to go watch some mind numing telly so i can hopefully get some sleep tonight
    Jas: thank you i know no matter what it is up to me what kind of experience i have and definately will have a birth plan in place and the wonderful thing is the ob i have is very well respected amongst other women who have had her as there ob, she is kind, gentle and very willing to listen i feel total blessed to have found her, the great thing is the midwife she works with actually helped me through my fertility treatment as well so i feel really comfortable with them both thankfully. i wanted to say that i highly respect the work you do and what you have said means alot to me, so thank you.
    Last edited by scooby; July 25th, 2008 at 10:45 PM.

  12. #30

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    Scooby, I know your planning on having a c section. But I thought that I would post this to you anyway.

    Just over a month ago I supported my first client as a doula. This was her 3rd baby. Her first birth ended in a massive tear (4th degree) into her anus, she pushed for 3 hours and had a failed vacuum, forceps delivery. She has suffered with mild bowel incontinence on occassion.

    Second bub was another vaginal birth and she had an episiotomy after pushing for a couple of hours.

    With her last baby she was getting scared. The hosp had told her bubs head was BIG. This frightened her to no end. They had suggested she could have a c section. She wanted desperatley to have a vaginal birth but at the same time was scared of the damage that had been done to her previously.

    My client was using EPO as it helps to soften scar tissue. As you would know scar tissue doesn't stretch like normal tissue. My client had an episiotomy once again, but pushed bub out on her own steam in under an hour. She has had no bowel issues since bubs birth. Bub was born the day before his due date. Mum was not prepared to go over dates though as she was worried about the extra growth. FWIW, bub's head circ was only 35cm. So not huge at all.

    Goodluck in whatever you decide. Your body, your birth and your baby huni.

  13. #31
    paradise lost Guest

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    Hi scooby,

    You're so right, it's frustrating that there aren't purer multipara studies. I'm searching searching searching but all i can find out is that for multipara's perineal injury is twice as likely with episiotomy or instrumental assisted delivery...which we already knew! I think there are too many factors to do a clear study. Like they need multiparas who had a 3rd or 4th degree tear last time and who then went on to have a natural (or at least vaginal, epidural and pethidine-free, non-episiotomy, spontaneous delivery without positional restrictions and coached pushing) delivery and that's REALLY hard to do in a hospital, so the studies instead focus on the risks of those things (instruments, epi's, drugs, positions etc.). The fact that studies find primiparas at higher risk means there is an inherently lower risk for multipara's, but that is statistically over all women, not isolating only those women who already suffered significant perineal damage.

    From the reading i've done today i would say if you had a spontaneous vaginal birth without epidural and gave birth on hands and knees or in a supported squat, and did not push once the baby was on the perineum, and maybe even had a waterbirth for perineal support, i'm sure you could get through without a serious tear (to the point that i would advise a close friend to go for it if they were considering it, rather than just telling a stranger on the internet to do so!). BUT i don't know how easy it would be for you to GET that kind of delivery, and the risk of tearing remains if anything on that list is missing or ignored by your caregivers. And birth is so personal - i could see me easily achieving that sort of birth because of my previous experiences (which were not at ALL like yours, i was at home, the midwives came only an hour before i delivered and i did whatever i wanted, when i wanted, where i wanted (almost had her in the loo!)), but i have many friends who simply couldn't consider such an approach without being terribly afraid and i really don't blame them given their own experiences.

    I'll keep looking and see if i can find anything more for you. I think for you a vaginal birth would be possible, but there might be a long road ahead to get to a place where you want to attempt it (and by that i mean getting to a place where you are TRULY happy and ready to do it and not doing it because of feelings of fear, guilt or any other negative feeling women have put on them around birth) and where you have a supportive caregiver. I guess it depends on what it means to you. I think a successful vaginal birth could be very healing for you, and it is certainly very important to some women (not sure where you would stand on that one) BUT i think it might involve a lot of "fighting" to get it the way it needs to be for you, and if a peaceful pregnancy and delivery, after the terrible trauma of last time, is more important (which is a VERY valid way to feel about it) then an elective c-section is a safe and reasonable option too.

    One thing that did strike me is that in everything i've found about perineal body length studies, while a short perineum has no effect on the risk of tearing, cutting an episiotomy into a short perineum is VERY likely to cause severe damage and two studies i read suggested that cutting such a perineum, unless the baby is in severe emergency distress, is clinically inexcuseable. It's clear if you cut a 2cm epi into a 6cm perineum you've created a 1st-2nd degree injury, but if you cut that into mine it'd be a 3rd-4th degree.

    One study i just found had a few sentences in it stating that faecal incontinence 6months post-partum was NOT found to be associated more with vaginal delivery - women who had c-sections suffered at the same rate. Perhaps you could get a referral to a urology/gynae to talk about strategies for that as a (sort of) seperate issue?

    Bx

  14. #32

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    Thanks Hoobley i totally agrre with everything you said and was very close to tears when i read your post, i truly would love to have a natural birth to be honest i wouldnt want a home birth but would be open to water etc. (too scary after my sons situation) My other "fight" i see if i do choose that option is family and friends i was out for dinner with them all last night and they mentioned recovery after CS and how they would help and i said i wasnt totally decided on that at the moment, well you can only imagine the barrage the " why on earth would i do that to myself again" etc. etc. my DH doesnt even want to discuss it (prob something to do with the inability to have sex for almost a year after ds) any way im still determined and if i have all the info we will see im not closed to it. I have actually thought cause my ob said if i go early i can try a VB, i might say she can book me in for a CS at 39.5 weeks if i go before that i want natural and if its a big bub or after that then i will agree to the CS, or something to that effect. Either way i will be in control thanks Hoobley.

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