Birth plans and prevention

A question that I think haunts many women with prolapse (certainly me) is — was this preventable somehow? Could I have had a child without this level of trauma to my body?

The obvious solution is C-section. Then you avoid all the pressure from pushing. But studies show that women who have c-sections can also develop prolapse, so it is no guarantee. Still, it might not be so severe.

Because my son was stuck, I ended up exhausted with a spinal block about 2 hours into pushing while they let me rest and encouraged him to turn. When pushing started again, I was on my back, doing sit-ups while holding my breath. All very hard on the pelvic floor. Even so, not all women who spend so long pushing on their backs end up with my level of damage.

The thing that annoys me most is that the field knows there is a hereditary component in prolapse and yet we aren’t screened for it. It’s almost universal on my mother’s side, as far as I can tell. Not that we had these conversations before I gave birth.

A birth plan seemed like kind of a joke the first time. You just have to go with what nature gives you, right? You might need pitocin. You might need an emergency c-section. So I just figured out what drugs I would and would not take, and left it at that.

While I can’t go back in time and make a birth plan appropriate to my genetics, I can make one now with respect to my genetics and my injuries. I’m lucky enough to have the option of knowledgeable midwives who will take the time to talk over my injuries, my goals of maintaining as much urinary and fecal control as possible, and what positions might be best. Whether an epidural is possible (it is — you can push side-lying with an epidural). At what point we opt for an emergency c-section.

I also went back to the specialist gynecologist to ask when to go to c-section. She agreed with the midwives’ hunch — a long pushing stage should be avoided. On positioning, she deferred the midwives. They recommend all-fours and side-lying. Probably squatting too. So we’ll see how that goes. At least, the gynecologist also predicted that this baby would be out in two pushes.

But on the plus side, we could be the last generation with prolapse in such high numbers — at least at young ages due to giving birth. The specialist gynecologist is working on a computer model that can take a scan of a woman’s pelvis and a detailed ultrasound of the baby’s head and predict her odds of ending up with these kinds of injuries. Our daughters may have better information about whether to just schedule a c-section, or when to not push through when the baby seems stuck.

Or, if you’re pregnant and reading this in 2022, you might ask whether it’s available. She said she thought the predictive model might be ready in five years.

Posts in this series:

Prologue
Part 1: Is this normal?
Part 2: Sometimes you won’t get better
Part 3: Menstruation
Part 4: Pregnant with prolapse
Birth plans and prevention