Midwifery Today Community

This is re: a woman i know, who wondered out loud the other day about birth options for the future.  She's not as clear on the details as i would be, but here is what i know.

#1 was a smallish boy (6.5lbs), spontaneous labour, she had an epidural and he "got stuck" during the 2nd stage.  She had a forceps delivery with a large episiotomy and some tearing, and said she remembers that as the ob was pulling with the forceps she was physically dragged several inches down the bed (she was completely numbed and in lithotomy).  After the delivery she was ok overnight but the next day was in immense pain.  The hospital midwives kept telling her it was to be expected after the forceps but at some point she began to bleed massively and collapsed.  She had developed a large haematoma inside her vagina.  Over the next 3 days she had surgery 3 times on that haemotoma, which kept recurring, and had 15 units of blood in total in the 4 days following birth.  Her milk never came in and she was too ill t hold her son for almost a week.  It was 2 months before she could put her legs together normally and 4 or 5 months before she could stand for more than a few moments without throbbing dragging aching in her pelvic region.

#2 was a fair sized (7lbs - mum is 110lbs at a normal weight and is small but a normally proportioned woman) girl, born at 39 weeks by planned c-section.  I balk at saying "elective" because when she went to talk about a vaginal birth with her Ob he picked up her notes from #1 and counted the blood transfusions aloud until she shut up.

So she has since talked about a VBAC.  But her concern is whether or not her vagina is still capable of the stretching necessary.  She is very badly scarred inside (she can feel the scarring) and still has pain against the scar now (#1 is 3 next month) from tampons and sometimes during sex.

She asked me and i didn't know what to tell her except that VBAC wasn't as risky as a repeat c-section statistically.  BUt then i don't know to what extent the Ob is trying to cover his own butt since her forceps-ob obviously did a real number on her vagina.  She was in such terrible pain for such a long time that she would rather have the section if the likelihood is that she's going to have to go through that again.  She told me after her c-section that the recovery was so much better, she finally understood why women got excited about birth - this after abdominal surgery and coming home to care for a newborn and a toddler - so the first experience must really have been horrific.

So, i know you can't see/feel her, but any experiences/wisdom to share?

Bec, ugh, that sounds completely horrific.  I can see why this woman would be scared to have another vaginal birth.  She'll need lots of support if she does decide to VBAC in the future.  Sorry, but I have no other advice.  Just wanted to pop in.

I can tell by the way she talks about it that she'd love to have a vaginal birth, but i think she really needs to know more about the potential problems her extensve scarring could cause.  She is fearful, yes, but most women i know would simply tell themselves that they'll just have sections for the rest of their kids and she seems genuinely interested in other possibilities.  Thet're not planning another for a good while, so she has time to think about it.

Bec,

Whether or not she has another babe, yoni birth or surgical birth, she needs to heal her first birth experience.  Yoni tissue is very much like the inside of the mouth.   We've all taken a big hunk out of our mouths at some point and go back a couple months later and the tissue is smooth, no sign of the previous injury.  Her yoni can do that.  Allow it to do that, ask it to do that, eat well and drink well to support it to do that. Beyond the physical healing she must forgive herself and her birth experience with ther first babe. We all know, a different pregnancy, different caregiver (get a new ob for sure) supported physiologic birth is very possible and in itself healing for mind and body.  She should do some inner work.  Lots of reading, maybe counseling.  You know what to recommend to her.  Remind her, she didn't have life threatening bleeding with the cs, the hematoma was iatrogenic.  It was a direct cause of her physician's actions.  Her body did not fail.  You can help this mama.

I agree with April.

This mama needs to know that it's OK to feel sadness about her first birth and probably her second one too. It's OK to grieve those births forever. She needs to discover within herslf what it will be to assist her healing and encourage empowerment...regardless of how she births again. She needs to have a sense of "control" of what her next birth might entail.

I agree, she could more than likely have a vaginal birth..but please oh please with a midwife!

Mary