need info

[skeetaboat]

I totally agree with Marydean regarding mental health being an important factor. We're disillusioned with the medical model for clinicalising everything and divorcing medicine from social and emotional factors.. when in fact these things can't be divorced at all. Mind, body and spirit is one. That's why I've been arguing so hard in support of Meringue (even in her absence!) and others in her position.. because her (and every woman's) mental health needs to be considered aswell. Without mental health, mother and baby run into all sorts of problems and it really upsets the health of the whole family.

I also agree with Marydean's surgeon re: higher rates of satisfaction when the C/S is requested. There are a lot of negative stories because people feel forced into cesareans they don't want (), but there are also really positive stories that tend not to get posted on public forums because people don't so much feel the need to. Fionas, maybe it'd help you to reflect on how you feel about cesareans generally? Maybe writing down various possible outcomes and thinking about how you will feel about them will also help. How would you feel if you had a c/s and still had difficulties with your condition afterwards (or is that not likely??)

If you do go for a VB, I think it would be really important to have a care-giver who knows what you went through last time and is knowledgable about SPD and labour.

[skeetaboat]

sorry fionas i posted while you posted.. will catch up and post again..

[skeetaboat]

Ok, caught up.

Regarding point 3, I wouldn't trust them! Even if they have educated themselves about caring for someone with SPD, having them as your caregivers again isn't a recipe for a good experience, if for no other reason than you keep thinking about their incompetence last time. Can you seek out another care giver? Maybe even one who specialises in SPD and labour?

I guess there's two things to look at (maybe more?): the experience of birth, and the outcome. In terms of outcome, you've got the risks of VB and CS to consider and weigh up. I think searching through some studies comparing the two and thinking about the risks is a good start, as is thinking about how you will feel about various outcomes (sounds like you're doing some of that ). In terms of outcomes for your SPD, as you've said, no one seems to be able to tell you what the outcome will be either way whether via CS or VB, but you do know that the last VB caused considerable problems, so it's fair to assume that the next VB has potential cause the same/similar problems, potential which may be minimised with better care (which you don't yet have). You don't know if a C/S will cause them or not (is that right? how would you feel if it did? Or if it didn't cause the problems but the SPD didn't go away after the birth?)

In terms of the actual birth experience, it sounds like CS might pan out better for you, unless, that is, you feel adversely towards having one or any of the associated risks. So the question there is how do you feel about CS?

Sorry, haphazard post, just thinking aloud...

[fionas]

I guess the main problem I have in making a decision is that I can't find any studies comparing the recovery from a VB to a caesarean. And my caregivers keep spouting the usual - it itakes longer to recover from a caesarean but I think they are speaking generically not in relation to SPD. I have asked them about this specifically but their answers were vague and I don't want to base an important decision on vague, anecdotal answers. The support associations cite a figure of 93% of women recovering within three months of giving birth. They don't break this down into VB versus caesar and I obviously was one of the 7% who didn't recover within that timeframe last time. The research seems to concentrate on whether the condition affects outcomes during labour but this is not what I'm interested in. I'm interested in what happens AFTER the labour.

It is really hard making an informed decision when the data just isn't there and when anecdotal experiences are contradictory. When we look at VB versus caesarean generally, inductions, episiotomies, VBACS there are lots of studies we can look at. For this, there isn't. And obviously there's no point comparing apples with oranges. I'm only interested in looking at women with SPD similar in severity to mine and what THEIR recovery was like. Ideally, what the experiences of women who had a long recovery the first time was like compared to their experiences the second time around either with a more carefully managed VB or with a caesar.

And because there isn't and because I'm already in the minority of people who took 3months+ to recover, then I find it difficult to trust ANYONE'S opinion.

Skeetaboat, you're right, the only way I would try for a VB is by having a midwifery model of care or an independent midwife. I don't think I would try for a homebirth because the whole concept of transferring to hospital if something goes wrong completely puts me off. We're also moving in June so a few months ago I started ringing around the local hospitals and spoke to a few midwives there. I explained my situation (that I was unsure but there was a possibility that I would ask for an elective caesar) and they asked me about what happened last time. They both said that I might be better going for an elective. Again though, that's just an opinion.

So that's what the head says. It says "I want data". And I can't get any.

The heart iscompletely freaked out that my caregivers say that it takes longer to recover from a caesar even though, when pressed, their answers are not convincing. I guess, I'm damned if I do and damned if I don't. If I choose a VB and have a long recovery then I will feel foolish for ignoring all the evidence from what happened last time. If I choose a caesar and have a long recovery, I will foolsih for ignoring some, not all, of my caregivers.

I don't think I have any hard and fast feelings about caesars. I'm not really scared of surgery, I don't see the birth as an integral part of motherhood and am not really concerned about its impact on bonding/breastfeeding. I will be in a much better position to bond and take care of my baby if I'm not worried about being in pain and immobilised for months and months afterwards. The only thing that really does put me off about the caesar is being reliant on people to lift the baby in the early days, having to buzz for a nurse, all that logistical stuff. But obviously I would rather do that than being housebound for months and months afterwards and having to delay having no.3 on the basis of a long recovery. Obviously having no.3 given my age, may be a long shot anyway but I appear to get pregnant at the drop of a hat so I'm hopeful that this option will still be open to me. It will most definitely be closed if I take as long to recover from No.2 as I did from DD.

So, I guess the only thing I can do is to keep seeking out info (even though I don't think it exists).

[fionas]

I'm a little embarrassed that I've turned this thread into a me, me, me thing but I trust the wise women on BB much more than my IRL friends who have not faced similar dilemmas.

It also prompted me to have a 50-minute consultation with my physio this morning specifically about the birth rather than my usual pilates where we touch on it briefly but usually still leaves me with unanswered questions.

So, I have more information to hand which is terrific.

My physio tells me that it's not the length of the labour that damages the pelvis but the length of the pushing stage and the position. I sort of knew this but it was good to have it spelt out. She agrees with me that the position I was in last time (knees open against chest), the length of time (3 hours) and the fact that DD didn't actually move with very much which ended in a high forceps delivery would have caused a lot of damage resulting in the lengthy recovery. She said that each push in effect strains the pelvis and it is strained even more if you are in a position which is inherently bad for you.

However, she says that women who are in good positions with a very short pushing phase often go on to have very fast recoveries. That's why usually they advocate a VB.

On the other hand, they normally tell people that caesareans take longer to recover from because the muscle has been cut. You need your muscles to be strong to support your pelvis. Even though your pelvis won't be damaged from a caesarean, the muscles will be. She says if you do all the right things then the muscles could be recovered within a few weeks, if you do nothing up to a few months.

She said in my case I have a few things to consider. Firstly, considering I had a long pushing stage last time with a big baby which ended up with forceps anyway, some people would say that it's likely that I will have a long pushing stage again which may in any case end up in a caesarean.

She said that if I do want to try for a VB then I have to ensure that I have a very strict birth plan that spells out what positions I can be in and have to put a time limit on the pushing of 20 mintues tops.

So, I think my next steps are to talk to do more research on whether a long, ultimately fruitless pushing stage first time around means that a second birth is likely to follow a similar route. I also need to go make an appointment with the Birth Advisor at the hospital and explain my fears and find out what exactly happens if the baby's not out in 20 minutes ie. will I be forced to "just push for 10 mins more" if they're not set up for a caesar etc. etc.

I think I now understand why the midwives I spoke to were advocating an elective caesarean after hearing my history.

So, I'm very happy. I still haven't made a decision but I feel like I have got some decent information.

[Inanna]

It must be very challenging trying to make the "best" position.

FWIW I would like to allay one of your fears. Because you had a long second stage with your daughter that does not mean you will with subsequent children. To birth a posterior baby on your back is very far from optimal and I would offer it likely protracted your second stage.

I too had a posterior baby and I too was on my back (due to epidural headache) & I too had a very long second stage.

My other live babies were 20mins for DS, 2 pushes for DD2 and one big one for DD3.

They were all very active births, using water (I would very very highly recommend this it is known to be very helpful for SPD sufferers) & lots of movement.

I don't think you will find any studies as such to help you decide as I would assume that it's clearly physiologically easier to recover from a vaginal birth with SPD than with pelvic surgery that c/section requires. (so therefore studies are a bit moot yk?)

I think you're just going to have to really go into yourself on this one. Examine your feelings, listen to your wise woman voice... Take lots of time - you have plenty up your sleeve... Good luck!

[Inanna]

It must be very challenging trying to make the "best" position.

FWIW I would like to allay one of your fears. Because you had a long second stage with your daughter that does not mean you will with subsequent children. To birth a posterior baby on your back is very far from optimal and I would offer it likely protracted your second stage.

I too had a posterior baby and I too was on my back (due to epidural headache) & I too had a very long second stage.

My other live babies were 20mins for DS, 2 pushes for DD2 and one big one for DD3.

They were all very active births, using water (I would very very highly recommend this it is known to be very helpful for SPD sufferers) & lots of movement.

I don't think you will find any studies as such to help you decide as I would assume that it's clearly physiologically easier to recover from a vaginal birth with SPD than with pelvic surgery that c/section requires. (so therefore studies are a bit moot yk?)

I think you're just going to have to really go into yourself on this one. Examine your feelings, listen to your wise woman voice... Take lots of time - you have plenty up your sleeve... Good luck!

[fionas]

I would assume that it's clearly physiologically easier to recover from a vaginal birth with SPD than with pelvic surgery that c/section requires. (so therefore studies are a bit moot yk?

Not necessarily. It depends on what position you've been in and how long the pushing stage is. It's the pushing stage that damages the pelvis. It's perfectly possible to have a very long pushing stage in a bad position that results in a much longer recovery than a caesar ever would. My first birth being a case in point.

Thanks for the information about your different births Inanna. It's heartening to know that one long one does not necessarily mean other long ones. Though I don't like being reliant on midwives listening to my wishes that I want a caesar after 20 minutes.

I'll have a think about the water birth scenario. It's just a pain that yes, although I have time up my sleeve, I will have to change caregivers from private ob to a birthing centre if this is one thing that I want to consider.

[skeetaboat]

Wow fionas, you've come a long way in 24 hours I'm glad that you were prompted to dedicate a physio appointment to getting some more information to aide in your decision, and that info has taken you quite a few steps closer to making a decision. Woohoo!

Try not to put too much pressure on yourself to make the best decision. As you said, it's not like a VBAC vs repeat C/S where all the stats are on hand and easy to access and therefore a truly informed decision is easy to make. For you, there's no way to know ahead of time what the outcome is going to be. All you can do is what you're doing - seek out evidence-based information and make the choice that you feel is right for you with the information that's available. I agree with Inanna () that you need to go deep and find peace with your decision - whatever it is.

It sounds like either way has some potential to cause some problems afterwards - but the good thing is that it's probably not likely to be as bad as last time; if you have another VB, you know which positions to avoid (who knows, maybe you'll be fortunate enough to have a 5 min pushing stage and also be one of the lucky %age for whom it resolves straight away), and if you have a ceasar, the effect of the muscle being cut is unlikley to cause difficulties beyond a couple weeks at best and a couple of months at worst.

One thing stands out to me - I think it could be difficult for the hospy to guarantee that you can have a ceasar exactly 20 mins after pushing starts. Of course, they can do it in an absolute emergency, but I wonder if it would really be treated like an emergency on the day? If I were you I'd want clear answers there. You'd be relying them to come to the table on the day if your second stage isn't nice and short. If you really do only have 20 minutes I think I'd be nervous about that, even if they are onside as there are still variables which may interfere even if you do have a prior understanding with your care-givers.

If you do end up going c/s, I highly recommend getting on your feet as soon as you can and starting the physio exercises the very next day. Anecdotal evidence wont help you much and I certainly didn't have the compounding issue of SPD, but after both my ceasars I did find that I had very little pain in the first couple of days thanks to the meds and not much more than a twinge in the mornings after about 5 days. In fact after the second I was out the front weeding on day 5 (not recommended, just to demonstrate how fine I felt). But then my SiL says she was in agony for weeks (but she did have a long labour prior to c/s, didn't do a jot of exercises and had major abdominal muscle separation, so things weren't stacked in her favour). So it's different for different people, but I think doing the exercises *really* helps.

And if you end up going VB, I think it is is SO important that you your caregivers have detailed knowledge of your history and condition and are really 100% behind you to help you achieve the best chances of avoiding the terrible outcome you had last time.

I must say, you seem to have coped brilliantly with the card you've been dealt. I myself would have been very angry that poor (I would say negligent) labour care contributed to/caused the ongoing problems you had post-birth.

If you would like me to search academic journal databases for anything in particular that could help you further feel free to PM me

[suse]

Fiona - I'm off to bed for the night, but will come back when I can to join in properly. I'm facing (or have faced) a similar decision, and have decided that as much as I want a natural birth, my reasons for wanting it are less because of the spiritual aspect of it and more because of the potential for ease of recovery and immediacy of bonding. I am in a situation where the circumstances which led to my son's birth by emergency c/s after a long labour do not appear to be situational but rather inherent, but it's impossible to tell without going through labour. Given that the difficult recovery I had last time was related more to the 'emergency' part of the c/s rather than exclusively because of the c/s, and the impact of this on my ability to bond with my son (an extended lack of mobility on my part which made it physically difficult to interact with him), I have decided that I am more likely to have an empowering birth by elective c/s than by undertaking labour when there is as much likelihood that it will end in emergency c/s again as that it won't.

To be honest, fear of labour plays no part in my decision - pragmatism does. But I also believe that an amount of success in VBAC is trust in one's body's ability to achieve a VBAC, and in my case the jury is certainly out on that front. The amount of willpower and confidence I bring to this is nothing if there is good evidence to suggest that my body is simply not going to co-operate. I don't fear the consequences of a labour that doesn't succeed, but I am fully aware of the practical impact it had last time and on my ability to parent.

I've been able to plan for the most positive c/s experience than I can, and know that although my recovery will probably be more difficult than if I had a successful natural birth, it is also likely to be much less difficult than if I had another emergency c/s. I've been lucky in that I've got care providers who are supporting me whether my decision is to attempt VBAC or for an elective c/s,

Perhaps I can help you through this process to a point where you are able to make a decision you can be happy with, whatever that decision may be. If you want to ask me any questions about the process I've taken, ask away.

[fionas]

that will be great Suse - see you in the morning.