Dr wants to do C-section; I'm not sure

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Registered: 03-27-2003
Dr wants to do C-section; I'm not sure
5
Tue, 07-01-2003 - 3:39pm
Hi, everyone. I'm 24 weeks PG with my 2nd child. My first was a vaginal delivery at 40 weeks with a 4th degree tear. My son was 8 lbs. 13 oz. with a 15.5 inch head (much bigger than average, apparently). The recovery was unbelievably bad, and 4 years later, I still don't feel completely normal down there. Last week my OB told me he wanted to do a C-section this time because he's worried about more tearing. I told him I'd rather have a vaginal delivery, maybe induced at 38 weeks (if possible) with the goal of keeping any tearing down to a 2nd degree. He told me that I couldn't afford ANY more vaginal tearing because I couldn't risk any more damage to my pelvic floor later in life. So to him, the only acceptable vaginal birth would be one with no tears whatsoever. I don't know if that's possible for me. I'm a pretty small person, and babies in my family are almost always over 8 or 9 lbs.

Anyway, I'm terrified of having a C-section. The thought of having major abdominal surgery just doesn't thrill me, to be honest. (Of course, the thought of another 4th degree tear is absolutely unacceptable to me...) I don't know whether to stick to my guns and go for the vaginal delivery, or just have the C-section. I want the best thing for the baby, of course, and for my own health as well, but I'm just really confused about what the best thing is.

Any advice?

Lori EDD 10-21

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Registered: 07-21-1998
Tue, 07-01-2003 - 4:28pm
Get a 2nd opinion, perhaps several from different kinds of practitioners. Generally speaking, there is seldom a reason good enough to plan to deliver a baby surgically when you've already delivered vaginally, and don't have any other indication of problems. 9 lb is bigger than average, but not phenominally, and the 2nd birth usually goes better, even with a larger child.

What else was going on? Can you get the records from the doctor or hospital? Was the baby posterior? Did he have a hand by his ear (I've heard the term "telephone baby" and they're supposed to be terrible for tears, but there's no reason to expect a 2nd one of them.) Did you have an episiotomy? (LOTS of practitioners and patients think that's a bad idea. Statistically most really bad tears are an episiotomy extending.)

You could plan to birth with a doula or midwife. So far as I've ever heard, doctors do nothing about tears except let them happen (with or without an episiotomy) and then sew. Midwives & doulas try to prevent tearing in the first place, and have lots of tricks to help.

What about your family? You're not the runt, are you? The babies are big, but is there a history of THAT much trouble? Can you find out about your grandmothers? (Female relatives who predate current obstetrics methods are a good baseline for whether you really might be built badly. The fact that you exist suggests that they were mostly ok.)

One thing, though. Inducing may not be any better, although again you'd want a doctor's opinion on your particular case. Induced labor contractions may be stronger, and perhaps just as hard on you, even with a smaller baby.

Good luck.

Cthulu Crochet

Avatar for lorifurb
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Registered: 03-27-2003
Tue, 07-01-2003 - 5:22pm
Thanks for the great advice. I know the answer to some of your questions. My mom, two aunts, and a cousin also had 4th degree tears with their first babies, but none of them tore badly with any subsequent children. I keep trying to tell my doctor that, but he doesn't seem to think much of it. I feel like statistics are on my side that I won't tear badly this time around.

My first baby wasn't posterior, but I don't know if he had his hand up by his ear. The doctor first cut a 2nd degree episiotomy, and then I tore the rest of the way. It took 3 years to find out that he had cut an episiotomy; at first, he kept denying that he had cut one at all, but I saw it in my medical records.

The thing that bothers me the most is that no one did anything to prevent tearing. I was told to "PUSH, PUSH, PUSH" over and over, and I understand now that it's much better if you have slower, controlled pushing. No one did any perineal massages or warm towels, either. I feel like I could've avoided such a bad tear if I'd pushed less aggressively and had some sort of massage done. The fact that the doctor was dragged out of bed at 3:30 in the morning might have had something to do with the speed of my delivery. Everyone told me that they wanted me to deliver in an hour or less (and this was a first baby), so I really pushed myself and got him out in exactly 59 minutes. When I look back on it, I wonder what the rush was. My son was in no distress whatsoever and tolerated labor beautifully. I think the doctor just wanted to go home! Instead, he got to spend over an hour sewing me up. He told me that the problem was not so much the baby's head, but his shoulders.

Unfortunately, I don't have the option of having a midwife deliver my child (thanks to my insurance and the obstetric practice I go to), but I might look into getting a doula. I'm really leaning toward not getting the C-section. I had problems with a laparoscopy for endometriosis, and that was very minor surgery compared to a C-section. It makes me a nervous wreck to imagine my abdominal muscles being cut open!

Thanks for your advice. I think I'll call a doula and go from there.

Lori

iVillage Member
Registered: 07-21-1998
Tue, 07-01-2003 - 8:06pm
The "push, push, push" bit seems to be standard. I got the same drill, and I should have known better. Fortunately, I didn't always listen, and the baby was slightly small, but under the circumstances, I think I shouldn't have torn at all. But neither doctors nor nurses seem to be trained in how to prevent tears, or they don't think it's their job or something.

Are you telling me that you're STILL going to the doctor who wouldn't fess up to the episiotomy? That does not sound like a good sign.

I DO believe in heredity. My labor (VBAC) went line-by-line just like my mother's with HER 2nd kid, despite all the different circumstances.

Cthulu Crochet

Avatar for baby_stinkbug
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Registered: 03-24-2003
Thu, 07-10-2003 - 12:31am
sounds like you've gota good plan in place! I totally agree with ca_dreamer- I see no reason (other than doc's convenience) to plan a c/s for your second birth!! I can't beleive he lied about the epis- that would make me want to switch right then and there!! shop around- get another opinion from a less knife happy doctor. I tore pretty badly (plus had an epis) with my vbac baby (he had a very large unmolded head and was in the "telephone" position- it was his elbow sticking straight out that did the trick), and my midwife assures me that it's doubtful I'll tear again (we're also looking at a smaller baby most likely, by feel, and likely a smaller head). Doing kegels seems to really help too- I'd definitely do them as much as possible if you're not already.

your doc is definitely playing the "scare you" card, and doesn't sound totally honest either. I'd definitely switch if possible! Good luck!

kris #3 9/3

Avatar for paccookie
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Registered: 03-27-2003
Sun, 07-13-2003 - 1:17pm
Lori,

I'm sorry your last birth was so traumatic for you! There are several things you could do differently this time and you may have a very different result. First of all, can you get a new doctor? Or better yet, a midwife? Check with your insurance and see who else in your town is on your plan. I wouldn't go back to that dr since he wouldn't admit to doing the episiotomy! What else is he doing that you don't know about???

What position did you deliver in? Where you on your back or semi-sitting? Or worse, did you have your feet up in stirrups? Those positions are not good for pushing! They cause lots of pressure on your perineum and can actually contribute to tearing. Try squatting or being on all fours when you push. Even laying on your side is better than being flat on your back.

That episiotomy is most likely the reason you tore so far. Think of it this way: take a piece of paper and hold it at the corners with both hands. Try to tear it. It doesn't tear easily. Now take a pair of scissors and cut a straight line in the center of the paper. Try to tear it again. It tears easily. Same concept for your perineum!!

And lastly, please go get the book The Thinking Woman's Guide to a Better Birth by Henci Goer. She covers all of these topics in her book and I think the book will really help you assert yourself this time. Stand up for yourself! Don't let this dr just do whatever he wants. It's YOUR body and YOUR baby!

Christina