Would you elect for a C Section if..

[lovin2shop]

It would possibly prevent a future surgery? I've had bladder issues since delivering my DS which never improved on its own (or with millions of kegels) after 5 years. The bladder problems are increasing quite a bit already and I'm only in the early 2nd trimester. My OB said that we will have to deal with this issue after delivery, but that I can likely expect it to be worse after a second. Well, "worse" would leave me pretty much incontinent. If I elect for a C Section, then there is a good chance that the damage to the bladder is much less and would be tolerable without corrective surgery. I'm surprised to even be considering this, but after a pretty traumatic experience with the birth of my first and this added problem, I'm starting to think that this might be a better way to go for me this time. Feel free to try to talk me out of it, I'm really torn on this decision. I'm also excessively frustrated with it right now because I have bronchitis, and I feel like a balloon with a slow leak!

[brittone2]

have you considered (or would you consider) physical therapy? THere are PTs that specialize in this area. They use things like vaginal weights, biofeedback, etc. to make the pelvic floor exercises far more effective. It might be an option now or later, C/S or not. I know a lot of docs don't offer this as an option, but I know I've seen an increasing awareness of how effective it can be. I hope you can get some relief from the problems.

[stella]

I would consider the C-section for that reason.
I think it would be a medically-based decision, unlike a vanity or convenience reason, which is so objectionable.
If you trust your doctor, then I would consider the surgical option.
I'm sorry you are having so much trouble, and I hope you feel better soon.

[JBaxter]

a year ago I would have said yes but in the past year I have had 2 friends w/ serious bladder issues because of the csection ( their bladders were cut during the surgery ) So my answer for an elective ( sort of) Csection is NO WAY NOT ON MY BODY.

[kransden]

Could you get it fixed during the cs operation, or would you have to wait?

Karin and Katie 10/24/02

[bunnisa]

NAK (sorry if choppy!!)

I wouldn't have a guaranteed major surgery (C section) to potentially prevent a future surgery.

I would think it would be better to have a natural delivery, recover fully, and have a bladder surgery later when I'm not caring for a newborn and recovering from pregnancy. Additionally, having the c-section will not guarantee you won't need the bladder surgery, right?

Of course you need to decide for yourself - but having surgery to prevent a potential surgery doesn't really seem like a great trade-off. Additionally, if you ever decide to have more children it will be harder for you to have a natural birth.

Wishing you well on your decision! It sounds like a difficult place to be.

...blessed wife and mama to two & one due this summer!

"We must remember that life begins at home and we must also remember that the future of humanity passes through the family"
-Mother Teresa

[cvanbrunt]

From what you've described I would absolutely consider a C-section. Incontinence is not a minor inconvenience! After my first DD was born I found that I couldn't "hold it" like I used to. I wasn't prepared for that. Now that I'm pregnant with #2 I "leak" a tiny bit if I sneeze or laugh really hard. I find that mortifying. I understand a C-section isn't minor but it would be very hard to convince me that avoiding one is preferable to loss of bladder control. Good luck!

[KBecks]

It sounds like you need to evaluate the risks / outcomes / recovery of the c-section vs. the risks of whatever surgery would be needed on your bladder.

If you are very torn, could you get a second opinion or see a specialist or someone who could give you more information on what treatment options may be available?

Best wishes,

[brittone2]

I'm curious about this too. Elective c/s means you could have a nick of the bladder, etc. which could adversely affect you. Would they repair anything if you had an elective c/s? Will a c/s really dramatically improve your chances of having fewer problems if pregnancy has already created weakness of the pelvic floor? Those are the things I'd dig into before making a decision.

Isn't pregnancy itself part of the issue? I mean, just carrying a child weakens your pelvic floor. I think there is less damage from a vaginal birth if you don't do coached pushing, etc. but I'm not 100 percent sure about that.

I came across this:
http://www.childbirthconnection.org/article.asp?ck=10200#scientific


http://www.wholewoman.com/drupal/node/4


You can go to pubmed.com and do a search for "pelvic floor cesarean prevention" or similar terms and there are tons of studies. It looks like at best, the jury is still out, so IMO it doesn't look all that guaranteed that it will make a difference. It is something you'll want to dig into for yourself.



PTs that specialize in pelvic floor dysfunction (one list, there are others)
http://www.ic-network.com/md/ptlistings.html

[Momof3Labs]

Yes, please at least explore physical therapy before going the surgical route!! My PT is on the link above (I started seeing her following pelvic issues that developed from a pelvic separation during the birth of DS2), and is considered one of the pioneers of PT for pelvic floor issues. I know that she'd be happy to talk with you on the phone and recommend you to someone local, or even see you if you want to make a trip here. PM me if you want her contact info.

Gather as much information as possible before you make your decision about major abdominal surgery - and IMO that wouldn't be complete without a talk or visit with a physical therapist specializing in these issues.

[lovin2shop]

Thanks everyone for the feedback. I obviously have a lot to think about and a lot more research to do! One part about the corrective surgery that I left out before is that it is not likely permanent and there is only an 80% rate of effectiveness. Most people have to have repeated surgeries over time as the bladder slips back to the wrong position. You are also prevented from lifting anything over 25 lbs forever without risking complete relapse. And, it is only 10 lbs for the recovery period which would be impossible with a baby.

So, it is obviously a very big deal to me, and if I'm convinced through research and my dr. that a C Section *could* prevent additional damage, it would probably be worth it to me to try. But, I do want to find out a lot more about the physical therapy options (which sounds important whatever route I choose).

[gatorsmom]

I would absolutely have a c-section. Unless you plan on having several more children, in which case most doctors advise against more than 4 c-sections in a row.

Your health is important! And the benefits to mama and baby of vaginal birth are great- provided that it's not going to harm you.

I can't believe you would consider becoming incontinent rather than have your baby via c-section. Take good care of yourself- you and your family need you to.

Lisa
Mom to Gator July 2003
And Cha-Cha July 2005
and surprise! twins due 11/07!

[lovin2shop]

Beth, thanks so for posting the links, especially the list of PT's. I'm so excited that there are two listed that are in my city, very close to my house. I'm definitely going to book a consultation appointment now before making any decisions. Fortunately, I have plenty of time.

And Lori, I'll PM you for your info. Thanks!

ETA b/c I hit send to soon!

[lovin2shop]

Oh, if I knew that it would prevent incontinence, then I would have the C no question. The problem is that like Beth said, a lot of the damage is already done in pregnancy. So, no matter what I do, I may need the surgery anyway. Preventing further damage is my goal, but it is not totally clear that a C Section does accomplish this outcome.

On the flip side, I also definitely know that the long difficult birth that I experienced certainly got me to this point, so avoiding that again seems pretty much like common sense, studies or no studies.

Thanks again everyone for helping me think this out!

[tiapam]

I don't think there is any such thing as a tolerable bladder problem, though I guess it's all relative. FWIW, I had an unscheduled C-section and have had no bladder problems, so I suppose the C-section could make a difference. I am dismayed to hear that there does not seem to be a way to make it 100% (or close to) better at a later date. I thought they had come much farther in treatment for bladder control problems for women. Have you spoken to a specialist in that area, not just your OB? If not, I would definitely do that before deciding. If you are still undecided, how about scheduling a C-section past your due date? That way you give the baby time to come on his/her own, but you are in control past the due date. People have elective C-sections for much more frivolous (sorry, can't think of a better word, your situation is not frivolous) reasons, so keep that in mind. HTH.

-Pam

DD - Two years old!

[shilo]

sounds like you're already on the right track, but i would second (or third or whatever it is) seeing a PT who specializes in PFD (pelvic floor dysfunction). i ended up with a mild separation of my pubic symphysis with sam and the first stop i made was to a PT who specialized in PFD even tho i'm a PT myself (we get a little bit of it in grad school, but nothing like someone who chooses to specialize will get thru specialist training and continuing education). definitely credit her with my excellent recovery from that part of my pregnancy/labor/delivery. also, she/he should be able to refer you out to a good uro-gynecologist or urologist who can work with you and your ob to help you make the most informed decision possible regarding the risks benefits of the C for both you and the baby. many of the large teaching hospitals now have at least a women's health clinic which should have an interdisciplinary team who will consult on cases like yours, and many now have 'pelvic pain and dysfunction' or 'pelvic health' clinics that specialize in the care of pelvic floor issues. you need a good PT and a good urologist/uro-gyne to weigh in on this issue with your ob so that you can make the best decision for your body.

good luck! lori.
Sam 5/19/05 How lucky I am that you chose me.

[ColorBlue]

I have had the physical therapy for incontinence issues (three vaginal birth in two pregnancies). I chose PT because of the issues with lifting that you mentioned and I had one year old twins at the time so no lifting for eight weeks was impossible for me. That said I think the PT was wonderful..amazing...changed my life. BUT did not entirely solve the problem and I will eventually have to have surgery.

I would not choose to have a c-section because of this however. Too many possible complications. And its very likely that damage is already done and having the c section won't change anything.


Feel free to ask any questions about the PT.

Tracy

[Dcclerk]

In short, yes. Feel free to PM me if you want more info.

[Dcclerk]

dp

[maestramommy]

I had a friend with this problem. The catheder tore her bladder with her first delivery, so after the second delivery she had corrective surgery, then she had a C section with the third delivery.

[kijip]

I would strongly consider it. For all the talk of pregnancy causing the initial bladder weakening, it seems like most of the women I know who have bladder issues have had hard vaginal deliveries. I would not make the choice automatically, but I think it is a reasonable thing to evaluate.

****Rocking out while parenting my smart little munchkin Toby. Just trying to do good in the world, a little at a time. Words to live by: it is *never* the wrong time to do the right thing :)

[stella]

My physician father has made reference to the fact that it's the vaginal births, not the pregnancy, that can damage the bladder and cause problems with incontinence.

I know that isn't any kind of persuasive scientific evidence, but I did think it was interesting in the midst of this discussion.

[SAHMIL]

I had a C-section. Be aware that having a c-section is not a piece of cake either. I had a spinal headache from the epidural. I also had baby blues bigtime in the hospital because endorphins are not released the way they are in Vaginal deliveries. All in all I was shocked by the experience as much as people told me it was not a big deal. But it is. it's major abdominal surgery.

However, despite all of this, the end result was the same. I got a beautiful baby boy out of it and I love him dearly!

[Nooknookmom]

Please note that my exp may not happen to anyone else, that said...

NO, I had a C in May b/c of a severe back problem (Dr. didn't want her going down birth canal). After the complications I had w/ the way the surgeon on call sewed me up I would have delivered vaginally & dealt w/ the aftermath. I am TERRIFIED to ever take a chance on getting preggo again. The del. ruined my last birth experience.

When the block wore off in the hosp. I felt like I had a hot fire poker in my right side. I had 2 hematomas burst on the right side, the entire incision almost ruptured & at 6 wks PP I had to have the area re-opened to drain. I had to have home health come each day to pack my wound.

I had an open incision for 13 weeks. I have nerve damage on the right side that may not go away. Dealing w/ all the pain, not being able to do anything around the house put a huge strain on my family.

I just closed up last week.

I just wish someone had told me the risks involved w/ a C. All the medical staff led me to believe it was a scheduled piece of cake. I'd save a C for an emergency.

GL!

[Melanie]

I would not, though I would likely opt for surgical correction later, if all other options had been unsuccessful. I would not put Dc through surgery unecessarily.

I'm sorry you're dealing with this.

[HannaAddict]

Based on what you posted, I would strongly consider it. I would not say "no" to a c-section for a sound medical reason because there could possibly be complications. Many c-sections do go as planned. Of course, I wouldn't have a c-section for kicks and it is a serious procedure, but so is possible lifetime incontinence. I would see if you can talk to you OB in greater detail on this issue and maybe even visit a specialist (urologist??) and have them review your records, etc. and confirm that a c-section might help you avoid more damage. If they say a c-section could avoid more damage to your body, then I would seriously consider one. There are valid medical reasons for having c-sections and you shouldn't feel badly for doing what is best medically, including maybe electing for a c-section, because of a tend for more c-sections (some of which aren't medically necessary). Good luck and take care.

Kimberly

[stella]

I really agree with this post. Any surgery has inherent risks, as does any vaginal birth, and most births (of any kind) have good outcomes.

I don't like hearing about the C-section complications that have occurred with mamas on this board. It scares me to think of a painful, prolonged recovery, or a botched surgery. I hate to think of that happening to any of us. But I have IRL friends (I'm sure we all do) who have suffered complications from vaginal births, too.
I have had two C-sections, and will have a third next month. I have not had difficult recoveries in the past, and I pray that this one is the same.

I just really feel strongly that it is a medical decision you will have to make, and I would definitely consider it in your situation.
A cesarean birth is NOT a terrible thing under ordinary circumstances, and like the PP said, you shouldn't feel bad or defeated or less-than if you choose that option.

[bubbaray]

ITA with this post as well.

Good luck with your decision.

Melissa

DD#1: 04/2004

DD#2: 01/2007

[american_mama]

Check out this book "Ever Since I Had My Baby..."
http://www.amazon.com/Ever-Since-Had-Baby-Understanding/dp/0609808729/ref=pd_bbs_sr_1/002-6342367-7260041?ie=UTF8&s=books&qid=1186972022&sr=8-1

The specialist you are looking for is a urogynecologist, and you can can search for one in your state at www.augs.org.

I'd also start making crystal clear your desire to avoid an episiotomy, in case you had one before or your current ob tends to perform them. There is strong evidence that they cause far more harm than good, with one "side effect" being greater incontinence problems in women who had them. The book discusses this thoroughly.

The book was writtn by a urogynecolgist and was recommended by someone on these boards who herself is a urogynecologist and knew the author during training. PM if you want her name.

I have loaned my copy of the book out, but I believe there are a couple of different surgeries, not just one, plus other treatment options, including collagen injections and medications that can help firm up a floppy urethra. Based on something my sister's gynecologist told her that seemed incomplete to me, I am not sure that all gynecologists are up on all the options and treatment subtleties.

Smoking/chronic cough and excess weight put you more at risk, in case either of those are factors for you that might make a difference. I believe there is also an age and genetic tendency. So a C section might not avoid problems, especially since they are already there. In my case, I had labors that followed all the best practices to reduce bladder problems, yet still I have them. I remember a cold/cough that I had late in pregnancy with #1 and post-partum with #2, and I can imagine how you are feeling now. I would definitely re-visit this question when your bronchitis has cleared: even though the pregnancy advances, I bet you will have more control once the cough is gone and that may make you more optimistic.

In your situation, I probably would not have a c section. Admittedly, a lot of that is because vaginal birth matters a lot to me, which may or may not be a factor for you too. But some of it is more rational. You already have some problems from DC#1 which are probably going to be worse just due to a second pregnancy... I'd rather plan for the birth I wanted and later specifically address my bladder issue, which is probably the more effective way to solve it anyway. I mean, a C section isn't going to improve your current status, just maybe keep the status quo, whereas a specific treatment at a later date will target and hopefully improve the situation.

I feel for you.