Recovery after c-section vs episiotomy/ tear | ExpatWoman.com
 

Recovery after c-section vs episiotomy/ tear

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EW EXPLORER
Latest post on 18 April 2013 - 09:57

I suffered a 3rd degree tear after my last baby, the recovery took more than 3 months and was extremely painful. I am expecting my third baby in early July, and am leaning towards a c-section for several reasons:
1) Research (RCOG UK) shows that VB after a previous 3rd degree tear can result in a worsening of incontinence issues is 17-23% of cases. While I am ok now, I definitely haven't gone back to what I was before the last birth, and I definitely dont want any worsening 'down there'.
2) even if symptoms dont worsen immediately, the risk of problems with incontinence post menopause is much higher if I have another VB, even if I dont tear this time.
3) I am much older now than I was with my last two babies, and I dont think I'm in good enough shape to 'bounce back' from VB easily.
I understand that a c-section is a major operation with risks, and of course, I wouldn't choose it for no reason. however, I feel that the long term risks of another VB are very high in terms risking my quality of life. I also feel that 2 weeks of pain and discomfort would be easier to manage than 3 months of the same, and caring for the wound/ stitches on my tummy is easier than after a severe tear, where even going to the toilet is an issue.
I have discussed these concerns with my Dr in previous visits, and she has agreed that the risks are real and that I am entitled to ask for a c-section. At my apptmt yesterday, I asked her about provisional dates for scheduling the section and she wants me to wait until 38 weeks, and if baby is engaged, not too big etc, to try for a 'controlled VB'. ie she breaks my waters, induces contractions and delivers naturally, most likely with an episiotomy. I left the apptmt feeling quite distressed.
Dr's main argument was that as I have had 2 natural births 'with no complications' (!), it would be 'a waste' to have c-section for the third just to avoid possible tearing. She said she has managed to deliver many patients naturally after 3rd degree tears, and some without any need for episiotomy.
I am also not keen on an induction as this usually leads to stronger contractions and a faster birth, which was the most likely cause of my tear last time (baby shot out around 2hrs after contractions started, we didnt even get to the hospital on time).
Doc also seemed to think i was underestimating the pain and recovery time with a section, although I figure it has to be better than what I went through last time? If I'm going to be cut anywhere again (and an episiotomy is very likely), I'd rather have the cut and stitches on my abdomen.
she also doesnt seem to take into account possible further damage to muscles that could cause problems in 10-15 years time.

I am feeling v unsettled, and will probably see another OB/ GYN for a second opinion. In the meantime, if you have read this far, I'd appreciate any feedback from people who have had c-sections about recovery/ healing as I suspect it is easier than what I went through before. Also those who have had VB after 3rd/ 4th degree tear.
thx

849
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EW GURU
Latest post on 22 April 2013 - 10:08
OP, the biggest red flag I saw in your post was mention that your OB wants to induce and automatically do an episiotomy. This doctor is not practicing evidence-based medicine. Most of the research shows that natural tearing is less severe and better to heal than being cut by the doctor. The fact that your OB is telling you the best way to avoid a repeat of your traumatic birth experience is to use a method that has proven to do just what you're seeking to avoid would have me running for the exit. The wisdom of a planned c-section versus a vaginal birth in your situation is a completely separate issue...
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EW NEWBIE
Latest post on 21 April 2013 - 22:22
I have had one forceps delivery with episiotomy and epidural, followed by two vaginal births without any pain relief,( elsewhere in the Middle East) As no-one knows how any birth will progress, in terms of speed and degree of difficulty, I firmly believe that the woman must trust the professionals who are helping her at the time of delivery, to make the best decisions for mother and baby. Yes , one can have an 'ideal birth plan', but must be realistic and flexible when the time comes. The epidural was following a very long labour, and was wonderful. Prior to delivery , it was the one thing that I didn't want. The absence of pain relief was because there was none available. Sometimes, the availability of choice, makes decisions harder. Good luck, at the end of the day, torn tissues heal, and an episiotomy is much better than a random tear. On the day of delivery, all that mattered to me, was a live, healthy baby.
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EW NEWBIE
Latest post on 21 April 2013 - 21:50
Dear OP, I am really sorry for the horror you must have gone through but it is not always like that. Because the tone of this thread has become quite anti natural birth I feel like I want to share a small part of my story. I had a natural birth and thanks to an amazing midwife I had not 1 tear. I already put in my birthplan that I did NOT want an episotomy, as far as I was concerned that was my biggest fear of giving birth. When they wheeled me in the labor department I kept screaming I DONT WANT AN EPISOTOMY... I was terrified by the idea. Anyway, the midwife on call reassured me that if I did exactly what she said and followed her lead I wouldn't even have the smallest tear. She was right. How ever, if I went through what you went through I would probably entertain the same idea for a last child. Whatever you do, just make sure you weigh all the pro's and con's. Good Luck!
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EW MASTER
Latest post on 21 April 2013 - 16:07
What I think we should agree on is that a woman has the right to an informed decision about how she births, her doctor should give her unbiased, up to date advice, and armed with good info ultimately the decison should be the woman's as to how she proceeds and really, nobody should be passing judgement. Spot on kiwispiers.
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EW EXPERT
Latest post on 21 April 2013 - 15:57
well if you you read through this thread, you will see a wide raange of experiences, women who have had very easy c-sections, women who have had a lot of pain and damage to the body after c sections, women who have had easy VBs with epidural, women who have had failure to progress and instrumental births after epidural, women who have had drug free VBs with no tearing at all, women who have suffered significant injury during VBs..... Its pretty clear there are no guarantees that if you do it "this way" that there will be "no drama", we all have had very different experiences each time (I've had one scheduled c-section and one VB withut pain meds, so def both ends of the spectrum!) What I think we should agree on is that a woman has the right to an informed decision about how she births, her doctor should give her unbiased, up to date advice, and armed with good info ultimately the decison should be the woman's as to how she proceeds and really, nobody should be passing judgement. Hopefully the pregnant ladies reading this thread are not freaking out too much! There are horror stories out there, but most births do go well (although there is usually a degree of ouchie in there somewhere whatever you do, sorry ;) )
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EW MASTER
Latest post on 21 April 2013 - 13:49
I really know nothing about labor. I just lay there and pushed a few times. I am not a drama queen about this kind of stuff. [b'>Billions of women have done it[/b'>. Indeed they have although millions of women have also died doing it so it's not always without drama. True. That is why it is so important to give birth in a hospital with medical professionals nearby.
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EW MASTER
Latest post on 21 April 2013 - 13:46
I really know nothing about labor. I just lay there and pushed a few times. I am not a drama queen about this kind of stuff. [b'>Billions of women have done it[/b'>. Indeed they have although millions of women have also died doing it so it's not always without drama.
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EW MASTER
Latest post on 21 April 2013 - 13:36
I have had three easy NVDs with no tearing. The recovery was so easy. I can't imagine ever choosing to have a C-section. I recognize that every birth story is different, but there are plenty of good NVD stories too. The key to having a good NVD is an epidural IMO. :-) Anon- I'd love to hear your tips on pushing and labouring lol I'm realllllllllyyyyyyy hoping for a vbac in Oct! LOL I really know nothing about labor. I just lay there and pushed a few times. I am not a drama queen about this kind of stuff. Billions of women have done it.
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EW NEWBIE
Latest post on 21 April 2013 - 09:41
I have had three easy NVDs with no tearing. The recovery was so easy. I can't imagine ever choosing to have a C-section. I recognize that every birth story is different, but there are plenty of good NVD stories too. The key to having a good NVD is an epidural IMO. :-) Anon- I'd love to hear your tips on pushing and labouring lol I'm realllllllllyyyyyyy hoping for a vbac in Oct! LOL
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EW MASTER
Latest post on 20 April 2013 - 21:00
I have had three easy NVDs with no tearing. The recovery was so easy. I can't imagine ever choosing to have a C-section. I recognize that every birth story is different, but there are plenty of good NVD stories too. The key to having a good NVD is an epidural IMO. :-)
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EW NEWBIE
Latest post on 20 April 2013 - 19:58
Reading all of these stories are picturing the VB as the worst thing in earth and CS as the answer. None of them is easy and none is gurantee. OP if you asked the question in different way and said who had horribble CS I'm sure loads of ladies will share awfull stories about it too. I had painfull VB with baby number one with epistomy which took more than a month to heal and i was scared to try it again. But with baby number 2 i had VB without a tear or epistomy and i was completly pain free the moment the baby came out Although he was big size baby. What i want to say please don't take your descion based on others experience. Find an OB that you trust, discuss all the options with her and take informed descion based on medical facts and statistics for the short and long terms effects. Best of luck and I hope you will have safe delivery for you and the baby.
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EW NEWBIE
Latest post on 19 April 2013 - 20:03
Hi, I had a c-section in December - first baby and elective due to blood pressure issues. Things I experienced in terms of pain: first day was fairly out of it due to pain relief, second day was by far the most painful but was up and had a shower with help, shuffled round a bit and mainly used a wheel chair to move around, third day was up walking, showered on my own, fourth day discharged back home, fifth day was walking round the supermarket - briefly! but could generally cope moving round by myself. I was off pain relief after the first 10 days and the stitches felt comfortable after the second week although did I have some tenderness on my tummy up until 3 months afterwards. It's apparently the bruising of all the layers inside your tummy that take longest to heal, even after the stitches look fine. My tips for post surgery would be: get a straw for your water/drink so you it's easier to sip when you're in bed, when you shower in the hospital sit on a plastic chair (if there's one in there) it makes it so much easier and put all your toiletries within reach before you start showering! Buy some knickers a size bigger than you normally use to wear afterwards. I took pj's but didn't use any, I wish I'd taken more nighties - longer length ones! Before you leave get the nurses to show you how to get out of bed. I found that in the hospital it was easier to get out of bed because there were the sides of the bed to hold onto and it was electric so it moved up and down, but the first night home I had not idea how to lay down, or get up out of the bed as there were no bars to hold onto! My husband had to lift me the first few times and then I used some weird shuffling actions for me to get up on my own and just swing my legs round, but took me several attempts until I was brave enough to do this!!! so see if they can show you before you go home. I also slept slightly propped up with some pillows under me for the first few nights. Buy some nice decent tissues, I used these to pat the stitches dry after showering. Keep moving - it is scary and I found myself holding my tummy for a few days while moving around, but you have to be brave and just do it, it really does help. We had no help with the baby and our relatives didn't come over until 6 weeks after the birth and I really think the fact that I had to move around, feed etc really helped me to recover. Good luck and I hope whatever happens you have a safe delivery for you and bump x
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EW EXPERT
Latest post on 19 April 2013 - 14:36
If your other children are older and you don't plan more children (or lots more children) after this one, then I would say the c-section is a good idea. With my VBAC, my preferences was for a non induced non instrumental birth, my second preference, before induction or instruments was for another c-section, basically for the reason below, as far as I can gather, the horrible c-section stories you hear are almost always "emergency" c-sections and the worst tearing seems to happen with the epidural/intrumental birth combos. My c-section was a very positive experience, I would say, if you are shopping around for doctors/hospitals, make sure you find one who will keep your baby with you during the surgery and recovery, it is entirely possible (and much better for mum and baby)to do skin to skin while they stitch you up (it takes around 5 min to get the baby out and another 30 min or so for the stitiching from memory). Once that baby hits your chest you don't notice anything that is going on around you though. Also, do get up and moving as soon as possible after the surgery. The pain Ruby refers to below was probably trapped gas, which I didn't have but happens quite often, I think the sooner you move, the sooner it gets things moving, so to speak ;)
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EW OLDHAND
Latest post on 19 April 2013 - 13:36
A very close friend of mine from home had a 3rd degree tear with her first baby. Her 2nd pregnancy she desperately wanted a c-section however she was unable to so had another natural delivery. I don't want to scare you, as every woman and birth is so very different, and I won't go into detail, but it didn't turn out well at all. She desperately wanted to have 3 children, always had wanted 3, but now she absolutely will not have a 3rd as her experience was horrendous. I've also had a few friends who did have a VBAC and thought it was the most amazing experience. You will get all sorts of experiences and every one of those will be different. I totally believe you have to do what your gut instinct is telling you. Yes, for sure do your research and talk about it with other mums. But I would just hope for you that you do not have to go through the same or similar experience my friend did. She was so depressed that it really affected her life in so many ways apart from the physical aspect. With regards to healing time from c-sections, this is not fact, and only what I've been hearing from mum friends and other mums in general, but it seems that if its somewhat of a 'planned' section as opposed to an emergency section, the healing process, both physically and mentally, is a lot more positive and overall quicker and easier. (obviously not everyone, but just a trend I'm finding) All the very best to you. I truly hope you have the birth you set your heart on, whatever that may be, and that your recovery is good. <em>edited by shellly on 19/04/2013</em>
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EW EXPLORER
Latest post on 19 April 2013 - 13:36
Daza, if you don't mind my asking, who was your ob/gyn? [url=http://www.drtazyeenobgyn.com/'>Dr Tazyeen[/url'> she has delivered my last 3 babies, all c-section and she's been great. Thx!
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EW MASTER
Latest post on 19 April 2013 - 13:33
Daza, if you don't mind my asking, who was your ob/gyn? [url=http://www.drtazyeenobgyn.com/'>Dr Tazyeen[/url'> she has delivered my last 3 babies, all c-section and she's been great.
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EW NEWBIE
Latest post on 19 April 2013 - 12:10
Dear KH & all, I'm so sorry some of you had bad vb experiences- it sounds horrible! I had my son 2 years ago. I was induced, labour progressed but when came time to push, the DR's realized his head was stuck and he wouldn't descend so I had a c-section. In my experience, I wasn't mentally prepared for a c-section and I am a scaredy cat when it comes to surgeries. I had never been cut open before and I was really intent on having a natural delivery. I was gutted. For me personally- recovery from my c-section was really hard. Not being able to go up/down stairs, lifting, ect... I didn't feel like myself, and I was upset about the risks I would now have to face if I were to get pregnant again. It took me a very very long time, until I felt 'normal' again. I always had an ache/pain at the incision site even a year later. I'm not sure if this was psychological but it felt very real and I even spoke to my OB about it. She said I was fine, but some women, can experience some pain up to a year later as it takes that long for the incision site to FULLY heal. That's also the recommended time, Dr's say to wait before getting pregnant again after a c-section. I was an active person before my pregnancy, and the biggest thing for me, was that I was no longer active. Getting in and out of bed, was difficult, in and out of cars...walking even trying to breast feed my son was painful because I couldn't get into a good comfortable position to hold him... I was very depressed. I'm now pregnant again, and I'm hoping for a VBAC. I feel- even if I tear, or need an episiotomy my recovery would still (hopefully) be quicker than my c-section. I have an active 2 year old, and I can't afford to be down and out like last time- especially now that I'm in Dubai and don't have family around. However, in the event that I do need a c-section, I do feel like I am better prepared mentally for it, and know what to expect mind you- every pregnancy and L&D is different. To protect my perineum and help any incontinency issues that could result from a VB, I am religiously doing kegels and pre-natal pilates to strengthen my pelvic flood muscles. I would suggest to do what feels right for you and your body. A C-section did not agree with me, and I hope to VBac this time around.
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EW EXPERT
Latest post on 19 April 2013 - 10:57
I had an episiotomy/tearing/forceps and it was a number of weeks before I could even walk properly. 6 years on and i'm still not sure things have returned to normal! Although I've only one child I have also had a myomectomy which is similar to a Csection and apart from the initial couple of days it was a walk in the park compared to a natural birth! Good luck with your decision, not an easy one. <em>edited by Tattie Bogle on 19/04/2013</em>
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EW EXPLORER
Latest post on 19 April 2013 - 10:22
Thanks again for all your valuable input. Kiwispiers, the stats I have looked at are what made me decide in a c-section in the first place, unfortunately there isn't much longer-term research on consequences of VB after a 3rd/ 4th degree tear, but what there is indicates a high (in my view) probability of further damage. Of course I won't rely solely on others' experiences to make my decision but it is useful to know what others have experienced. Whatever I decide will be after I've had a second opinion from another specialist, and in conjunction with whoever will deliver me. Also, after my first two births on the NHS, returning to a mid-wife led birth, even if that was an option, would be my worst nightmare! My older two children are no longer toddlers, so no issues with not being able to carry them afterwards. Ruby-A, this is exactly how I have been feeling. I hate drama and uncertainty (both of which are the overriding memories of my natural births, along with the long recovery). I would much prefer a calm, controlled birth. Daza, if you don't mind my asking, who was your ob/gyn? Thanks again for ALL your comments and support. Inshallah this birth will be smooth and safe, whichever way I decide in the end!
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EW NEWBIE
Latest post on 18 April 2013 - 20:29
OP, what you went through sounds absolutely horrendous :( i'm so sorry. I'm due my first baby any day and was told until a month ago i'd have a c section, now apparently there's no need. What i find terrible is that when i was TOLD BY A DOCTOR I had to have a c section, many ladies actually made me feel bad about it! telling me VB is the natural way bla bla bla! Now i'm pretty sure i'm having VB, i am considering requesting an epidural and people are actually making me feel bad for wanting it! I know if i have a horrific experience delivering my baby, i probably won't want another or will be an emotional wreck next time round. I can only offer this advice. To **** with everyone else - do what you want and what makes you comfortable. It's your body and no one can imagine what you went through last time. I'm really feeling so bad after reading how you suffered last time :( hope you'll have a much better experience this time round. xxxx
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EW NEWBIE
Latest post on 18 April 2013 - 14:53
Hey KH, I chose to have a C-section done for the birth of my first child three months ago. No complications. No reasons. Purely out of choice. I don't fancy labour, and I refused to allow an episiotomy to even be an option. I also didn't want to stretch or feel any different down there. The operation was a breeze. No pain. I was calm and peaceful, looking into my husband's eyes as our son came into this world. We had our wedding song playing in the background. My son was born in peace, serenity, calm and silence. No screaming, no labour no pain, no fear. Just a pure, calm and welcoming energy for him. And yes, the first few days after the operation hurt more than I can describe. Perhaps I have a very low tolerance for pain. Perhaps the nursing staff couldn't understand my needs. Regardless, it was an indescribable 4 days of suffering. Then then, miraculously, by the fourth night, I could walk again. In agony, but still, it was the first real walk I was capable of. By the fifth day, I was out of the hospital. To celebrate my son's first week, we went to the park. By the end of the first month, I was out in the desert, camping. Compared to your three months, my one week seems the less painful option. I defy anyone who says a VB is the "natural way" of birthing (what's so natural about induced labour anyway?), or the preferred way to bring a child into this world. The only way that's natural is the one that works for you. That's the preferred way. And don't let anyone convince you otherwise. I would choose a pain-free, welcoming birthing experience any day over a painful, distressed one. And as for the pain after. Either way, it's excruciating. Why not opt for the lesser of the two evils with a shorter pain timeframe and a more empowering birth?
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EW MASTER
Latest post on 18 April 2013 - 14:09
Hi KH, I'm sorry you had such a rotten experience last time and your OB/GYN is not being supportive of your fears. My first baby was a natural birth, she had a large head and got pretty stuck on the way out resulting in an episiotomy. I had a lot of stitches and they took forever to heal. 5 weeks after the birth it was still painful to wear underwear so when I was at home I'd have to not wear underwear and sit on a towel. I found the entire experience horrendous. It was painful, humiliating and once I'd finally healed physically I still wasn't fine emotionally about how it all went. So, with my second baby I had a c-section. In comparison to my the first time around, the recovery was an absolute breeze. A bit limited in terms of what I could do for a few weeks but so, so, so much easier. And I felt great emotionally :) I was a bit uncomfortable for a few days but it never reached the level of painful. And if I'm going to have stitiches I'd rather they were in my tummy than where I'm going to pee on them ;) Babies 3 and 4 were also c-sections. It was absolutely the right decision, physically and emotionally, for me to go for an elective c-section after my experience. Good luck with your decision.
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EW EXPERT
Latest post on 18 April 2013 - 14:08
Truthfully, it's a gamble, I have had one c section ( scheduled) and one VBAC with second degree tearing. I had a very easy recovery from my c section but it would be a lie to say it was easier than from the VBAC. The c section pain was not bad at all, I really didn't need any pain relief after the first 24 hours but I didn't want a repeat section fir my second because of the effect it would have on my ability to care for my toddler. After a c section, you can't lift a toddler, or put them in a carseat, or lower them into a cot, or carry them up the stairs or bend down and okay with them on the floor, or wrestle, or have a tickle fight...... For several weeks! After my VBAC I spent three days thinking the pain " down there" was far worse than a c section, because obviously you have to pee, poo and sit. But by the 4 th or 5 th day it had pretty much healed and I was more or less back in action. A third or 4 th degree tear is much more serious, a " good" c section recovery is most probably easier on you, there are higher risks involved with c section for both mother and baby and some c sections can result in mo the of pain too. I don't really think you should base your decision on others experiences, you need to find some actual statistics. If you go for natural you need to know what will increase and what will minimise your risk of tearing. I would think that bring induced, with its increase risk of failure to progress, likelihood of epidural and likely hood of instrumental birth would increase your risk, but I'm not an expert, perhaps you would consider a doula or even returning home to a midwife run system? A doctor who routinely does episiotomies is very unlikely to know how to protect you perineum during birth.
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EW NEWBIE
Latest post on 18 April 2013 - 10:59
i have not had a c section but with my DS i had an episiotomy and also tore inside- an hour and a half of stiches and the after pain after was absolutley awful... along with emergency forceps delivery because my baby was in distress which caused him to be in NICU for 3 days after i will 100% chose to have a c section next time... my Dr has already agreed to this also. obviously i cant comment on the pain after c section but in my opinion i would rather be sore on my stomach then 'there' again.
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EW NEWBIE
Latest post on 18 April 2013 - 10:47
Hi KH, I have had three delivers first two natural and the third a request section, my reasons for my request section was I had only delivered 18months previously and I had a very unpleasant "natural" birth, it was very fast like yours, although physically I was fine, physiologically I was a wreck. So I opted for a section and for me it was the best decision ever, I enjoyed it and felt so much better mentally afterwards, yes there was pain, I had a lively 18month old to look after and that was also a lot of lifting I had no help. He sit is a major operation but at least you can sit comfortably afterwards, if you have some help with your older child then even better, if I do have another baby I would choose another section again. Best if luck within you decision, if you want to chat more let me know and I will give you my email add :)
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EW GURU
Latest post on 18 April 2013 - 10:45
Hi KH Sorry to hear you had such an awful experience with your last birth and that your OB/Gyn isnt being more understanding and supportive this time around!! I had a planned C-sec with my DD almost a year ago now here in Dubai, and although i was a little disappointed at not being able to have a VB (DD is my first child) to be honest, I think i got away really lightly compared to some of my friends who had a VB. I know quite a few people who have had C-sections and have struggled for months afterwards, but to be honest, in my opinion a lot of it is in your attitude towards it. I resigned myself to the fact that this was how it was going to be, and planned to be up and out of bed same day - which I was. I didnt try to play the hero - if i was offered pain meds, i took them; followed the rules on what i could / couldnt do and just got on with it. Yes, it was uncomfortable at times but thats all i can describe it as. I didnt have what i could really call pain at all from my c-section. I didnt have any family support here besides my husband for the first 5 weeks after DD was born and we managed just fine (with a little help from our friends! :) ) The biggest pain in the bum with it all was the no driving for 6 weeks afterwards, but give me that any day compared with what you went through!! Maybe one of the things in my favour was that im a physio and used to see all the maternity patients post c-sec so i knew what to do, how to do it, and the fact that i wasnt about to split open as soon as i stood up. I think fear is usually the biggest problem and barrier for people when they've had surgery, so my advice would be, if you decide to go for a c-sec, get all the info you can on how to do things post op (i.e. how to get in / out of bed, walking, coughing/sneezing, etc) then at least you know what to expect and its not so scary afterwards. Dont trust the nursing staff to always show you the best way - I had a nurse trying to drag me out of bed until I told her to get off me and asked her if she remembered ANYTHING I'd taught her in her manual handling training only 18 months before!! ;) Good luck with your decision making. If i were in your position, I'd definitely be wanting a c-sec. For me, a few weeks of discomfort and inconvenience would definitely be better than what you went through before and the potential problems you could encounter in the future!! Hope you manage to find an OB who will be more supportive! HTH xx
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EW NEWBIE
Latest post on 18 April 2013 - 10:06
Hi KH I haven't had my baby yet but i just want to say that what you went through sounds awful and its such a shame and disappointment that your docs are doubting you and not listening. Go with what you are more comfortable with- this is your body aswell and god willing your baby will arrive safely and healthy by both methods, you need to think of yourself too!! Good luck x
 
 

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