elective c-section after forcep assisted delivery

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Joined: 11/01/07
Posts: 650
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.

nmc
nmc's picture
Joined: 01/03/11
Posts: 268

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!

Joined: 11/01/07
Posts: 650

"nmc" wrote:

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!

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!

Joined: 03/01/09
Posts: 655

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.

Spacers's picture
Joined: 12/29/03
Posts: 4100

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!

motorjunkie89's picture
Joined: 06/03/10
Posts: 143

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.

Jenn0113's picture
Joined: 03/09/07
Posts: 5335

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.

Joined: 11/01/07
Posts: 650

"Spacers" wrote:

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!

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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Joined: 12/29/03
Posts: 4100

"RobinBG" wrote:

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.

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.

carg0612's picture
Joined: 09/23/09
Posts: 1554

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.

Joined: 08/27/11
Posts: 1
banning unnecessary c-sections

C-section is really a safe way of giving birth. The only problem with the matter is the financial trouble that it causes for those who doesn't have enough money and just really needed to undergo the operation because it definitely cost so much from the operation until the recovery. You really need to have enough budget for that though it's really safe specially if you don't have abnormalities with your body like high blood pressure. But at present, a growing number of people, including medical professionals, are coming to resist the idea of “designer births” and non-medically necessary cesarean sections. A group of clinics already prohibited elective c-sections recently, if performed before 39 weeks of pregnancy. A group of public medical centers in Britain is also suspending all medically needless c-sections, refusing to put them on the public tab. I found it here: NHS clinics banning needless cesarean sections.

Spacers's picture
Joined: 12/29/03
Posts: 4100

"kathrynCl" wrote:

C-section is really a safe way of giving birth. The only problem with the matter is the financial trouble that it causes for those who doesn't have enough money and just really needed to undergo the operation because it definitely cost so much from the operation until the recovery. You really need to have enough budget for that though it's really safe specially if you don't have abnormalities with your body like high blood pressure. But at present, a growing number of people, including medical professionals, are coming to resist the idea of “designer births” and non-medically necessary cesarean sections. A group of clinics already prohibited elective c-sections recently, if performed before 39 weeks of pregnancy. A group of public medical centers in Britain is also suspending all medically needless c-sections, refusing to put them on the public tab. I found it here: NHS clinics banning needless cesarean sections.

C-section isn't "really a safe way of giving birth." You're four times more likely to die after a c-section than a vaginal birth, and your baby is twice as likely to need a stay in NICU for birth-related issues. Babies are also cut during c-sections about 2% of the time, which can lead to infection and scarring. You're right, c-sections cost a lot more money, not only for the actual surgery, but for the follow-up care & medications, and the physical pain & suffering. The answer isn't for women to budget for it. The answer also isn't to simply eliminate elective c-sections, although that's a good start. The answer is to educate & empower women to make better decisions about their first births, where they give birth, whom they choose to attend, and what kind of support they have, so that more women don't fall into the trap of thinking they need a c-section, or have such a horrible experience that they see an elective c-section as the best option. Are some births horrible? Yes, but they seem to be happening far too often these days, and it's because too many women go blindly into birth, unprepared for the hard work, afraid of pain that might not even be there, unsupported or uninformed about the decisions they can make, and with caregivers who don't know about or simply just don't do simple things like getting mom onto hands & knees to relieve a low heartrate or shoulder dystocia, or pulling baby out of the pelvis to relieve a poor positioning. Sad

SunDevil28's picture
Joined: 04/30/07
Posts: 496

"Spacers" wrote:

C-section isn't "really a safe way of giving birth." You're four times more likely to die after a c-section than a vaginal birth, and your baby is twice as likely to need a stay in NICU for birth-related issues. Babies are also cut during c-sections about 2% of the time, which can lead to infection and scarring. You're right, c-sections cost a lot more money, not only for the actual surgery, but for the follow-up care & medications, and the physical pain & suffering. The answer isn't for women to budget for it. The answer also isn't to simply eliminate elective c-sections, although that's a good start. The answer is to educate & empower women to make better decisions about their first births, where they give birth, whom they choose to attend, and what kind of support they have, so that more women don't fall into the trap of thinking they need a c-section, or have such a horrible experience that they see an elective c-section as the best option. Are some births horrible? Yes, but they seem to be happening far too often these days, and it's because too many women go blindly into birth, unprepared for the hard work, afraid of pain that might not even be there, unsupported or uninformed about the decisions they can make, and with caregivers who don't know about or simply just don't do simple things like getting mom onto hands & knees to relieve a low heartrate or shoulder dystocia, or pulling baby out of the pelvis to relieve a poor positioning. Sad

I don't feel like this post fits the title of this forum, which is "C-Section Support". Honestly, even though what you say may be factual, it's awfully fear-mongering. What about women who have to have c-sections for legitimate medical issues, who come here for help? Do you think it's "supportive" to read about their likelihood of dying? Or of baby being cut during surgery?

I figured the purpose of this board was what it was when I had my son: information about the procedure without judgement, recovery, sympathy, etc. Had I read most of your posts when still recovering mentally and physically from my c-section, I would have ended up in tears. If I were trying to make a decision, I would be terrified. Is that your intent? Because it seems like it, and quite frankly, that's not "supportive".

I know you have had c-sections and we all have our own experiences. I understand that your most recent post was a direct response to the ridiculous statement that c-sections are "really safe". But your posts seem to always be heavily biased against c-sections. How does that create a safe haven for c-section moms?

I don't feel it's necessary to blatantly try to frighten people on this board with the intent of scaring them away from a repeat c/s and into a VBAC. If people are interested in VBAC, there is a board for that.

motorjunkie89's picture
Joined: 06/03/10
Posts: 143

I agree with the PP. I do believe that post was a bit unsupportive. I had a c-section and I am electing to have another one. They are difficult and there are risks but in some cases the benefits out weigh the risks. Without mine, my daughter and I would both be dead. Some people do it for medical reasons and others have their own set of reasons for their choice. I can be costly, yes. It does pose risks. However at the end of the day all that matters is your LO is healthy and here. Even if they do spend some time in the NICU.

VBAC is a beautiful option, but if it is not right for whatever reason then we are here to give support and advice.

Recovery can also be quicker with a second c-section, than with the first because you know what to expect and already know what your body can and cannot handle.