need info

[AnyDream]

Read back, fiona, I just edited the third para - I hope it helps.

And mental health is absolutely a valid reason. Your emotional health is just as important to your total wellbeing as physical health. Which is why the whole "empowered birth" notion came about, I think. My surgeon asked how I was travelling at the 6 week mark, and when I told him what an enormous difference having the CS had made to me, he commented that women who request CS usually rate their experience much more highly than women who have had elective (but not requested) CS. I think that's where the empowerment factor comes in.

Plus - this might help with your imagining each option - after they gave me the epidural (which I was the biggest scaredy cat over) it was the biggest Aaaaaah moment - being the first time in 6 or so months I was completely pain free it was BLISS!!!

[Inanna]

Firstly I wrote a lovely long post & it got sent off to Pluto... So I'm back with ironing completed...

Inanna, I think you've written some brilliant things in this thread but clearly in Meringue's case it is the choice of the patient, not the practitioner.

Perhaps Fiona you have misunderstood me. What I was meaning.. There is a growing number of practitioners that believe that c/section should not be granted due to maternal request. That it should not be a birth option unless for a medically substantiated reason... That we could see insurance companies being unwilling to cover maternally requested c/sections that are not medically valid.

I also absolutely disagree with the taxi driver metaphor. We will have to agree to disagree on this one.

And of course that's fine it's a fairly obscure relation to draw but one I have heard & can see the reasoning...

I know you see birthing as a rite of passage towards motherhood. I, and I'm sure many women like me, just don't.

I hear you don't see birth in the same way as myself & I also know many (in fact most I would offer!) don't either... However, my challenge is to educate, to inform and to stretch the women I touch to consider that there just might be more to birth than having a baby. That the process of birthing our children teaches us intricate and vital life lessons if we submit to the process of evolving the feminine. That the process of educating, of learning, of listening deeply to our inner self, to sending out the tendrils of ourselves to other women & to begin to form a tribe of women chosen as "our" women. That this process grows a person into a Woman...

Like I said, we will have to agree to disagree but I think you should respect that not everyone comes from the same starting position as yourself.

I am not much a fan of shoulds... I should do what I am doing! However respect is something I try very very hard to exercise. I think it is erroneous to assume that speaking a different truth, sharing accumulated knowledge & challenging ideas or beliefs is disrespectful. In this case it would be quite incorrect. For I respect the OP's decision. That does not mean I will not challenge it kindly.

As you've pointed out, it's all very well saying that caesareans are riskier but if the risk is quite small then they are riskIER not riskY. We always go off at obs who say that the risk of a uterine rupture from a VBAC is risky and point out that it's not THAT risky in the whole scheme of things so why do we make comparisons that imply that caesareans are much riskier than VBs? We can't have it both ways.

Just an interesting aside. I am just struck that surgeons have discredited homebirth with morbidity rates no less than their c/section rate.... Now there's an interesting angle huh?

Sorry, back to the quote. Of course.. Riskier to die having a c/section. But are we only concerned about death? We are not discussing the frequency of babies being tranferred to NICU/SCN from a c/section (largely for breathing problems) & other affects on infant and mother that don;t fall into the mortality stats...

[Inanna]

What I am wondering is, can a woman who wants an elective CS get the same hormonal kick if she allows her body to go into labour first? Would this be a viable option for someone who had decided to go this way?
_

Jasp ideally that would be good. However, it would depend on why the c/section was scheduled. For example if a placenta was covering the os this would put the mother & infant in danger. etc etc.
So the short answer is not usually. (thankyou for your kind words.)

[fionas]

Thanks skeetaboat - I would love some help nutting this out as it's playing on my mind. I guses my thoughts are these:

1. My absolute priority besides having a healthy baby is choosing an option that will lead to the best recovery for my pelvis. Unfortunately, no-one can tell me what that is. As I said, the Pelvic Instability Association usually advocates a VB because we all know that a VB usually means a shorter recovery. However, they do also say that for some women whose condition is severe that a caesar may be advisable. Either way, no-one can tell me how long it will take to recover.

2. I don't honestly think that there is anything that could make me relax during a VB except if I have a miraculous recovery between now and the birth and I can find a position that I can comfortably birth in!

3. However, my caregivers, seem to be pushing me to try for a VB. But these are the SAME caregivers that told me I would recover soon after the last birth. They were wrong, so why would I trust them?

[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..

[Inanna]

Fiona: My response to your SPD question...

Firstly how you birth is your contract & your journey & I couldn't say what is best for you. I too have had SPD. I had it with my first and through all of my subsequent pregnancies. I found the belt just didn't work. I also found the exhaustion at not sleeping like nothing I've ever experienced...

I had a posterior labour that started with cx 2mins apart and continued that way. I have not had since in any labour or situation felt such excruciating long lasting pain. In second stage I pushed for 3 hours. So, I am just establishing a personal understanding of SPD. I also had to work at a desk job as I couldn't lift my legs high enough to climb hospital stairs & getting in and out of cars was hellish...
Rollling over in bed at night would cause me to yell out. I believe that it's important to exercise. Movement is essential so that you don't seize up. It hurts but you need to keep going. Water exercise helps some women but I personally didn't get relief from it. I took supplements, I had accupuncture but by the 3rd pregnancy I resigned myself to the pain.

I can't explain why but during labour the SPD didn't even affect me. I used water - which was like heaven for me, I rocked and squatted and did things I hadn't been able to do for months. After the birth I was sore for a few weeks but it basically began to improve soon after. With Imogen I still have some of the associated pain. Despite yoga, massage, rare albatross feather massage () etc etc etc. So, I can't really explain how it was okay for me but it was.

I am not alone I have spoken to many women who birthed fine with their SPD. Of course not everyone. I would just like to offer that it is quite surprising how restricted you can be and then labour comes and it seems to just be okay... I know there are a few BB Mamas who VBAC'd with SPD & it didn't hinder their births...

How I see your situation is that it's yours. What I would suggest is that you really go inside yourself and uncover your feelings, ideas, views, fears... Make a decision from a knowing place. I know that if you have severe SPD that that would be seen as a medical reason. I can tell you that I too had severe SPD where physios told me I'd be in a wheel chair and I swung from the wardrobe, climbed in and out of a birthing pool and basically didn't sit still... So, perhaps it might be right for you to go into labour and see how you go. It also might be right for you to have a c/section...

I agree in principle, but this doesn't account for those of us who have processed our issues through deep therapies like rebirthing etc, did our research & preparation, and faced our first births fearlessly and in a state of complete self-awareness and clarity, and yet were still traumatised by the circumstances surrounding our births. Not every woman gets a choice over her birthing care providers - think regional areas - and often women are promised a standard of care when they meet with midwives etc but by the vagaries of hospital staffing & the reality of routine practices end up with a completely different experience to the one promised. In my case, I was issue-less when I entered the birthing suite, but horribly impacted for well over a year afterwards - the physical healing alone took 18 months - and no amount of debriefing, counselling, contextualising, healing, etc afterwards could induce me to go there again. Ironically, after my calm and empowered 2nd birth by maternally requested C/S surrounded by people who really cared about my wellbeing - this experience was healed deeply in me. So deeply that I felt from that point onwards that I could indeed contemplate another fearless VB, should the need ever arise.

I guess I'm saying that an empowered birth, in the sacred sense and in the context of the larger arc of life, can occur regardless of VB or CS. It's really important that there exists a space like this on the forum where those of us who find ourselves taking the CS journey - no matter what the reason or whether any one else thinks it's valid - can get information and support.

You are so right Marydean sometimes women are promised an experience or a method of birthing & they don't receive it. I too was clear when I birthed my first child & my experience also scarred me. Mostly as I was so informed and educated & it still happened - so Goddess help the uninformed was my thought... I was bullied, disrespected and treated like a naughty child. I was threatened. I understand... You are also correct with saying (essentially I believe) that due to the way the system is we (women) are often let down. That is why we as Women & Men who care about birth need to stand up and speak what we know and want. The system has to change and alter to suit the client not the system.
I hear what you say about regional centres - I had to travel 40 minutes to my nearest hospital and that's close by Qld health standards. However, about support. We do have a choice. We need to choose our support very wisely. It's integral to a positive outcome. Now more than ever Doulas and IM are almost essential to a good outcome. In almost every town there will be a wise woman, a doula - there will be someone. So Women need to put it out there that someone will come into their life to assist them to birth positively. Advertise. Seek it out!

[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]

Thanks Inanna - I just need to reiterate that the pain during pregnancy or of the birth itself is not my primary concern - it's the length of the recovery afterwards. If an ob was to tell me that I was going to have a long painful VB labour but be fine afterwards, or relatively soon afterwards, this would be a no-brainer. I'd just get on with it.

As for movement, I have found that movement exacerbates my pain considerably but other women, such as yourself, have certainly found that they do 'seize up' if they don't move and in their case pushing through the pain is certainly beneficial. That is not my experience unfortunately. I actually find the opposite - that moving itself does not cause TOO much pain at the time except for a sort of stiffness but that this stiffness then leads to agony hours later.

[fionas]

I appreciate you taking the time skeetaboat - you always make a lot of sense. I will digest what you've said and post in the morning. Thanks again.

[Inanna]

Fiona I too suffered hideously after walking but I credit it with my recovery. I couldn't get out of the car, out of bed. At some stages I needed to be assisted out of bed... It really was painful. However, I religiously walked as I had other women's experiences of this assisting so I went with that. For me it did help.

[fionas]

Inanna, I did the same as you in my first pregnancy and largely carried on as normal and was in a lot of pain by the end and had an 18 month recovery.

This time, despite the onset happening at lot earlier, I am in much less pain than last time.

We can only go on what works for us and this is working for me, as your approach worked for you.

[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.

[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!