So many questions....Alan? Kelly? Anybody!

OK, so a bit of my history first...I had an elective C/S last time, as I have suffered terribly with haemorrhoids for many years. I had had surgery twice before ever being pregnant, and of course pregnancy made them worse. I was worried about having a vaginal birth because of the damage that would be caused. So I chose a C/S. This time around is very different though.....

With a new OB who said that there really was no reason to have a C/S, and that pg is what causes most of the problems, not the birth, I have chosen to have a VBAC this time around. I have felt really positive about this & am really looking forward to the birth. At the beginning of this pg, I had 2 roids that thrombosed - extremely painful!!!:( I had them lanced & the relief was almost instant. They have been on & off 'normal' (for me) for most of the pregnancy. Just on Friday night though, I have discovered I have another thrombosed one - like I said, extremely painful (and I'm used to a fair bit of pain there!). I got SO upset, because TBH, if I'd gone into labour then & there, I know that I couldn't have gone through with the VBAC - and I hate saying that, but it's how I feel/felt.

Anyway, I called my support person, and talked through some of it, which really helped...what I need to do now is find solutions....So...

#1 - got to my GP tomorrow & have it lanced - I know that this will fix the immediate problem. It's just a shame it happened at the beginning of the weekend...

#2 - be prepared for if this does happen again right before labour. I'm not going to let this stop me having a VBAC, but I now realise that I need a plan...this is where I need help.

There is one solution that seems very obvious to me, but I've never heard of it being done, this is where I'm hoping Alan or Kelly might be able to help. Do you think I could ask for a local anaesthetic in 'that area' when it comes to stage 2? That to me would be the ultimate, as I would be able to forget about the pain in that area, while still being able to feel everything else & feel what my body is doing in the other areas. Then I can worry about the damage later, instead of stressing about it during labour (which I can only imagine would slow 2nd stage down heaps as I'd really have to try hard to ignore the urge to hold back).

I guess the other option is pethedine, but that is my much less preferred option. I would like to avoid it, but if it will allow me to VBAC then I will keep it up my sleeve.

Sorry for such a long post, I just wanted to fill all the gaps so that it makes sense. I'll be seeing my OB on Thursday so will also ask her about this then.

im not experienced enuf to offer advice.. except that prolly not pethideine, i dont think it would give u the relief that it sounds u may need in that area... I just wanted to say, yay you for being so positive and willing to research everything possible to have a natural birth/ and VBAC... I hope someone on here can over some advice... Best of luck and big hugs for your ouchy situation
take care
xoox

Thanks Gill :) I appreciate it. Good to know about the pethidine, that makes sense, I guess it's more of an all over type pain killer that such a specific area...

Yeah, I imagine you would want something more localised if possible, peth can really knock you around.

I don't know what you can do Linda, but i just wanted to say I hope it all works out great for you and send you some huge :hug:

I had one big one this pregnancy, but had problems last time post birth with a persistant fissure, and i'm also terrified of problems down there... The pain is horrendous, you wouldn't of thought something so little can cause so much pain! My mum is a midwife who does primarily colo-rectal nursing, so she has been a big support for me.

I don't know what to do to stop them, i had a big one that i thought was thrombosed, but it seemed to clear up by itself.. It was bleeding and very painful (like fissure painful).

The only thing i know about having a local (i had local with a vac extrac), was that there is so problem giving it depending on where the head is as they don't want to accidently hurt the baby, but i'm sure Alan can answer that one better.

I just hope it all ends up ok for you! And that you don't see any more of these ever!

Linda, I know this has been upsetting you for some time and I don't think there is anything wrong with having a plan for the time when it gets to the birth, like you say, gotta be better than a c/s to have a plan. That said, we hope there will be no need to worry at the birth, but just so you don't have to deal with the stress later, I think it may help you.

I never recommend pethidine no matter what, too much of a chance of breastfeeding attachment issues in those early days. Some effective natural remedies (some of which you could use as a preventative also) include:

* Tissue salts, which you can get over the counter from your pharmacy or a health food store
* Witchhazel which you can also purchase from your pharmacy, is used topically. You can apply it on a cotton ball to the affected area when going to bed. Leave the wet cotton ball on overnight and you will usually see great results in 2-3 days.
* Phytopro by Metagenics – you will need to see a naturopath for this one, but taking them around 2-3 times a day will usually result in haemorrhoids disappearing within 1-2 days.

If none of those help, then, I am not sure about local anaesthetic, you would need to ask your Ob or even call the delivery suite and see if you can speak to a midwife about it, what they think. Alan could probably tell you that one.

It sounds extremely painful and it's a reasonable thing to see how you could not want to go through a vaginal birth with the extra pain. I don't know heaps about how they interfere in normal labour as opposed to a c/s (I guess so many factors like size, location etc. and I have never had one to know) but definitely make a plan, talk about it and please let us know how you go... xx I hope you have a wonderful birth experience without those worries hon...

Could you speak to a colorectal surgeon about if there is anything else you can do??

Thanks so much for the detailed replies girls, I really needed to bounce around all of these ideas with you all.

Yael - how handy having your Mum as a midwife specialising in these things. That's great yours cleared up by itself. I know from history that once mine thrombose, there's just no chance of that. :( AS for talking to a surgeon, I saw one years ago (pre kids) who recommended having kids, then getting it all 'fixed' properly once & for all. Which is what I plan to do after this bub. I guess so close to the birth would be a bit too close for surgery (except for the lancing that I'm hoping will be done tomorrow). So did you have a local with a vac extraction? I can see what you mean about it being close to bub. I'm hoping they will say it's far enough away that they can do it.

Kelly - thanks for getting back to me. :) It's good to know that about the peth. I knew it made bubs on the sleepy side, but yeah, the last thing I want to do is make bf harder. I'm so excited about being able to bf straight after the birth that I really don't want to do anything that will hinder that. I have had 2 salt baths today which was nice. :) I will go to my GP tomorrow & hopefully get it lanced. Then I might ring the maternity ward & see what they say about the local.

I'll let you all know how I get on with it all. Thanks again for being understanding & supportive!

Hi Linda
First let me congratulate you on choosing a VBAC.
I have never soon anyone having a local anaesthetic for haemorrhoids but I don’t think I have ever seen anyone with the problem as bad as yours sound. Theoretically there is no medical reason that I can think of to stop you from having a local in fact, I would suggest that it is a far safer option than another CS. As this is a somewhat unusual request you would need to discuss this with your OB and get him to order it. Another problem that I can think of is that the midwives may be unwilling to do this if they have never done or seen it done before. That can easily be overcome by the procedure being by your OB or the hospital doctor.
One way to help reduce the chance of this problem arising is not to be directed to push. Your body will tell you when it is time. Listen to your body not the midwives/ob.
I don’t think that pethidine is a good option. It is not a very effective method of pain management for this type of pain. It will only take the edge of the pain and it has a number of undesirable side effects.

Thanks Alan for your honest reply. I was hoping to hear from you. :) I'm so pleased to hear that you can't see any reason not to have the local. I think I'll contact the midwives & see what they say - maybe then they can at least have warning & know about it in advance. I'll have a great support person with me too, so if it all needs to be explained when the time comes, I'm confident that she will be able to fill them in & get them to understand.

Linda- i think as long as u arm yourself with ur support person and ur knowledge then u are gonna be showing ur midwife a thing or too.. Peth really is a nasty drug.... not quite sure of the point of it at all to be honest... good luck tomorrow, and ill be waiting eagerly for your birth announcement.. big hugs babe
xoox

ow ow Linda, I feel your pain!!!

I also had bad hms with my first two pgs. When it came to pushing, that was one thing I was pretty concerned about. I did find tho, that when the baby was descending onto the perineum and starting to crown, although that tender area was pouting (sorry sorry TMI!), it wasn't too traumatic. The big stretching was happening elsewhere, it didn't affect the hms all that much worse that just the weight of the pregnancy in general IYKWIM. Right after the birth, I did have pretty big hms but because of the change in hormones and no baby weight, they healed in a happily short time.

2nd pregnancy, I waddled onto the plane at 8 months carrying an inflatable ring and this kind Qantas air crew woman said, "oh you poor darling come with me" and found me three seats where I could lie on my side for the flight! God bless her wherever she is!

They were so bad that time that the tips went black, then white (sorry TMI again!) and ooooh the pain! I tried putting muslin cloths soaked in witchhazel and herbal liquid in the freezer and that helped. (I also used proctosedyl - wonderful stuff!)

I have an idea - how would you feel about someone holding a cold cloth like that to support the area while you are pushing? I found hands & knees best for me as it felt like there was less pressure on the hms in that position. If you were on hands & knees or kneeling forward, an attendant could support the hms with a cold cloth. It might help. Maybe not as much as a local.

Third preg - no hms!!!!! Yay! I took a swallow of prune juice daily to avoid the problem that time - and it did actually work.

Linda I know how pain in that sensitive area can really put you off. I do want to encourage you tho, if you can push effectively through the worst bit, then right after, the good healing time comes - no more weight and no more hormones making things soggy. I would suggest a position NOT on your back or semi-sitting when it comes to pushing - so to keep options open you would want to avoid an epidural so you can keep your mobility & use of gravity. If you are off your back, and upright and kneeling, you can alternate between using gravity to help your second stage progress well, and going forward onto your hands or elbows (knee-chest) if you want to slow it down and lessen pressure.

I made a herbal bath to soak all my tender bits in - and I added a good amount of sea salt to my baths or sitz baths to help myself heal. I also used a peri-squeeze bottle which was a life-saver on the toilet.

These are the herbs I put in the herbal bath sachets (tied up in a muslin bag)
- Lavendar
- Uva Ursi
- Calendula
- Rosemary
- Comfrey
- Sage
Lovely smell and very soothing, I found.

I wonder if local anaesthetic gel would work adequately? (it would probably be nice to have that anyway before having an injection).

Herbalist Hilda Hemmes recommends this for hms (I have not tried this):
50g Shepherd's Purse
30g Knotgrass
Prepare the herbs as a hot infusion (tea) and drink 3 cups per day.
Also:
Apply Swedish Bitters tincture directly onto hms twice daily.

Healing vibes to your sore areas, Linda!!

Oh Julie - thank you, thank you, thank you. I appreciate your understanding what I'm going through! And your wonderful advice, I am very much taking it on board.

I think the compress during 2nd stage could actaully be really good. ATM it seems a bit 'confronting' IYKWIM, but I'm sure once I'm in labour I'll get over that ;) I have never heard of the anaesthetic gel, where does it come from?

Oh - & the proctosedyl - it's my lifesaver too! I don't know where I'd be without it! It's good to know that they should heal OK after the birth. I've already asked my OB that if any are thrombosed from the birth that she will lance them while she is checking/stitching me. Oh yeah, and the epi - I will be doing all I can to avoid one, mostly for the reasons you mentioned. I know how bad it would be for me to be pushing against gravity. And also to be pushing without feeling IYKWIM.

So thank you for your advice, it's great. :)

Just thought I'd come in & update. Went to my GP. I could already tell today that it was a lot better, which really surprised me. I still went anyway because I wanted to chat about different things. Anyway, he said it had begun to heal on it's own - Yay! and it would continue to do so. So that was a huge relief. I think being really sensible with resting yesterday made a huge difference. I think I really need to start resting more & not trying to do so much physically. I mean, it's not for long & worth it.

The downside to the visit was his opinion on the VBAC. He wasn't totally against it, but did say that if the midwives/OB suggest a C/S during labour then it will be better to have it sooner rather than later, because it's inevitable anyway.....etc etc. I know enough not to let this get to me too much & I feel confident about what I've chosen, but it did make me feel a bit down to hear that opinion. I guess I just don't want anyone putting doubts in my head at a time when I already feel a bit vulnerable...

But overall, now that a great deal of the pain has subsided, I am feeling much more positive about the birth. Please everyone keep your fingers crossed that the dreaded things stay away & allow me to focus on an active, positive birth!!!

Oh excellent Linda!!! WOO HOO!!! Perhaps you can do some preventative stuff with homeopathics and cell salts to keep them at bay? I wont wish you luck, you wont need it ;) Go girl!!!

Aww - thanks Kell! :) Yep, I'm going to do all the good stuff! I promise ;) And I'm going to let DH do lots around the house while I put my feet up! (lucky he's more than happy to). And I'm going to have a nap every day with Miss Em!

YAYAY!! Lets hope that mood gets switched over real soon ;)

Great to hear Linda, "you go girl!"

Don't let the GP's comments put your off - he's citing traditional medico lore that is assumed, but is out-dated, unscientific and not based on evidence. I'm sure s/he means well, but unfortunately s/he is ill-informed. What's your GP's email, we'll send off a whole bunch of info from 'Birthrites - healing after ceasarian' and 'ICAN - International Ceasarian Awareness Network'. (Just kidding! - but wouldn't it be an education!)

I have to differ with his comment, "if the midwives/OB suggest a C/S during labour then it will be better to have it sooner rather than later, because it's inevitable anyway".

I think that's dead wrong TBH. Many times c/s can be averted simply by adding patience and time to the formula. Failure to Progress is many times simply 'failure to wait' because a normal labour can plateau - go for hours with no progress - either to give the mother & baby a natural rest, or to allow tissues time to strech, or head to mould, or baby to subtly re-position. Then it can suddenly pick up again and there can be good progress.

I hope everything goes wonderfully well, stick to your guns, don't let the GPs comments spook you.

Thanks Julie. LOL about the emails to my GP!! Wouldn't he love me then! :lol:

Thanks so much for all the support.

Kell - I'm nearly ready to change my mood ;)Watch this space!