c-section vs. natural birth

I am extremely pro natural childbirth, and rail against the ludicrous c-section rate civilized women tolerate, and I am personally dead set against any surgery that isn't required as a matter of life or death. But one suspects vaginal delivery can certainly weaken tissues. There is evidence that much of the damage that leads to prolapse isn't from giving birth vaginally per se, but from the medical interventions such as episiotomy, that accompany so-called "natural" delivery in the modern hospital setting.

When you give birth the way nature intended, you're not drugged. Being drugged leads to weak contractions, which in turn leads to poor progress, which leads to pitocin, which leads to harder pains, which leads to an epidural, which leads to no urge to push, and indeed, spending labor sleeping in a bed.... which ALL ultimately leads to a heavily "managed" delivery... episiotomy, vacuum extraction, internal monitors, amniotomy.

Another aspect of this horror show is the mandate to induce labor at one week post due. Mother nature spends the last few days and weeks softening up your internal joints and tissues in the pelvic area in preparation for the passage of the baby. If you induce labor days or a week or two before your body was going to do it, you aren't actually, completely PHYSICALLY prepared... in the VAGINAL area. So if you are induced, without waiting for your body to signal the start of labor, you've got lack of tissue preparation plus the circus described above, and it amounts to a double whammy stress for your pelvic area.

In addition, the typical hospital birth does not encourage the natural positions women have always used to ease the child out with minimal damage. The best way to deliver your baby is vertically. Squatting, essentially, not sitting back on a bed at a 45 degree angle and certainly not lying down.

Painkillers are the first small step in the slide. With NO painkillers at all, a woman is restless during labor, and much more likely to move about. She is in tune with what is happening inside her body. She controls the pushing. Because she is sensing everything that is going on, she is responsive to things and a lot more active in delivering her own baby. She is much more likely to deliver in a non-damaging position, because it is going to be what FEELS better to her. With the right "midwife" she can deliver easily without an episiotomy, and, I believe, will be at much less risk for later pelvic organ prolapse.

But on the other hand, a C-section does avoid the baby stretching the lower tissue at all, and perhaps causing the theoretical "micro tears" (like runs in pantyhose) that lead to eventual macro weakening of the supportive fascia.

On the other, other hand, perhaps C-sections damage higher up tissues that are also used for support and have a set of risks all their own. I honestly don't know enough about it to tell you the statistics of C-section vs vaginal delivery as far as impact on POP goes, but I can state pretty certainly that IF you opt for vaginal delivery, then you should certainly go as natural as possible, being particularly adamant about refusing episiotomy. Get a midwife who KNOWS HOW TO DELIVER OVER AN INTACT PERINEUM. I think if I were in your boat, if I could not find such a midwife, I'd go for the section. Much as I despise surgery.

I had two vaginal deliveries. The first I ended up with an (unwanted and essentially unconsented to) episiotomy. The second came precipitously on the bathroom floor with no episiotomy. I don't know that the episiotomy caused my POP. Some say the precipitous labor is the cause. Who really knows? I might have gotten POP even if I'd had them both by C-section.

Like I said.... hard decisions.

So.....

There is a lot of really good info about c-sections and other medical interventions by the author Henci Goer. You can google her name, she has a web site and 2 books, both of which are very well researched. I know because I double-checked in all the medical journals at my university library ;) but I'm nerdy that way.

I am now disappointed that in all my pre-birth research, none of it mentioned pelvic organ prolapse at all, so I had no idea what the risk factors might be. I have 1 child, 5 months old, and developed prolapse about a month ago. I had no drugs, and no induction, but did have an episiotomy.

If you do are considering a c-section, you should also think about how many children you hope to have. Many of the articles on c-section versus vaginal delivery don't go into this, but having multiple c-sections can lead to complications affecting your ability to conceive again or carry a child to term (the risks after 1 c-section are often quite small, but grow exponentially with each c-section). A lot of this info can be found in articles by the author I mentioned above.

Canadian wife and mom of 1 boy

That is how my first birth was. I had a midwife who was very supportive of all my desires for a completely natural birth. We discussed episiotomy and she said she only did them if "absolutely necessary". I had no drugs, and if memory serves, don't think I even had a heparin lock. But at the moment of crowning, she said, "gee it looks like the tissues are so tight" and she did an episiotomy. It was not until much later I spoke with another patient of hers and discovered that she had a reputation for doing an episiotomy on nearly every mom. I guess the moral of the story is that even with midwives so REALLY have to do your research.

I have to admit that I cringed when I read the words "only if absolutely necessary"... because that is what my gyn told me as well. Why are they not listening to us?

I also have the thoughts of a future pregnancy on the back of my mind. I really would like to have another baby... so scared that everything would be made worse... husband is supportive, but asks why would I want to take that risk... trying to concentrate on other things and save that decision for another day.

I know 6 mothers, who gave birth over the last 6 months... 4 mothers who had c-sections, who had no depression, babies are doing great and are now fully healed and back to enjoying sex with their husbands... then the two vaginals... me... with several prolapses and the other who had 4 degree tearing (no prolapse yet thank goodness) and a baby with a nerve damaged arm. Both of us scared to try having sex...

I have always been very pro natural childbirth... but it's hard for me right now to defend it.

Want to also say thank you to those of you who continue to post on a regular basis. I have been sitting back, reading and absorbing over the past few months. You all were correct in saying that things would get better, as they have. The prolapse is the same, but I am enjoying the good days and better able to cope with the bad days (usually by spending hours reading the site)... I stuck it out and am still nursing my, now 20 lb 4.5 month old (lifting has become an issue)... we laugh together, we cry together and try to make the best of every day.

Hi Alexasmom,
Reading what you said about your friends who had C-sections, I would just say that they are lucky that they had such positive outcomes. there can be many complications from the surgery, and there is a higher risk of problems for the babies too (this month's Mothering magazine has good articles on this). Also C-sections often get in the way of breastfeeding, which again can lead to health problems for mums and babies.

I have known many many mums who birthed babies naturally with no problems, many at home. If i had another child there is no doubt that s/he would be born at home under the care of a home birth team of midwives. My first birth didn't progress for 4 days so I went to hospital, which is where I (and the surgeon I saw) am convinced my prolapse problems started.
Second birth was a lovely home birth, but a bad cough in pregnancy and far too much relaxin probably allowed the prolapses to make themselves known. Would they have happened if I'd had a c-section? I'd imagine so, maybe a bit later, who knows. but i had as good a birth experience as I could, and I have no regrets.

glad to hear things are getting better slowly, and congrats on continuing nursing! I just want to keep saying, it will get even better! I'm 9 month on, and i barely notice things most days. i really just get on with things, and my "it feels a bit funny today" is nothing compared to where it was at before! i never would have believed it could get this good.

as for the lifting, i find my ability to goes in waves. if baby has a growth spurt i really feel it for a few days, then my body catches up. same goes if I don't carry as much for a few days. but i never would have imagined that i'd be able to lift my 9 month old but i can, and we even still use the sling sometimes. the body is amazing. it heals in amazing ways.

kiki

your post, alexasmom, reminds me of my very good friend. she had a baby a few weeks before I did (roughly 5 mo ago), it was her fifth child, first c/s. long story, but one of those impatient doctor leads to 'emergency section' type of things. in any case, she wound up so incredibly depressed. and had debilitating pain at the wound for over 3 months. still is experiencing some pain, tightness in low abdomen. she was afraid to have sex the last time we spoke of that, a month ago. no one told her how painful the recovery would be and I *personally think that contributed to her depression.

likewise, I think some of us are experiencing some anger toward our health care providers for not warning us about POP. I think regardless of how we birth our babies, we all want, and deserve, full disclosure.

anyway, back to caterpillar.
you all know I'm pro-natural childbirth. I wonder how your history of vulvodynia will impact your body's ability to work with you and the baby. I dont' know much about it, only that a close friend of mine back in college had vulvodynia and couldn't even come close to using a tampon without (literally) passing out.

we can talk statistics and relay personal accounts until the cows come home and in the end nothing is guaranteed.
I think if you dream of having babies, believe that you WILL be able to birth them safely one way or another. don't let this stand in your way.

I want to make a general comment here that c-section is certainly called for in some cases.

However, I think it’s very important that we always uphold the ideal of natural human birth. Where would we be without our ideals of health, honesty, integrity, love, mercy and so forth? Ideals are what we strive for even though we also understand that the human condition is such that we often fall short of them.

I guess I feel like expressing this because I am witnessing the ideal of natural birth right before my eyes. My daughter, 8 months postpartum from a gentle home birth, is more beautiful than she has ever been – every ounce of (Irish pub) fat melted away, energetic, unscarred, happy, and extremely loving to her fat, healthy, and totally breastfed baby. That is my ideal of natural human childbirth and it is also a reality within reach of most women who want it.

There is no good or bad here. Only our ideals, which contribute greatly to shaping our existing reality. When reality does not measure up to the ideal we have yet another opportunity to grow through acceptance. It is a fact that mothers have great influence over how their daughters give birth. Nothing should ever compromise our ideals.

I had the same assumption about my mother except not about c-section but about miscarriage. I have the same body type she does, and she had 4 miscarriages, along with 5 live births. I always assumed I'd have an equivalent number of miscarriages as live births... just thought 50% miscarriage rate was "normal" for pregnancy. Was expecting it, and almost shocked when my first pregnancy didn't end in miscarriage. I never had any miscarriages as it turned out.

I can certainly understand your reluctance to "mess with" the area down there. I have Reflex Sympathetic Dystrophy, which is a form of constant pain in a limb and it is a nightmare. It is in remission, but can be triggered by any slight injury or trauma, so I am very careful not to injure or overuse that arm. If I were in your position, I might consider c-section a way to avoid traumatizing such an area, but I recommend doing a whole lot of research first. There may be someone, somewhere who has become an expert at treating your disorder, and might know how to handle natural childbirth with the condition.

I spent some time with a psychologist, years ago for reasons not related to POP.
one of the topics we spoke about was how many times a woman is (subconsciously) not willing to surpass her mother. this could be in areas related to education, employment level, love, children, health, etc.
could be that your mom's reasons for needing c-sections are hereditary and could be not. try to think positive (you DID come with two sets of genetic material!) and allow yourself to achieve, if possible, even that which your mother was unable to.
another thing is that when my mother had me, the 'science' and culture of OB medicine was not exactly one that empowered women. lots of dr's do things differently these days, and that makes a BIG difference too.