need info

[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.

[Inanna]

The length of the second stage has a bearing but it isn't just that that can cause on going problems. It is theorised that relaxin (a hormone that allows the pelvis more flexibility) that is released during pregnancy triggers SPD. Many of us in childhood fracture or injure the coccyx without knowledge and this is also thought to have a bearing on SPD. For the spine also supports the pelvis. So an already unstable structure becomes even more unstable with the influx of relaxin. ; A c/section cuts into abdominal muscle which supports the pelvis & this is why c/section is not favoured for SPD sufferers.(because damaging that muscle will sometimes lead to lifelong pelvic and back problems.)

I will rustle up some information but it's not a "study" so to speak...

[fionas]

Yep, I know all about relaxin. I wasn't saying that pelvic problems are caused by the second stage. If that was the case, no-one would experience it DURING pregnancy.

Just that what my physio said to me today (in my earlier post) makes a lot of sense. The underlying instability caused by the release of relaxin will be EXACERBATED by a bad position/long pushing stage.

The relaxin stops being released some time after the labour (I think it's two days) but if your pelvis is unstable already and/or damaged by the birth then the pain isn't going to magically disappear just because the relaxin has gone.

On the other hand, a caesarean won't damage your pelvis (if you have SPD) the way that pushing will, but it will damage the muscles that support your pelvic muscles. Those need to be strong in order to support your pelvis so that's why normally it takes longer to recover from a caesar with SPD. If you don't damage your pelvis from the pushing, then all is hunky dory but if you do, then you could very well end up with a longer recovery than the caesar would have been.

[Inanna]

I can't scan what I have...

I also want to add have you considered chiropractic or osteopathic assistance? Western Medicine doesn't really go for malalignment stuff - but it features quite strongly in other cultures.

I used osteo and chiro with some effect. I went for a few years after my first birth & during and after the others (except Imogen). My pelvis still aches and is still sore all these years later...

I also have a document produced by the physio department at the Royal Womens in Brisbane. One of the things that it does mention is that the lithotomy position (on your back with legs up) should be avoided if at all possible. Frequent small amounts of exercise to ensure that muscles stay supple (they suggest 10mins of walking at times throughout your day). Water to exercise in.

Sorry I couldm't scan it in...

[Inanna]

Just forgot to add. Along the malalignment thingy... Osteopathy would say that a breech baby or posterior baby is very often caused from a malaligned pelvis. So they work at sorting that out. Obviously it's best to tackle it early on whilst there is not too much weight from the baby.

I know for me I felt better after treatments & it helped me feel more proactive as well...

ETA: I would say if you are considering a c/section based solely on fear of a protracted 2nd stage I would really really advise getting some more opinions. It isn't really practical to say if the baby isn't born after 20mins you go to OT. For it takes time to set up etc etc. However, finding some expert advice from physios that specialise in pregnancy/birth/postpartum... And some chiros who also do the same... 3hours of second stage is excessive & I am actually really surprised that they didn't step in and manage the birth. (they tried to with me but I fought like a she cat! ) The chances of that happening again are very low. Good luck

[fionas]

I'd be interested in reading about ongoing, long term problems from cutting through the muscle. As I said in my previous post, my physio has indicated that the muscles should be functioning normally within a couple of months. Although a couple of months may sound like a long time to some people especially with the double whammy of caesarean plus SPD, to me it sounds like an absolute walk in the park compared to 18 months last time. I have reorganised my life and finances so that if need be, I will get a live-in nanny. Last time my partner went back to work after a week and I was wheeling myself around the house on an office chair for a couple of weeks because I'm a get on with it and don't complain sort of person. I've learnt my lesson - that is sheer lunacy.

I do know now what positions to avoid and intend having these tattooed on my butt so that I can graphically show the midwives if I go for a VB.

Looking into chiro on top of my weekly pilates. The Webster Technique is highly recommended as there is a school of thought that believes that the underlying problem is a misalignment, not just the hormonal influx. So I will give that a shot.

We will have to agree to disagree on the exercise. It just hasn't worked for me in the past. I do obviously walk around the house still and when I've used a pedometer in the past I've clocked up to 10,000 steps just from doing that (not with SPD). So I'm balancing not being totally inactive with resting. It's working. I'm reasonably pain-free despite being told at 7 weeks that I would be in a wheelchair soon.

[fionas]

ETA: the physios I see are experts in this. They specialise in this stuff and collectively, as a practice, have seen hundreds, if not thousands of women with SPD. They see women antenatally, in the hospital, sometimes pop into the delivery suite to remind midwives about positioning and see women postnatally. The very strong and firm advice is not to go over 20 minutes. If my ob can't guarantee that, then I will go straight to elective caesar.

[Inanna]

It sounds like you have all the info you need - that's a good thing. I hope your birth is all you want it to be.

[fionas]

Thanks Inanna. I do feel much more confident about my decision process today than I did last night which is why BB is so valuable - it helps you nut things out. I have a few more pieces of the jigsaw to find but at least I know what I'm looking for and where to look.

Oh, and the reason why I was allowed to push for three hours is that my ob wasn't available. He apologised when he got there saying that he'd been off vaginally delivering twins, one of whom I think was breech. He's very, very, very pro-VB and has the lowest caesar rate in Melbourne for a private ob. Usually this is a good thing. In my case, I might have been better to have a more knife-happy ob. That's why I have to balance what he tells me with other sources because he would never proactively recommend a caesar.

[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

[fionas]

Thanks skeetaboat - things are certainly a lot clearer for me now and hijacking the thread was worth it though still a little embarrassing .

Yes, I agree, the final piece of the puzzle will be to talk to my ob and do an interview at the hospital and see what they say about the 20 minute thing. If they seem a bit vague or less than convincing, I'll go the elective caesar. i don't need to be worrying about this for the rest of the pregnancy OR when I'm actually in labour as a less than positive mental state will not be conducive to a good labour.

Interestingly, my physio has told me that either way I should rest as much as possible for the first 24 hours and not attempt to do anything. She says rest is the best thing possible for my pelvis and given that I'm resting much more this pregnancy than last, and not in too much pain (except when I don't wear my belt or attempt to walk for more than five minutes) then I'm happy to take her advice.

Although I can take much longer to make up my mind, as I said before, I don't want it to be preying on my mind for the rest of the pregnancy. As I said to my physio today, it has barely registered that I'm actually having a baby; at the moment it feels like I'm simply managing a chronic health condition (which I am). I want to clear my mind so that I can concentrate on the fun bits of pregnancy like choosing names etc. etc.

I am quite angry about what happened last time but a large part of this was my own fault. Even though I was in a lot of pain, I really didn't talk about it too much with my ob or the midwives because I kept being told that it would go away after the birth. I am someone who doesn't whinge and gets on with things which did me a major disservice last time so this time I am broadcasting it loud and clear to anyone who will listen. Probably a little too much

[skeetaboat]

Oh don't be embarassed! I think Meringue left the building a long time ago, and if she's still hanging around, hopefully it's helped her see what a great community BB is and that it's well worth hanging around

Broadcast as much as you want, you're your own best advocate, no one else will be able to do as good a job of looking out for numero uno as you can do! Sometimes only way to guarantee you get your needs met is to know as much as the expert does and be a true partner in the decision making process.. not just with medicos.. with accountants, lawyers, you name it! Otherwise the care you recieve is sometimes only as good as the day at work they're having.. ETA - it's sad that it is this way though and I'm sure you trusted that your care-givers, having studied this stuff, knew the best way to care for you, or at least knew what *not* to do to exacerbate your condition! That is, afterall, their job!

I imagine it will be good to have the question resolved so you can relax and get on with business, so I'm glad for you that you're that bit closer.

[fionas]

Well, I saw a friend at Mothers Group today who also has SPD and has just had her second caesarean. Five weeks in she said she couldn't feel a twinge and she's able to do things that I certainly couldn't do after six months and could only do comfortably after 18 months (sit and play with DD on the floor, go for a 15 minute walk).

I'm edging towards the caesar. I don't need to be worried the entire pregnancy and worried throughout the pushing phase that I'm going to be crippled afterwards. I already feel extremely ripped off that my life has been dominated by this for the last three years. Spent $20k+ on a new pelvis-friendly kitchen because bending to reach things in cupboards was agony, had to rule out moving within this suburb because all the houses big enough have stairs, given up work at 16 weeks because I can't walk to/from train stations and am now housebound with a toddler.

I think enough's enough and I should cut myself some slack. OK, I might have a really good, easy VB but the midwives I spoke with on the phone said probably not. Time to play it safe and concentrate on researching how I can best recover from a caesar.

[skeetaboat]

It sounds like you've come to a decision, that's fantastic! I hope it turns out well for you and I'm sure you'll let us know. Now on to planning, naming, etc!

Seriously, I've been thinking today, surely the care you received during your first labour would be considered negligent. You've faced an awful lot of personal and financial costs. I suppose it can't be proven 100% that your ongoing issues were caused during the birth, but I think you would have a fair case that the care you received is at least partially responsible, given that they had you doing exactly what it is advised *NOT* to do for someone with SPD in labour. Not that I'm a fan of how litigous society is becoming, but in your case they very clearly went against guidelines for caring for someone in your condition, seems like a basic duty of care breech to me. Sorry, I'm just a little bit furious on your behalf, the more I think about it!

[Cocolove]

as someone who has experienced both natural AND Ceaser births i have to say id have a natural 100000 times over, yes i had 28 stitches yes a couple of things went wrong but hey the healing process was so quick and a hell of a lot easier and less painfull than my 2 ceaser births, if i go for baby number 4 ill be looking into a VBA2C for sure..

in saying that you do what you feel is right for your body, congratulations on the pregnancy and good luck

[alioops]

Fiona, I am wondering if you have looked over my threads from my DSP? I was advised by my BC MW to have a CS but the Obs refused. I deliberately avoided an Epi, because I knew I wouldn't be able to tell if I was stretching too far. I had the synto throughout labour, which may have sped labour up to allow for the vaginal birth to be easier. I couldn't waterbirth because I could not get in and out of the bath by myself, which I was devastated about. I actually sat up for most of labour.

There is nothing saying that if this birth is managed properly that you will have another long recovery. I was actually amazed at how fast I recovered, even though I occasionally ache. Dont forget I was in a wheelchair for a month and on Panadeine forte for 3 months, I do know exactly what you are going through, and I know it is not fun.

Have you had an ultrasound to measure your SP? It sounds to me like it is worse than SPD, it sounds more like DSP.

Fiona, I had a huge battle with my ob when I requested a CS. I was armed with all the info I could find, and only when she told me she had been there for another wheelchair bound DSP mum and could tell me exactly what happened did I feel I could trust her judgement. Textbooks tell them stuff but until they have been there and actually been involved without doing damage they can stick the textbooks where the sun don't shine.

All the best with whatever choice you make Fiona, If you need to ask me anything feel free.

[Peg]

Well what books have you read so far?
Have a read of these articles, they may be of help to you
Breastfeeding After A Caesarean Birth
Caesarean Sections - What Actually Happens?
Caesareans: What to Expect After A Caesarean Section
Epidurals - What Are The Risks For Mother and Baby? - not intended to alarm, but just so you have an idea of what to expect

and this title here
Caesarean Birth… Making Informed Choices (Birthrites Booklet, AUS) I don't know where you would get this from though.

thats a great list

do you have a list like that for vaginal deliveries?

[Peg]

Thanks Miss H, your comment is appreciated. I definately feel a little better from the bits of good advice most of you have given me, and will certainly look into your suggestions. Thanks also to those of you who support personal wishes and decisions. Pregnancy is a major event as Im sure you all agree, and I think support, advice, and understanding is an enormous component to having a good pregnancy : )

good for you Meringue

the outcome is the most important thing...a healthy baby and healthy mum is all that matters

birthing is a very small part of the journey, & what comes after it is all that matters.