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Thread: I dont know which way I should go.

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    Default I dont know which way I should go.

    I was planning a drug free waterbirth, until I was admitted to hospital last week and became too high risk for birth centre. I am suffering from Diastasis of the Pubic Symphysis and very restricted in my movements, on bed rest most of the time.



    There is a slight risk of a VB doing damage to my Symphysis Pubis, but I dont know the figures. If I did do damage I would need a pelvic reconstruction, which takes a long time to recover from. I am really struggling to make a decision as to whether I should ask for a CS. The Ob would prefer not to do a CS unless the risk of damage is higher than the risk of CS, but I don't know if the risk of being unable to care for my kids for months on end is worth taking for the risk of havingthe 6 week recovery time of a CS.

    What would you do in my situation? I really am stuck for a deceision, and they want her out as soon as it is safe for her, so in about 7 weeks.

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    Given the fact that DH works away at times and that your family is interstate and that you have 2 other young kids i personally would suggest a CS as that way you know you need help for 6 weeks and you can organise with DH work and your family to be there to help out.
    If you go for a natural birth you may end up with a prologed episode of needing help and harder to orgainse people.

    ADDED: As you know i had pelvic instability and 12 hrs after emerg cs i was up showered walking around ward and bathed bubs! so its not all as bad necessarily as people make out, now you wont be able to move as well as you are much much worse but i felt great after and walking was easier and less painful. I was doing things i shouldn't have been doing eg washing etc 6 days after birth (day i got home), i didnt drive till 6 weeks as DH wouldnt let me (well was 5 weeks 4 days in end)

    Good luck with decison
    Last edited by feeb; April 12th, 2009 at 12:03 AM.

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    Oh, Ali - I really do not envy you at all. You need more info on the risks of VB with DSP. A VB should be the easiest to 'recover' from, but in your shoes, I'd start to wonder if its worth trying for too. Although, it was interesting when I was reading about SPD that interventions can lead to damage and DSP.

    If they are showing so much concern and are clearly going to try and induce which could lead to a litany of interventions and raise greatly the possibility of damage - I'd choose the CS. Not something I could do lightly given I know for a fact I would need to go under general because of the syncope.

    I hope you can reach a decision in time. It really does seem like so much, and really 7 weeks is not long enough to make such a body-altering decision, either way. Always around if you need me.

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    Do they know what the estimated likelihood is of pelvic damage if you have a VB Ali? And is it viable to have a trial of labour with option for c/s if things look like they might be going pearshaped?

    FWIW, not all CS take a full 6 weeks to recover from. I was driving with Dr permission at 3 weeks post-op, and functioning pretty normally by then, and I had an emergency c/s after long labour and three hours of pushing and with haemorrhaging and mild infection. As well as a slower than 'average' recovery because I can't take anti-inflammatory drugs.

    Depending on the risk of pelvic damage and of the support you have available, given the extensiveness of the recovery if you do require reconstruction, I would probably choose a c/s as the recovery is less likely to be as severe. But given that your Ob is not rushing in with scalpel blazing (which is unusual), then it suggests that the risk of pelvic damage is indeed quite low. Does your Ob have a good understanding of the circumstances you are in and of the level of support you can expect?

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    Suse, Until I have a repeat ultrasound we wont know how fast it is spreading or the risk level. DH was away when the Ob saw me, and they know that he is in the defence, and that family all live interstate. The hospital social worker is aware of our situation, and the Defence are trying to arrange care options so DH can go back to work at the end of next week.

    My next Ob appointment is on the 29th, I am not sure if the physio will order the US when I see her on the 17th or when the Ob will want one, but I know they will need at least one more US to assess the speed and likely full spread at birth.

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    Oh Ali

    I'm so sorry that you have to be faced with this decision.

    Just my 2c though - I had pretty bad SPD (my hip had slipped out and rotated although I didn't know it) could barely walk and all that - and after the c-section it was soooo much worse.

    It hurt like hell just trying to get up and about with a wound to consider - and the SPD (which didn't go away for about 4 months with significant physio).

    PLUS - I got an infection in my uterus from the c-section - so I was bloody helpless for the first month, could barely take care of my kids at all. Ended up in hospital one night so had to call the in laws to watch my newborn and my toddler because I could barely function.

    I'm probably the worst case scenario though - how many people's SPD gets worse after birth, plus get hit with an infection?



    I know you will make the right decision for you babe
    xxxx

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    Ali In my case SPD improved after the birth. My pubis was a very tender for the first couple of weeks and I had to be careful with lifting but nowhere near as sore as when I was PG.

    I've had issues 6 months post PG before though so hoping it doesn't happen like that this time.

    What if you had a c/sect and still needed a reconstruction? It sounds like it is pretty severe already so it could be on the cards

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    Hun, only you can make this decision and it sounds like a really tough one so I wish you all the best. The thing that strikes me from your op though, is that the ob is saying he'd prefer not to do c/s. We all know that a lot of obs go the other way with c/s, so that alone says something for me. Personally before making the decision I'd be talking to your ob more to see what his reasons are, and also getting stats on the liklihood of needing the pevlis reconstruction. Best of luck hun.

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    Ali, you're going to need a hell of alot more info for this decision. I don't envy you at all hun.

    FWIW, my step-sister had undiagnosed SPD with her first pg. She had terrible damage to her symphis pubis during her VB, but it wasn't picked up on immediately. She was given a very hard time in hospital as the midwives all thought she should be up and walking the next day, but she just COULDN"T. The whole thing was a bit of a disaster, the hospital didn't want to know about it, and instead of checking her out thoroughly, just sent her home with a brace and crutches. She was a mess for some time, the only thing she could do for her baby was breastfeed him, with alot of support. So, she could not be alone with him for the first three months . It was a very difficult time for the whole family.

    As it turns out, she never healed correctly (surprise, surprise) and as a result has a fair bit of pain in the pelvic region. She certainly survives though. She elected (actually, fought very hard for) to have a caesarean for her second child (although he was alot smaller) as she just thought that pyschologically she couldn't go through a VB again. She found the recovery to be so, so, so much easier.

    This was all awhile ago, her first child is now 15. Look, I am all for VBs, and caesars only when absolutely necessary, but her experience has always stuck in my mind. I'm not saying that you should just go for the caesar, not at all. But just make sure you have as much info as possible to help you make your decision.

    Ali, wishing you luck.
    Last edited by Janie; April 12th, 2009 at 10:55 AM.

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    sweetie only a choice you can make. My cs was a good experice if you want to chat Pm and I will give you my number

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    I don't know anything about this condition but I would suggest doing lost of research intoyour option also getting a second opinion.
    Best of luck sweetheart, hope all goes well for you

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    Hun - I just wanted to give you a cyber hug, I`ve had to make 'that decision' (due to health reasons) as you know and it took me a long time to be emotionally prepared for a c/sec.

    I don`t have any answers only you and DH can decide on the final answer, hugs hun.

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    it's a very difficult decision to make and one that I'll be faced with if I have a second child though my condition doesn't sound anywhere near as bad as yours so big hugs.

    For me it's kind of not just about the stats and doing the research - it's about how I feel.

    I had SPD and a vaginal birth (with forceps) and was in severe pain for six months after the birth. I am still niggly 20 months later and feel far from normal. This had a serious impact on my relationship and although I coped reasonably well with the pain and the limitations that it brought, I simply do not want to go through all that again. Just the thought of doing that again reduces me to tears and I'm not easily reduced to tears.

    So, this is kind of the way I think. If I do the same thing as last time (VB with a long, long 2.5 hour pushing phase) and end up with the same result (severe pain for six months afterwards), I will not only have to put up with the agony, I will also have to put up with the thought that "I was stupid, I should have tried something different." If I ask for an elective caesarean ie. do something differently to last time then at least if I still have the pain, I won't have the, "I was stupid," thoughts.

    For those reasons, I'm edging towards a caesarean but my ob is like yours, he will not do a caesarean lightly. He has the lowest caesarean stats in Melbourne. All this has been churning through my brain even though I'm not even pregnant yet so I've made an appointment to go and see him next month to talk it through.

    He may mention something I haven't considered. I have a feeling he will say to aim for a trial by labour in positions that shouldn't exacerbate the SPD and to put a time limit on the pushing phase rather than going for 2.5 hours with my legs held open against my chest which personally I think caused the extended pain afterwards.

    What I'm trying to say is DO ask for more opinions and do your research etc. but also don't ignore your gut feel if it is telling you to do one thing over another - even if that gut feel contradicts your research IYKWIM.

    I did start a thread on outcomes of VBs versus caesareans in SPD cases, I'll try to find the link and come back.

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    OK, here's the link to SPD and birthing choices http://bellybelly.com.au/forums/labo...es-wanted.html

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    Don't really have any answers for you but just wanted to send a

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    I have been doing a lot of research and I still havent found any numbers as to the risks of doing damage with a VB. DH and I have been discussing it quite a bit though, and considering that it will be an induced labour if it is a VB then there is more chance of intervention, which I think would increase the risk of damage. Depending on what the Ob says we are almost 100% certain that we will ask for a CS because the recovery for a reconstruction if I do need one is so long.

    It really is a hard decision but I am more concerned that because I won't be able to use the bath that I will be wanting pain relief, which would increase my chance of moving too far, or having my legs pushed too far apart.

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    hun good to hear you and dh have had a chat

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    hi alioops,

    i have never heard of the condition so i cant comment on that, but i can comment on c-sections...i've had 3 of them myself.

    C's are not as bad as they sound. The recovery time was more like 3 weeks for me. You are actually up and walking around in 24 hours and the more you walk, the quicker you heal. I never got any infections or complications and the most blood i ever lost during the operation was 400 mls.

    the best advice i can give is if you are going to have a c-section...plan it before hand because emergency operations are higher risk due to things like getting you to the operating theatre in time, dr's and nurses rushing which could lead to errors being made etc...also after being in labor for a length of time, then having a c can be harder for your body to recover because of what its already been thru.

    So dont leave it to chance. Weigh up the risks with and without a caesar and get a second opinion from another doctor, and decide before you go into labor.

    good luck.

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