Should I get a c-section?

Body: 

Ladies:

I am almost 22 weeks pregnant right now. From delivery with my son (in June 2005), I got a cystocele & uterine prolapse. Pretty bad. Bothers me on a daily basis when not pregnant - mainly a constant urge to pee. WIth this pregnancy, I've had some leakage, too.

I am terrified about making the prolapses worse with this delivery. I can "live" with my conditions as they are now but life would be unbearable if they were any worse.

I know that a c-section is controversial but I need some sort of "guarantee" that the prolapses will not get worse. Any advice?

- Tori

Unfortunately this will not guarantee you will be no worse as every day you stand the weight is on your pelvic floor.

My sister in law just had an emergency caesar and is in lots of pain after (And having had stomach surgery I was after that too)

To be honest I would try other avenues like pushnot and taking control of your own birth...
Click for pushnot

And after you get yourself back into posture and take care of yourself through your recovery :)

Unfortunately there are no guarantees in life :( But women who have not even had a child get prolapse so it is not all about birthing etc

Sorry I am not more help - But there are no guarantees either way in this...

Just found this page too...
Clicky

WOW!!
I have been looking for info from Dr Mercola and as usual he is so thorough and concise!! Thank you SOOO much and it is what I have suspected!! Every baby --5 in all I was never allowed to have the urge the urge to push--except one time...the drs ALL made me push before I had it except one Dr--a dear man when I lived in Illinois...he was Korean and I swear I couldn't understand a word he said! But he was the only who allowed me the urge to push...all the others had me convinced I didn't have it and had me pushing so hard and for so long I and my babies broke all of our blood vessels in the eyes, face, neck and shoulders...I would look in the mirror and wonder what the heck?! I thought there was something wrong with me...
I think it is especially interesting that they bring up that once the urge is there our tissues tighted up in order to protect us in the pushing phase...makes sense to me ! Christine is always saying we are made perfectly...we are not coached perfectly though!

sue posted some great links, I plan to check them out more thoroughly when I get a chance...hopefully soon as I am already 37 weeks pg (with cystocele, rectocele and in all probability a low uterus as well).

bear in mind that a c-section involves cutting of muscle and fascia...the very structures needed to properly hold up your pelvic organs. the uterus, bladder and rectum are not only supported from below, but more importantly held UP from ABOVE and ideally held in optimal position, which is over bone and not the vaginal opening. with that in mind, a c-section is not likely to prevent worsening of prolapse.

and as the others have said, there are no guarantees in life. my sister has 7 kids under 10, all vaginal births, and no prolapse. some women here have pretty significant prolapse and no kids.
I think you're best course of action is to implement the posture and try the gentle no-pushing birth.

good luck!

Maybe one of the reasons doctors encourage pushing, is that so many women today have epidurals, and therefore don't feel their labors. They need an exam to tell them they're dilated, and a monitor to tell them they're having a contraction and they can push.
I would guess that pushing on instinct, or letting nature and gravity do the work, would be gentler.

I understand that there really can be no guarantee, but wouldn't a c-section have less likelihood of aggravating my prolapes?

Also, with my son, I was induced at 36 weeks (pre-eclampsia) - so I had pitocin & magnesium sulfate (or chloride - I can never remember which)... was on complete bed rest for 4 days, had an epidural... the whole thing was a disaster. I'm kinda concerned that will happen again, too...

Interestingly, my prolapses have not been worse during this pregnancy (in fac tthe uterus is better since it is higher up)... I am having some occasional leakage with the cystocele but nothing I cannot live with, I guess.

Any more advice? Also, how do I see/find these links? I cannot seem to see them although people are referencing them. Thanks!

- Tori

You just click on the browny coloured words - That the hyperlink

I would say that neither holds more risks for differing reasons

Prolapse wise they hold EQUAL risk - As neither is better for prolapse - The weight of the baby you carry can prolapse you even before birth! A hard bad vaginal labour can prolapse you at birth - Forceps etc - Usually in 2nd births it is far easier though...

Caesars can damage you internally during surgery...

It is all about your choice but personally if I was pregnant right now (I have all 3 prolapses) And this would be my 4th child (I am not preggo tho lol) I would still go the Vaginal birth route. My Sis in law just had a caesar a week ago - She can hardly lift her baby at this time a week after te birth cos of pain etc... But this does not in any way say she will not get a prolapse...

It is like saying 'how long is a piece of string'

Any thing can happen in each choice of birth. Ya never know - So you just do the thing you feel best with. In UK you will not be given the choice for a caesar that easily though... But I would do the pushnot thing - Last time when I had my daughter they kept telling me ''You can push now you know'' I replid 'Next time' lol Eventually my belly went solid like concrete and I KNEW the next one meant pushing I would do... After that I think my body went into automatic mode and one or maybe two pushes (Small ones too nothing amazingly arduous lol) and there she was :) And I had not even read the pushnot page back then... So I found out before that - That your body is a very good machine - IT will tel you what to do and when - All you hafta do is listen :)

your previous birth has no bearing on your next- I had my first at 38 weeks my 2nd at 37 and my last at 41 (he was big) I thought after the first that I would just have the second at 38- but he had something else in mind- then you can imagine my frustration as I waited forever for #3.
If I were you I would do it vaginally. A c-section is major abdominal surgery- you can look at the long line of risk associated with surgery-
not to mention hospital stay, breathing probs with the newborn, lifting your son-(don't bet on it), bonding, breastfeeding(don't know if you do it or not but it is hard to nurse when you have a large incision over your tummy),recovery time, healing (my sister still had incision pain 6 months out), cost......
I hear you saying you want some definite answers- As far as your prolapse goes you will be fine fine fine-
Research more
don't have surgery based on fear of what if-

Being someone who has had a different type of surgery in stomach area on 16th last month I can say IT HURTS... And once the initial pain has gone away - It still hurts - It is an annoying kinda pain and I am a few weeks on now.

Last time I had an incision (same thing not caesar but still a cut in belly) It was at least two months before I even felt semi normal again and about 4mths till I felt like a normal human.

As I said I would go the Natural vaginal delivery route... It holds a more natural result... Say your prolapse is a bit worse right.....

You get into posture and things do heal for up to a year after the birth - Things get better in time - Especially with the posture etc...

The only thing us women can do is tell you what we would do. And the thought of getting over surgery and having to del with a new baby and having to lift babe and do all those things sounds far worse than the prolapse thing

My Gynae told me most women have a prolapse to some degree after birth and to have another birth (Unless it was like forceps or something baddddd) would prolly not change as ''the damage is done''

Think of your baby - Enjoy that thought - All WILL be well :)

We will all stand by you on here - OK

And I have tried both...
I had my son three years ago by emergency CS. And although the birth of my daughter six months ago was very far from natural (epidural, forceps, shoulder dystochia) and I got my prolapse from it it was still a thousand times better than delivering my baby in an operating theatre.
I started a treatment with this woman who does massages to improve circulation to help the body to regenerate and she claims that she can move/help fascia to regenerate, too. I am very sceptical about this sort of thing so I don't feel very comfortable writing about it just yet but I can tell you that the results are very hopeful.
What I want to say is that so far she has only been working on the damage done to my abdominal muscles and fascia during the CS. And the results 'down there' (where she has not done anything yet) are quite amazing. My uterus is much higher than ever since I started cheking it after the prolapse. And it is not prolapsed, it was just not very high. This shows me that a cut of this kind really is BAD for prolapse.
The lady says that 'old-type' vertical Cesarean cuts were much less damaging, by the way.

If I were you I would stay away from doctors and hospitals and let my body do the work of birthing my baby...

Please let us know how you are getting on.
Best wishes,
Reka xxx

Vertical cuts may be much less damaging in certain ways but...

Vertical cuts lead to Incisional Hernias more often (cant remember who told me that - One of the docs at hospital I think - about my Incisional Hernia!)

I guess everyone has to weigh up all the pros and cons for them and make their choice from that though

I think that's the question here.
which muscles, how do they run, etc. I know the major abdominal muscle group runs vertically, which is probably why a transverse incision damages more fibers while a vertical one makes it harder for the muscles to rejoin (though in any case there is scarring when they do rejoin) leading to hernia, potentially anyway.

I guess no cuts are 'good', and like sue said, its a game of weighing the pros and cons and then placing your bets.

by the way sue, how're you feeling these days?

I am ok I guess - I have a large haematoma - Hopefully it will be gone by 23rd or it gets drained... It still feels 'wrong' like the clips pull or something and it feels like there is a book in my belly or something lol - I guess that is all the scar tissue forming itself - Who knows - I am unable to have a peek inside myself (Which would be great if I did) But - I am praing the lump drains itself and things get back to normal asap - I am not allowed to drive or lift anything at present and life is very challenging having to ask other people to do this for 6 weeks until I see the Dr again...

Cutting top to bottom lets the fibres part in some cases - It is apparently easier to herniate through this way

I am told or I read that if you sut kinda diagonal that is the safest cos of the muscles and scar tissue not being at such risk of breaking down

Dr's tend to cut side to side or top to bottom though - Guess that makes it easier for them lol

I think all cuts have the possibility of causing more problems, though I have never heard of a woman getting Incisional hernias from Caesars - I only now of two or three women who have gone through that so not exactly a wide amount of women lol

The thing that makes me say I would choose normal delivery over a caesar if it were me is that after the birth you heal faster and you are able to care for your baby. Having seen my sis in law yesterday she is really (in my opinion I dont like her much so only know what Isaw lol) She is sat on the sofa and brother is doing all the baby stuff - How will this affect her bonding with her baby? Only time will tell.

I really believe if you manage your own birth with the less pushing thing - You will cause alot less damage to your system than going under the knife by choice.

In UK the caesar 'cut' is a very low side to side cut in the bikini line - So it is hidden away in the future - And as it i side to side the tissues should heal better than the old top to bottom cuts etc. But even aying that - Unless I had to have a caesar for medical reasons. I would avoid it cos of all the pain.

I agree with you, I'd avoid a c-section at all costs. I'd rather have stretching/tearing what have you of the perineum than surgical incisions of uterus, abdominal muscle and fascia. also the increased risk factors for mother and baby, and I know what you mean about the healing. a good friend of mine wound up with an emergency c/s recently and she had a very hard time postpartum, dealing with her older kids and taking care of herself and her baby. she didn't want to delegate, she wanted to take care of her baby!

in any case, I hope your healing speeds up and this all becomes nothing more than a memory really soon. you seem too energetic and independant to sit back for 6 weeks and let others do stuff for you. its gotta be hard.

((hugs))

It is sooooooooooooooooooo hard (not to mention boring)

You ask for someone to do something - They say 'in a minute' And maybe days later the job still isn't done (Like that cat litter - Still waiting I sellotaped a note on to the bathroom mirror so my sons are unable to miss it this time - Unless they remove the note lol)

I hate asking people to do things - Being 'out of action' is so annoying - I just refuse to keep asking people to do things they are old enough to KNOW need to be done anyways. lol.

My 4yr old knows what has to be done far more than my 18 or 17yr old!

I just hope things get back to normal real soon cos it just makes me more cranky than I normally am - lol...

Oh - and cutting the abdominal muscle hurts sooooooooo bad - as every movement you make - the muscle is involved - There is NOTHING you can do to avoid it - You cannot cough You cannot sneeze - You cannot laugh - You cannot cry - you cannot breathe or sleep - You name it - It bloody hurts to do it! And at same time you cannot sit down or get up or lie down in bed or get outta bed (lol still remembering everything it was so painful to do) lolol

I've been doing some therapy with a body worker and it really seems to help me too. I haven't been made any promises but when she works with my pelvis and gluteal muscles everything just seems higher.

Well, I got Christine's book yesterday. It mentions risks of c-section (but in large part the risk seems to be for future pregnancies & I am DONE after this). I also agree that the recovery is no fun... but, I think I would rather have 6-8 weeks of "bad" recovery time than a lifetime of a worse prolapse.

Right now, my prolpase (uterine and cystocele) is noticeable every day & bothers me with trying to take care of my son (22 months old). What would I do if things were worse? I would be no mom at all. I've already had to give up aerobics and running (was a marathoner & aerobics instructor until I had DS).

Does anyone have any "concrete" information on whether the c-section can make prolapses worse? I have heard some of you mention that cutting the abdominal muscles can make prolapse worse but is there actually a study (or something from Christine) that supports this? I've yet to see any complain that they got a prolapse after having their c-section.

I would love any more help with the "research," as I simply cannot find anything! Thanks.

- Tori

I don't have any concrete info that shows a c-section would make a prolapse worse. I don't have any that shows it prevents a prolapse from getting worse either.
no guarantees either way. many women have had no worsening of prolapse after future vaginal births, and many women have prolapse without having children at all.

like any elective surgery, c-section is a highly personal decision. In my opinion, not one worth the risk, but again, that's just my opinion. my gut tells me that cutting fascia is not going to help stabilize a prolapse and you never know how you'll scar, where adhesions can form, etc. flip side, of course, is you never know how you're baby will push his head against your vaginal walls either.
for me, I'd rather do the natural thing, because when it comes down to it, I have more trust in natural design than in surgical theory (when it comes to childbirth anyway). I could better live with the consequences that way.

Tori you are coming at this from the perspective that you must prove that vaginal birth is safer- Which tells me you really are wanting validation for your desire to have a C-section.
I can not help you do research to try to prove vaginal birth carries more risk. It doesn't- for prolapse or other wise as far as I have read-
that said - I think if you had already had a C-section you might go for one again as the damage has already been done with the cutting of the muscles and whatnot- but since your last birth was vaginal I think that is still the way to go.
I think you are afraid to have another vaginal birth- Have you considered therapy for Birth Trauma? I worry that any decision you make at this point will be out of fear and that is not a good place to be to make a decision.
This is your decision to make and what ever you decide you will live with the consequences-
I don't think you will get any recommendations here to have a C-section. Everyone will just keep telling you to do what you feel is best.
So do what you feel is best and enjoy your pregnancy, birth, and new baby and for goodness sake- keep us updated.

In a way you are right that I want some answers (not just theories) - - maybe they just don't exist.

All I know (from personal experience) is that I got this prolapse after giving birth (vaginally) to my son. I'll never know if there were other "contributing factors" or if I was somehow predisposed to this condition - that's just an unknown for most of us, I guess.

While I know there are women who get prolapses without ever giving birth, I've yet to hear of more than 1-2 examples of that - - and I've yet to hear of anyone getting a prolapse from a c-section (although, again, I'm sure there are cases). Frankly, the vast majority of us seem to "suffer" from these problems as a result of vaginal birth.

I don't intend to show bias one way or the other, it is simply an observation from the posts here and elsewhere. That's why my quest is to gather some information - - to be able to assess the options. How else is a person supposed to make an informed decision about these things? Doesn't it make sense to assess the various options in an effort to minimze future damage or any worsening or my present condition? I would like to avoid bladder-sling surgery or a hysterectomy in the future, so I want to do whatever I can in the present to prevent that.

I have not made a decision one way or the other as to how to proceed with this birth for the very reason that I am trying to gather as much information as possible about it before making a decision. But, sadly, I don't feel like I am making any headway.

I sure would appreciate some help. Thanks, ladies.

- Tori

Well, it's a start. Here's a summary of one study (skip to the conclusion if you want the interesting part):

The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence.
McKinnie V, Swift SE, Wang W, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, Schaffer J
Am J Obstet Gynecol 2005 Aug;193(2):512-7; discussion 517-8.

OBJECTIVE: The purpose of this study was to determine the relative effects of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. STUDY DESIGN: This was a prospective, observational multicenter study of women presenting to 6 gynecology clinics. Demographic data collected included: height, weight, gravidity, parity, and number of vaginal deliveries. Patients were diagnosed with incontinence by questionnaire. Standard univariate logistic regression analyses' were performed to determine the contribution of pregnancy, mode of delivery, and BMI on the prevalence of urinary and fecal incontinence. RESULTS: One thousand and four women were enrolled over an 18-month period. Two hundred and thirty-seven and 128 subjects had urinary and fecal incontinence, respectively. Odds ratio (95% CI) calculated for the prevalence of urinary incontinence by pregnancy and mode of delivery were: any term pregnancy vs no term pregnancy was 2.46 (1.53-3.95), any term pregnancy but no vaginal deliveries (cesarean section only) vs no term pregnancy was 1.95 (0.99-3.80), any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.53 (1.57-4.07), and any term pregnancy but no vaginal delivery (cesarean section only) vs any term pregnancy, and at least 1 vaginal delivery was 1.30 (0.77-3.95). Odds ratio (95% CI) calculated for the prevalence of fecal incontinence by pregnancy and mode of delivery were: any term pregnancy vs no term pregnancy was 2.26 (1.22-4.19), any term pregnancy but no vaginal deliveries (cesarean section only) vs no term pregnancy was 1.13 (0.43-2.96), any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.41 (1.30-4.49), and any term pregnancy but no vaginal deliveries (cesarean section only) vs any term pregnancy, and at least 1 vaginal delivery was 2.15 (0.97-4.77). BMI and age did not impact these results.

CONCLUSION: Pregnancy increases the risk of urinary and fecal incontinence. Cesarean section does not decrease the risk of urinary or fecal incontinence compared to pregnancy with a vaginal delivery.

Hi Tori,

I understand your frustration with all of this, it is a difficult issue. I understand also your need for some real facts though they seem scarce.

I found the following post from here:

"I had a c-section because after a very long labor, (22 hours) they discovered my pelvic bone structure is malformed even flat and vaginal birth was impossible. I noticed the cystocele within days of c-section but I did not know what it was. I had to keep getting catheterized to urinate. And that was the start of what was to become a three year nightmare. My first sexual experience after birth was a shock. I did not expect such pain since I had a c-section. But when I sought some kind of explanation from my doctor, I was told probably vaginismus. I was furious when I found out what vaginismus is. I'm sure for the women who suffer with this it is a real problem but for me it was a slap in the face, as if he was just saying it was all in my head. I have battled ever since just to get a serious evaluation. It's my belief that some support structure or nerves were cut at time of c-section and it caused an immediate prolapse. I am still completely numb from my naval to pubic."

The original thread is called "Pain With Sex".

I have also read elsewhere of women getting a c- section and stating that their prolapse worsened from the pregnancy anyway.

I am not trying to sway you either way. Like others here I would most likely go for another vaginal delivery, but I do completely understand your situation as well.

Also, read Christine's blog "A prominent Urogyncologist offers perspective on elective C- section". This highlights research which concludes that C- section is not necessarily protective over the long term against damage to the pelvic floor.

It seems to me that you have already decided you want a caesar and are trying to substantiate this? Please so not take offence at that as NONE is intended. If the Caesar works for you then that is fabulous :) Remember this is your life and any choice you make is OK

Unfortunately they have not told us the very most important thing about the vaginal delivery routes - Were they DOCTOR LED or PATIENT LED deliveries? Were the women in charge of whether they push or not? Were the owmen flat on theirback or were they under epidural (That btw may make your pain less but also takes away your very needed feelings to understand what your body is doing and whether you are truly needing to push or not)

Stats are easy to manipulate

The female body is made for this - Females are fantastic becauseof this :)

To be honest - It has not gone into enough detail to really make me see one way is better than the other. Problem is - The pelvic floor is put under stress from carrying the baby anyway - Alot of women who work on their feet alot have alot of problems as the pelvic floor is constantly under stress.

If it came to the choice for me - A - Caear or B - Restrict myself to sitting for last few months - I would take B (Tho I am lucky I have an electric wheelchair here as I have Multiple Sclerosis and have needed it in the past tho not at the moment)

I really think that adapting to what life throws at you is what we women excel at.

If you truly think a caesar is what is best for you then do it - We would love to know if it has beena good choice afterwards.

I really hope that whatever choice you go by - That all will be well and you will tell us your birth story and beyond afterwards :)

Exactly what I expected... The more research I do, the more the condlicting results arise. I found a good website with articles (summaries) at www.pevlicfloordigest.org. You can search by key word. I've found information both pro and con the c-section & the vaginal delivery route. I guess I will keep searching.

- Tori

If you were given the choices and had a heartbeat to make the choice - You have been given a 50-50 choice in each direction...

So - Csect or Vaginal delivery -

One heartbeat

What is your choice?

I think the more you research it the more stressed you may get. The best thing is to talk to your Gynae or to a midwife and see what they think is a probable best. Thing is - Nothing is 100% best - Everything always has it's pitfalls.

I had a prolapse with my first son (Now 18) And I went on to have two more children Vaginally - Now - My 2nd son is 17 and my daughter is 4
Every delivery is different - There are no concrete anythings it is all a 'probability'

I look at it differently as I have had 2 surgeries that were painful - And have changed me for life inside. But at that point I knew if I didn't then I stood the chance of death - Makes the decision easier when you have survived one strangulated hernia - And know another could happen at any moment.

Surgery is a big step and holds no definitives just possibilities.
My Gynae told me last year that if I decided on a 4th pregnancy unless it was a very hard bad labour that everything would be in a similar state after ''The damage is done'' he said (He is a well known UK Gynae) He is a lovely man too lol

We believe it’s so important to keep emphasizing that in natural posture there’s virtually no weight on the “pelvic floor”, but rather this “floor” exists as a vertical wall of muscle behind us. This is what Christines entire work is about and we are proving the reality of it every day

So.... What does your heart tell you?

Hi Tori
Ive been trying to find information about pregnancy and prolapse also without success. I have a moderate uterine prolapse with a weakening of the vaginal walls so the bladder and the bowel are collapsing in, Im currently fitted with a pessary ring to keep my insides inside, its mildly uncomfortable but it is better than having my uterus at the entrance of my vagina. The cause of the prolapse is due to damage sustained during child birth.
Im now 8 weeks pregnant and want to know what to expect and is there any complications and like you would like to know whether c-section is necessary or not.
I was booked in to have my uterine ligaments tightened to bring the uterus back into position but for obvious reasons cant go through with the procedure, its similar to the elevest procedure http://www.inletmedical.com/about_elevest.asp
I totally understand how this turns your life around I also enjoyed running and fittness on all levels, today I can barely manage a brisk walk, any high/moderate impact activity is not possible.
I can afford to be fortunate for small blessings I dont have a constant urge to pee as uterus is in the vagina rather than sitting on the bladder and Im not incontinent (but for how long I dont know).
I totally appreciate your concerns and worries but unfortunately have no answers just wanted to say your not alone

Ange

I have heard of cases (both from people I personally know and from some on this forum) that prolapse has gotten better after a subsequent pregnancy and vaginal birth. Don't know why, but heard it often enough that I began to wonder whether there is a reason for this phenomenon.

I would check out Ina May Gaskins current book. I think its called Ina May Gaskins guide to Natural Childbirth, or something like that. While it doesn't discuss prolapse, it does discuss in detail other aspects of c-section. Might be helpful.

I can certainly understand not wanting to worsen a prolapse. Who wants it to get worse! Yee gads. Great questions.

Blessings on your search for your answers.

Marie

Just have to say that I am one who ended up with a POP (cystocele) after a c-section. I did not have any POP beforehand (though I never tried to look during pregnancy). I'm not sure exactly when it appeared, as I didn't notice any symptoms at first. It's entirely possible that my posture and exercise habits had something to do with it - and maybe even pregnancy - but it's also very possible that having the c/s pushed my body over the edge. I didn't want the c/s to begin with, and you can bet that if I have another child, I'll try hard (again) to avoid another.

Hi there Zandria72,

Great to hear from you again after so long! How are you doing? Would love to know if things have improved for you? Its always good to hear back from members who haven't been around in a while!

All the best and take care!

Hi. I'm surprised you remember me. ;) I posted in the Bodywork section a few days ago. I think my prolapse has been fairly stable until just recently - now it feels a little worse. I've been sloppy though, not thinking about my posture, and I haven't been able to walk much due to a neuroma in my foot. So I'm just plugging along, doing what I can. I think I'm going to revisit the video and see if there's something else I can start doing.