Uterine Prolapse & Pregnancy: Vaginal vs. C-Section - Dr. Rappaport

Question
Hi Dr. Rappaport,
I am emailing you out of desperation.  I am currently 35 weeks pregnant and trying to decide whether to have a vaginal delivery or a c-section for two different reasons.  1 is the issue of having uterine prolapse, a bladder that has "fallen", a rectocele, and a rectum that is seemingly wanting to prolapse out also--all of which occured after the birth of my daughter 2 years ago.  (I am 27 years old.)  The second reason for the big decision is that I am still suffering pain from the 4th degree epis that I had with my daughter, leaving me with ALOT of scar tissue down there.  I've consulted three different doctors here and nobody seems to have dealt with prolapse and pregnancy which is EXTREMELY frusterating!  Obviously I'll have to have surgery to fix it all in the near future, but my question is will I make things worse by trying to a vaginal delivery?  One dr says yes and that I could become incontinent in the future (something that surgery may or may not fix.)  Due to the tramatic 4th degree and fear of making things worse I originally wanted a c-section.  My current dr says that she didn't see a need for c-section if I have to have serugery to fix it all anyways.  She also says that my painful epis could stretch out and "feel better" if I push another child out vaginally.  I do believe this but, knowing that scar tissue isn't as elastic as the original perineal tissue would've been and also that my rectal area already is presenting issues, am I just asking for more trouble by a vaginal delivery?  Please send your advice right away, I don't know where else to turn.  Thank you!

Answer
Even with all your previous problms, I doubt that having a cesarean section will help avoid any further problems. You still are going to need the surgery for the prolapse . I think you would be better off with a vaginal delivery and you may be able to repair or improve the scar tissue that is already there. You will also further stretch out the tissue and may notice improvement. Usually, the uterus can be replaced into the vagina and dilatation should progress normally. A vaginal delivery should be fine.