elective c-section after forcep assisted delivery

Hello ladies. I have an almost 3 yr old son. My labor went quick and easy until it was time to push. I am only 5 foot and my son was almost 22 inches long. His head/neck was in a bad position for me to push him out. I pushed for an hour with no progress. I had an epidural so I did not feel any pain, but I could feel him move down slightly when I pushed then moved back up when I stopped. The OB used forceps, he was fine. I had a 3rd degree tear that took an hour to stitch up. I had issues with fecal incontinence the first few weeks. I also had tons of pain during intercourse for some time. I went back to the doc and there was a small flap of skin that had to be cut. I am 23 weeks pregnant again and I am already having a ton of urine leakage. Not just drops, but running down my leg sometimes. I feel alot of pressure down there already too. I did not feel this until the last month in my first preg. I mentioned to my doc at my last appt I am already terrified of delivery again. She mentioned that they could possibly do a c section since I may have further "issues" down there this time. I know it is major surgery, but I have done alot of research and it may be the best option for me. I was just wondering what you ladies thought? She said we could discuss it again at a later time. I have another appt 7/25 with another doc in the practice and would like to get his thoughts. Thanks ladies, I appreciate it.

I had a 4th degree tear with DD1 and am still having issues from it (she was only 6lbs 14oz and 19 in long). I spoke with multiple OB (from different practices) and they all agreed that a csect should be offered and that would be their suggestion, but ultimately left the decision up to me. I have done lots of research on my own and I decided that a csect is the best choice for me this time. I personally don't know anyone IRL that went through a similar experience to what I did so it makes it very difficult to get opinions/experiences from others. Most likely another vaginal delivery would result in little to no damage. Having a 3/4 degree tear the first time increases your risk of it happening again by about 7x but in reality that only increases the overall risk to 3.5-7%. However if a 3/4 degree does happen the second time, there is only about a 50% chance of it healing without any long term fecal incontinence or other complications. I stressed about this for months before finally deciding that I was going to have a csect. As far as pain/pressure early on, mine started very early too and has become progressively worse as the weeks have gone on. There are days where I'm practically in tears because of it. It is significantly worse than when I was pregnant with DD1 so I'm assuming it has a lot to do with my first delivery and the fact that I probably still need another reconstructive surgery.

Sorry this got so long! Definitely talk to another doctor or 2 and get their opinion. In this situation you shouldn't feel 'forced' into a csect by the doctors but if you choose one, I think they should be supportive. Good luck!

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Originally Posted by nmc

I had a 4th degree tear with DD1 and am still having issues from it (she was only 6lbs 14oz and 19 in long). I spoke with multiple OB (from different practices) and they all agreed that a csect should be offered and that would be their suggestion, but ultimately left the decision up to me. I have done lots of research on my own and I decided that a csect is the best choice for me this time. I personally don't know anyone IRL that went through a similar experience to what I did so it makes it very difficult to get opinions/experiences from others. Most likely another vaginal delivery would result in little to no damage. Having a 3/4 degree tear the first time increases your risk of it happening again by about 7x but in reality that only increases the overall risk to 3.5-7%. However if a 3/4 degree does happen the second time, there is only about a 50% chance of it healing without any long term fecal incontinence or other complications. I stressed about this for months before finally deciding that I was going to have a csect. As far as pain/pressure early on, mine started very early too and has become progressively worse as the weeks have gone on. There are days where I'm practically in tears because of it. It is significantly worse than when I was pregnant with DD1 so I'm assuming it has a lot to do with my first delivery and the fact that I probably still need another reconstructive surgery.

Sorry this got so long! Definitely talk to another doctor or 2 and get their opinion. In this situation you shouldn't feel 'forced' into a csect by the doctors but if you choose one, I think they should be supportive. Good luck!

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I SOOOO appreciate your info and insight! When I first got pregnant I told my husband, I would rather have a c-section than forceps again. I was actually shocked that she brought it up. I also have a feeling that t his baby may be bigger. I don;t know anyone personally that has had an awful tear or forceps delivery. I know a few people who have had c-sections and most did not have a horrible recovery. I am very open to it. Dh hasn't said too much, but I think he would jump on board. He knows how miserable it was for me with the tear and then the recovery. Thanks for responding!

After hearing both your stories, I think I would opt for a c/s too. I had an unsceduled c/s with my DD. The recovery was long, but not terribly painful. After maybe a week, I really didn't feel like was restricted in most of my daily activites. However once I tried heavier activities, like running, I would experience a weird pain sensation in the incision area for a day or two afterwards. Nothing dibilating, just annoying. This lasted for about a year. It really wasn't as bad as I expected.

That being said. If I have another, I'd like to try a VBAC. Mostly bc I feel like I "cheated" on the whole "delivery" thing. And since I'll already have a child to look after, I would like a speedier recovery. BUT, if I can't I'm perfectly fine with another c/s too.

You might want to investigate whether your pushing position might have made a difference. If you had an epidural and/or were pushing on your back, that definitely could have hindered things, so if you do things differently this time you probably have a better chance of not tearing, or at least not as badly. Also remember that forceps delivery usually requires cutting an episiotomy, which greatly increases your risk of tearing, so avoiding another forceps delivery will also put things in your favor. Your best bet would be to prepare for a natural childbirth with something like Hypnobabies, that would address your fears as well as help you stay comfortable & adopt a good pushing position. I could personally never sign on for a voluntary c-section, and I can't recommend it for anyone. I healed well, but my belly is still numb two years later and there's a horrible flap of skin hanging over the scar that will never go away. My first c-section I was in horrible pain for weeks, and the residual pain lasted for months. The second time they kept my pain under control pretty well, but I was still in a good deal of pain for at least two weeks and some pain for about two months. I had fecal incontinence for a while both times, too, that was after the painful surgery-induced constipation finally passed.

Your issues with urinary incontinence are likely from pregnancy itself, or simply aging, and not your delivery. Most women have incontinence as they age, and it gets worse with each pregnancy. It's the damage caused by carrying babies & muscles losing their elasticity, not from the baby's mode of delivery. And bladder damage is a common side effect of c-sections so I'd be surprised if your doctor recommended a c-section to avoid further bladder damage, that makes absolutely no sense. Now, you *might* have bladder damage from your forceps delivery; your doctor can do a bladder ultrasound to diagnose if that's the problem. If that's the case, then an elective c-section *might* accomplish both delivery of the baby *and* repairing the damage from your first delivery that would require surgery anyway. But I would make very sure of that before agreeing to a voluntary c-section for that reason.

And finally, I'm going to respectfully disagree iwth the pp who claimed that a 3rd degree tear increases your future risk. Every single woman I know IRL who had a bad tear the first time, either hasn't torn at all or had only "skidmarks" in future deliveries. And here on pg.org the Birthing Naturally board has a number of moms who experienced the same thing, Emilys4Guppies is one who comes to mind. Most moms who have that happen do things differently the next time, and it really does make a difference. Good luck to you, both with your decision-making, and with your birth!

My c-section saved mine, and my baby's life. Yes it is a bit long of a recovery, but if you keep up with your pain medicine and stay mobile to avoid painful gas cramps it is not bad. If you feel comfortable with your doctor then you should have no problems. It is major abdominal surgery but I was feeling much better after only about 2 weeks.

The only reason why I was told to continue taking my medication was to prevent infections and remove the pain. If you are not in pain you can move more and you tend to heal alot faster.

I just wanted to say that I can't see anyone blaming you for wanting a csection this time. Labor can be scary. I will say that all I keep hearing is that no two labors are the same and perhaps next time will be easier?! No one knows for sure though.

With my csection it wasn't planned and came after 53 hours of labor. I stalled at 9 and my OB tried to stretch me while I pushed - however DS just wasn't coming out. So after I had had enough I was begging for a csection. I will say that my recovery was a breeze and the surgery in general was much easier than I had expected. I'm not trying to decide a vbac and a repeat csection and its a really hard decision for me.

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Originally Posted by Spacers

You might want to investigate whether your pushing position might have made a difference. If you had an epidural and/or were pushing on your back, that definitely could have hindered things, so if you do things differently this time you probably have a better chance of not tearing, or at least not as badly. Also remember that forceps delivery usually requires cutting an episiotomy, which greatly increases your risk of tearing, so avoiding another forceps delivery will also put things in your favor. Your best bet would be to prepare for a natural childbirth with something like Hypnobabies, that would address your fears as well as help you stay comfortable & adopt a good pushing position. I could personally never sign on for a voluntary c-section, and I can't recommend it for anyone. I healed well, but my belly is still numb two years later and there's a horrible flap of skin hanging over the scar that will never go away. My first c-section I was in horrible pain for weeks, and the residual pain lasted for months. The second time they kept my pain under control pretty well, but I was still in a good deal of pain for at least two weeks and some pain for about two months. I had fecal incontinence for a while both times, too, that was after the painful surgery-induced constipation finally passed.

Your issues with urinary incontinence are likely from pregnancy itself, or simply aging, and not your delivery. Most women have incontinence as they age, and it gets worse with each pregnancy. It's the damage caused by carrying babies & muscles losing their elasticity, not from the baby's mode of delivery. And bladder damage is a common side effect of c-sections so I'd be surprised if your doctor recommended a c-section to avoid further bladder damage, that makes absolutely no sense. Now, you *might* have bladder damage from your forceps delivery; your doctor can do a bladder ultrasound to diagnose if that's the problem. If that's the case, then an elective c-section *might* accomplish both delivery of the baby *and* repairing the damage from your first delivery that would require surgery anyway. But I would make very sure of that before agreeing to a voluntary c-section for that reason.

And finally, I'm going to respectfully disagree iwth the pp who claimed that a 3rd degree tear increases your future risk. Every single woman I know IRL who had a bad tear the first time, either hasn't torn at all or had only "skidmarks" in future deliveries. And here on pg.org the Birthing Naturally board has a number of moms who experienced the same thing, Emilys4Guppies is one who comes to mind. Most moms who have that happen do things differently the next time, and it really does make a difference. Good luck to you, both with your decision-making, and with your birth!

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Thank you for your insight. I was not pushing on my back. The doc even turned down the strength of the epidural when I did push. DS was a very long baby, that was the issue. He only weighed 7 lbs 4 oz, so not heavy at all. It was his long skinny body crammed in there! His head/neck was at an odd angle. I have a very low pain tolerance, so a natural childbirth is not for me. I know I just couldn't hack it. I wish I could have a natural childbirth, I am pretty green and natural with alot of things I do for my family! Pain is just something my body does not handle.

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Originally Posted by RobinBG

Thank you for your insight. I was not pushing on my back. The doc even turned down the strength of the epidural when I did push. DS was a very long baby, that was the issue. He only weighed 7 lbs 4 oz, so not heavy at all. It was his long skinny body crammed in there! His head/neck was at an odd angle. I have a very low pain tolerance, so a natural childbirth is not for me. I know I just couldn't hack it. I wish I could have a natural childbirth, I am pretty green and natural with alot of things I do for my family! Pain is just something my body does not handle.

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Birth doesn't have to be painful. Look into Hypnobabies, it helps rewire your thinking about birth and what your body is doing, you're just relaxed & confident. I was in labor for three days with Weston, and wasn't in any pain until the last few hours -- when I was at the hospital with an epidural! It didn't work, and then I was dealing with Pit-induced contractions on top of what my body was doing, and couldn't move to work with them in any way. Horrible, but I gave it eight hours before finally requesting another c-section.

Also, if his head was at an odd angle, did they try anything to shift him before forceps? Laboring on hands & knees can help. There's also a technique that doulas & midwives use where they stand behind you & pull your belly up & back with a long scarf or a towel. This lifts baby out of the pelvis, which is normally NOT something you want to do during labor, but it gives baby a chance to settle back down in a better position.

I can understand your trepidation. I had 2 vaginal and 1 c-section. Here's my story and reasoning behind my c-section with #3:

For me my first was crazy difficult. I labored for a very long time and pushed for over 2 hours and couldn't get DD out. She was showing serious signs of distress. They finally used the vac to get her out. She had shoulder dystocia which is why I couldn't push her out and wasn't breathing. She spent 3 days in the NICU before we were allowed to bring her home. I had 3rd and 4th degree tears and problems with incontinence and sex for months.

So #2 was a bit easier. I was induced (as with #1). I labored for only about 6 hours but had an epi to help with the pit induced contrax. I pushed and pushed - yup, another should dystocia. Fortunately DS#1 came out ok thanks to the nurse who was able to climb on top of me and press my pelvis in the right way to release his shoulder - my pelvis was bruised for weeks. But I will say that my tear was only2nd degree and smaller. My recovery time was much less than the months I suffered from DD.

Baby #3. My doc offered the c-section due to the previous shoulder dystocias. He said it was my option but we could also try for a vaginal as there is no guarentee that I would have another dystocia delivery even though the odds were increased given my history.

When weighing my options, risks, recovery times I opted for the c-section. For me it was the right decision. for someone else, though maybe not.

I'm not trying to influence your decision - I just wanted to let you know that there are others out there who opt for the c-section for a variety of reasons.

If you, your DH, your doc are all comfortable with whatever decision you make that's what really counts. After all the goal is a healthy baby and mom.

GL to you - I'm sure you'll make the choice that's right for you and your family.