How unlucky was I?

[daphne1]

I hope I can explain my question clearly!

I had a pretty shitty labour, delivery and (incomplete) recovery. It has made me completely rethink my desire for more children, but I’m not yet ready to mentally close the door on that. One thing that is really bothering me, and that might help me decide on whether to get pregnant again in the future, is trying to guess how likely I am to have a similar experience again. I guess I really have two questions:

1. How likely is it for all or some of these adverse events to co-occur in one labour/delivery/recovery? In other words, did I just have rally terrible luck that a lot of unfortunate things happened to me, or did the fact that one unfortunate thing happen make it more likely that others followed?
2. How likely are these things to happen again in a second labour/delivery?

I have managed to get some numbers on some of the adverse events, but it’s not clear to me the extent to which things are linked or are likely to re-occur. Here are some of the things that happened:

a. PROM (but contractions started pretty soon after).

b. “Active labour”-type contractions (lasting about a minute, happening every 2-3 minutes) from the beginning, so for about 23 hours. I think this can happen with PROM, but not sure if it happens every time.

c. Unsatisfactory progress during labour, necessitating augmentation with pitocin. (I needed a lot of pitocin, and at this point got an epidural, which may influence some of the other things.)

d. Extended pushing - pushed for nearly four hours.

e. Third degree tear.

f. Prolapse of bladder and urethra.

g. “True” low supply when breastfeeding (tried literally everything to increase supply, under the care of IBCLC and doctors, over the course of 6 months, and still never had a full supply).

h. PPD and, I think, PTSD (from threatened forceps during pushing). Subsequent lack of bonding with baby (still not really dealt with).

I want to emphasise that I’m not hear for a pity party! Lots of women have had it much harder than me. But it would help me decide whether or not to try for another if, say, I knew that your chances of a serious tear on a second delivery are the same as for a first, or that avoiding an epidural would help avoid a lot of the other issues.

I’m mostly looking for evidence-based answers but recognise that there won’t be studies about these specific questions, so some extrapolation is likely to be necessary. If you know of any evidence-based ways of avoiding any single one of these issues, that would also be welcome.

Thank you if you’ve made it this far!

 

[bluedragon1988]

@daphne1 As far as I could find, a PROM birth at 38 weeks isn’t associated with PROM in subsequent pregnancies (with pPROM there’s a high likelihood of recurrence, but since yours was nearly full term PROM it’s less likely to happen again)

I couldn’t find much info on the likelihood of requiring labor augmentation in subsequent labors, but this is something you can discuss ahead of time with your OB and make it clear that you don’t want Pitocin unless absolutely necessary. Me personally, I always take alllll the pitocin to just get it over with more quickly but there are very few cases in which a laboring woman absolutely must have Pitocin augmentation.

Unless you have unrelated complications with your second baby (large baby or large head, unfortunate positioning for baby, etc) then your likelihood of having extended pushing again for subsequent births goes way, way down. Time spent in 2nd stage labor almost always reduces in subsequent pregnancies, unless other complications are present.

Severe tearing happens in approximately 1.2% of births. If you have had a previous severe tear, your likelihood of tearing again increases to 7.2% So not a huge chance, but a slightly elevated risk. However, other factors such as size and position of the baby and extended 2nd stage labor can also increase your chances of tearing. So if you don’t have those things going on, then your chance of tearing again is lowered.

Approximately 35% of women will have a prolapse at some point in their life. If your prolapse was able to be managed with exercises and PT alone, then the likelihood of recurrence is low since the problem has been fixed. If you had a severe prolapse requiring surgery, then your doctor will probably advise you to wait to have the surgery until you’re done having children, because a surgically repaired prolapse is more likely to recur in subsequent pregnancies. However— size/positioning of the baby and duration of 2nd stage labor factor heavily into the likelihood of having a prolapse. If you don’t push as long, you’re less likely to have another one.

Inadequate breastmilk supply is far higher in first time mothers than with subsequent births. PROM also contributes to low milk supply, and so does prolonged labor. Without these complications, your likelihood of having low milk supply is a lot less.

Risk of PPD happening in subsequent pregnancies is 30-70%, depending on the severity of the previous occurrence. It is definitely something to keep an eye on, but it’s not a guarantee— especially if your next labor is shorter and smoother than your traumatic first time around.

So in summary, most of the issues you had with your first labor were just bad luck, but none of them are guaranteed to happen again in subsequent labors.

As an anecdotal story, my first labor was over 36 hours long with a sunny side up baby. They pumped buckets of Pitocin into me and all it did was make it hurt worse. My second labor was just under 12 hours, and my 3rd was about 4 hours of active labor. I joke with my husband that baby #4 will only take an hour, and if we had a 5 they’d be out in under 15 minutes! This is not always the case, but statistically speaking— and controlling for other complications— subsequent labors are usually much easier.

 

[daphne1]

@bluedragon1988 This is very helpful, thank you! I did not know that about the effect on breast milk coming in, but the whole thing did feel like some hormones were out of whack causing things not to proceed as usual.

 

[bluedragon1988]

@daphne1 Yes, inadequate milk supply occurs in almost 15% of first time moms! It’s much more common than you’d think. Some women just don’t produce for whatever reason (we have archeological evidence of prehistoric baby bottles, so we know it’s been that way since the dawn of time) but just because you had low supply the first time doesn’t necessarily mean you would again!

 

[russ44]

@daphne1 While details may differ, traumatic births are very very common. With modern medicine, we’re able to save lives of moms and babies, but it comes at the cost of mental trauma, which never heals because we never have enough support to get us through it. A LOT of women AND men are traumatized by complicated births, but no one talks about it because we’re expected to be simply happy, thankful and delighted with the arrival of the baby.
I would suggest, try not to analyze every detail of your birth and statistics around such events. There is no way to predict what’s gonna happen with next pregnancy. I have struggled with these same questions over last year and I decided that I’m gonna focus on things I can control such as
1. Being healthy before and during pregnancy
2. Having hired help for recovery (my job will pay $2000 for a doula)
3. Being flexible when it comes to nursing. I’m open to doing breast milk and formula, rather than obsessing over exclusively breastfeeding. The stress is not worth it.
I suggest think about what you can do to make your and your family’s life easier, and then ask yourself, if all these problems don’t matter after 1-2 years, then do I want another baby.

 

[qody]

@russ44 This is such a great response. All of this. I would add, find a GREAT, amazing high-risk OB you can really talk to and trust.

 

[promiseokon]

@daphne1 The researcher Maria Gyhagen has studied pelvic floor disorders after vaginal birth versus cesareans using the birth registers we have in Sweden. Here is a risk calculator that she took part in developing:

https://riskcalc.org/UR_CHOICE/

Here she discusses some of her research in English:

 

[katrina2017]

@daphne1 This is all anecdotal so take with a grain of salt but I wasnin your shoes and went for the second and don't regret it.

So I had all this and actual forceps and full episiotomy. It was terrible. I had reallllly bad postpartum anxiety for a year following to the point of OCD. Rectocele that caused a ton of pelvic floor issues. (Which are much better now) However, my second labor....was a literal fucking breeze. I stayef home laboring until my sister forced me to go in. When I got there I was at 8 or 9 cms. Wasn't even that bad. Got in the delivery room and they broke my waters and actually 5 minutes later I got hard contractions which yeah felt like a train hitting me. But they got me on the table and after 3 pushes we had a boy. It was one hour ish from arriving at hospital to holding my baby. It was euphoric.
Don't let one bad birth make you avoid it forever. Heal. Come to terms. And move forward. I was nervous but ready to take control of the second birth in a way I wasn't prepared for with my first. It was empowering. Hugs to you ❤❤❤

 

[abidingtv]

@katrina2017 Just replying to say this makes me feel so much better. I had forceps, episiotomy, 3rd degree tear and pushed for 5 hours. My recovery was worse than that of a c-section.

I'm 22 weeks pregnant and literally want to cry when I think of giving birth again, to the point of considering an elective c-section.

 

[cocoon87]

@abidingtv Please read the comment I just left under another thread here. My story is so much like yours but a 4th degree tear. And my 2nd is almost 2.5 and it feels like a distant memory, but I spent most of my pregnancy stressing about his birth. And it was great, minor tearing, and I felt absolutely fantastic after. Get a C-section if you want 100% - but please don’t have anxiety about the birth.

Enjoy your pregnancy for me and consider a doula. I’m not a crunchy person but it was amazing for both me and my husband.

 

[katrina2017]

@abidingtv Aww! I hope you have a wonderful birth this time. ❤❤❤❤

 

[daphne1]

@katrina2017 This is good to hear! Unfortunately I also read stories from people who had worse second deliveries after bad first ones and I don’t think I could handle that. But it is hopeful to hear that these things can get better!

 

[katrina2017]

@daphne1 Definitely a possibility. The reality is you can't know until it happens. I hope you find peace with whatever you choose

 

[zach0024]

@katrina2017 It’s rare to read from a fellow rectocele sufferer! It’s the thing I’m most worried about in case of a second pregnancy. Did you have similar problems again? Any tips? I’ve got mine under control through PT and stool softener but ugh. It was so uncomfortable and gross when it was bad.

 

[katrina2017]

@zach0024 Yes it was really bad towards the end and I had to be really careful with constipation. In hindsight resting off my feet more and picking up less would have been even better. But the birth itself was great and directly after was decent. I started PT about 6 weeks following the birth and do the exercises everyday. I think avoiding picking up my toddler was helpful. She was 2 and a half at the time. It was hard emotionally but my pelvic floor couldn't take the weight. I started making psyllium fiber shakes every morning. Lots of healthy eating. And making sure to breathe properly while lifting. At 9 months postpartum it's managed well and hopefully once I finish breastfeeding that also will help. (I have been breastfeeding since 2019 )

 

[katrina2017]

Did you tear the second labor? I had an episiotomy (felt it was unnecessary seeing that I had only been pushing for not even 40 minutes and baby was not in distress), and I worry that it'll guarantee a tear along the episiotomy scar.

 

[katrina2017]

I did but very minimally like 2 stitches

 

[katrina2017]

That's reassuring to hear! I'll probably end up like you and laboring as long as possible at home.

 

[katrina2017]

I reccomend it. It avoided me having to argue with nurses trying to give me interventions which I think was the issue the first time.

 

[katrina2017]

My waters broke at home spontaneously. Waited 6 hours before heading to the hospital hoping the contractions would get closer together and they didn't. Due to the risk of infection, went in. I was 6cm dilated. Unfortunately, the OB on call for my practice was not one I had seen and had very different philosophy when it came to child birth. I was put on Pitocin, which they increased in dosage every half hour to the point where it was so painful, I begged for an epidural. The L&D nurse laughed at me for asking for it. Overall a terrible experience, including them messing up the epidural to the point where I couldn't even move my legs for 6 hours after. It felt like they just wanted to speed things along to free up a bed.

2 of the midwives I saw at the practice heard I had given birth and visited me the next day during their rounds. One read my chart and was shocked I had been given an episiotomy. I'm not even going to go into details about being berated by the day time nurse for struggling to get a good latch breastfeeding. Just absolutely horrible experience. The hospital I selected was highly rated. I just keep telling myself that it could have been worse and to be grateful for not having complications or an emergency C-section. Still planning to have another. I just hope that the experience will be a much better one.