Reply to Bad advice / things you wish you’d known

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]I wish people were more honest about pelvic floor damage from birth. I don’t remember them mentioning it in any pre-birth classes. [/quote]

This is mostly due to the way women give birth (on their back with legs pushed back) and purple pushing. There is also no pelvic PT prior to birth that would alleviate some of the tightness and teach women how to properly engage the TVA to assist with childbirth. Pushing a poo out is not the same and to be frank, pushing a poo out is one of the worst things for your PF when pooping so when an 8lb baby is coming down vs a 1lb shit, the damage is greater than 8x the poo.

PF damage can happen from c-sections too because it can start just by being pregnant. A c-section does not absolve PF damage. We need better healthcare for WOMEN pre, post, and during childbirth.

I am distressed that women continue to think that vaginal vs section is the equalizer. Nope. [/quote]

You are wrong.

spontaneous vaginal delivery is significantly associated with stress incontinence and prolapse, and the most dramatic risk is associated with operative vaginal birth.

A scheduled (not emergency!) c section can be protective. No woman with a scheduled C section who did not go into labor will have levator ani avulsion.

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NP and no - [b]it’s really only the use of forceps/vacuum during vaginal deliveries that increase risk of pelvic floor issues. [/b] Can scheduled C-sections reduce the risk of them, sure, but they’re not without their own risks.  Ideally, more awareness of how to push during vaginal deliveries would be helpful, e.g., on the side, on all fours (which can be done with an epidural).

This is a great thread, OP.  My kids are older now - 11, 9, and 7, but there are still things I wish I’d known:

-Many, many women *hang onto* weight while they breastfeed and lose when the wean
-It’s okay to supplement (truly! It’s okay!)
-Having low supply doesn’t mean there’s something wrong with you or that you’re doing something wrong.  It doesn’t mean you need to go to great lengths to get your supply up.  Bodies are different and that’s okay
-Stress urinary incontinence is common, but not “normal” or healthy.  *talk to someone* if you have it - there are ways to help
[/quote]

This is a good reply generally, PP, but the bolded is not exactly true. I had hypertonic pelvic floor (overly clenched muscles) because of pushing for a long time and basically being "stuck" while in the pushing phase. I pushed on all fours and in various positions as well, and that's a valid point, but vaginal deliveries present a lot of different pelvic floor risks in addition to forceps/vacuum which are the big ones.[/quote]

Agreed. I did not need forceps or vacuum but have had incontinence just from the pushing. My sister had a major tear from pushing. [/quote]

I’m the PP you’re both referring to - I’m sorry about the damage from pushing you both experienced.  I didn’t mean to minimize that risk, because it is there, certainly, even without instrumental assistance.

More, I think it’s important to consider the *trade-off* of risk, because those exist with C-sections.  I know people who had severe infections after Cesarean.  Who needed revision surgery because the healing led to secondary infertility.  Who experience permanent nerve damage as a result.  I think the ultimate take-away is that birth is inherently risky and pregnancy and delivery carry risks to the mother, which aren’t discussed enough.  I’d never presume to tell an individual woman how to account for those risks because I’m not her.

Broadly, though, the “have a C-section, save your vagina” isn’t helpful, for multiple reasons.[/quote]

NP. Agree. WHO statistic is that c section rated above 10% are not associated with an improvement in maternal or fetal health. I’m not advocating for vaginal or c or c over vaginal, but both have risks and it’s not really possible to know what delivery will be like because there are so many factors playing in - maternal health, fetal health, baby size and position, pelvic size etc…

Anecdotally I have a smooth c section but I horrible recovery involving a splitting incision and severe constipation that resulted in muscle tears. I ended up developing ptsd from my c section post partum recovery. Obviously this is not representative of c sections as a whole but I had a horrible experience. No guarantee that vaginal would have been any better. Could have also been a horrible recovery or even worse. [/quote]

Nerve damage can happen regardless of the delivery mode. My vaginal birth resulted in nerve damage in my pelvic floor that caused anal incontinence for over a year! I could hardly leave the house and wore diapers for over a year.

And please, for the love of god, do not cite the WHO. That stat is wrong, and it’s outdated, and it has been debunked thoroughly. You also got it wrong - they initially set a target of 15 percent back in the 80s and then further evidence have shown outcomes at that rate are horrible!

There was a huge JAMA study done by Gawande and others that showed that a minimum of 19 percent C section rate is necessary and target rates could even be higher!

“Conclusions and relevance: National cesarean delivery rates of up to approximately 19 per 100 live births were associated with lower maternal or neonatal mortality among WHO member states. Previously recommended national target rates for cesarean deliveries may be too low.”

https://pubmed.ncbi.nlm.nih.gov/26624825/

https://pubmed.ncbi.nlm.nih.gov/28253469/

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