3rd degree tear merit cesarian?

[bertie007]

Hi. Advice welcome. I'm 18 wks pregnant with my 3rd child. I had a poorly healed episiotomy with 1st and forceps. 3rd degree with second and ventouse so lots of physio for continence training (no.1.... and 2). I am frightened that I'll have this bad tear again down the same line if give birth naturally and am not confident anyway that I'll push the baby out by myself as never managed before and have very weak muscles. However, worried about being cut open for cesarian and the receovery time and that I will not be able to look after my other two children well as my husband has to go to work. If the choice is given to me, I don't whether to say yes to a cesarian or not.

I would consider your longterm health as well as the immediate weeks and months of recovery. Incontinence tends to worsen at the menopause as hormones change so make sure any assessment of risk you make considers that possibility.

The Royal College of Obstetrics and Gynaecologists have guidelines - here on tears

See section 12 for their discussion on future births.

I had bad tearing and an episiotomy from an emergency forceps birth with DC1 and months of bladder incontinence afterwards. I chose an elcs for DC2 as I was also very concerned he would get stuck and be in danger as DC1 was. I also felt it best for my health to have different scarring and avoid another bad tear on a weakened area. My phsyio did say that an elcs would also avoid another huge stretch of the pelvic floor as the head comes through. One side of my pelvic floor is especially weak as the episiotomy is on that side and I then tore beyond that too.

If you look at the childbirth thread of those of us asking for an elcs after a traumatic birth you will see lots of different stories of elcs and lots of people had them after bad tearing. In General Health there is a thread for those with childbirth injuries which is somber reading.

Since it has already affected your continence I would push to have the anal muscle strength assessed if you are leaning to another vb - there are scans that can be done to see how much weakness there is. There are people who come away from very bad tearing with colostomy bags, very, very rare but I preferred to know the worst case scenario when I weighed up the c-section risks v.vaginal birth risks with a history of tearing.

Hope that doesn't sound too negative! I am sure you know all the positives that a good vb would bring, so I'm obviously just pointing out the other side.

I was also offered a cs after 3rd degree tear but turned it down after having a ultrasound of the area and a discussion with a colorectal surgeon about how it had all healed. Is this an option for you to help you be more informed about your decision?

In your situation I would definitely go for an elcs.

Everyone considering an elcs talks about the "longer recovery time", but this isn't necessarily the case: it depends what you are comparing it to. The recovery time is slower than for a straightforward, easy vaginal birth but is usually quicker than for a difficult vaginal birth involving bad tearing.

Also, bear in mind that the recovery issues for an elcs (soreness across stomach, not being able to drive, etc) are all temporary. This is not the case with damage to the pelvic floor from a bad vaginal delivery.

Can you dh not take some paternity leave and/or annual leave?

I have this choice this time but I healed very well after my 3rd degree tear and forceps birth which is why they are letting me choose rather than recommending a c section.

I have to say that in your situation, I would be opting for the c section, definitely.

Having experienced looser muscles with the back passage, I wouldn't want to think about it being worse than what I had. I have healed well and I am lucky, but if the damage and after effects had been any worse, I wouldn't even be considering a natural birth again.

I am 21wks pregnant with DC3 and have been advised to have an ELCS as I had 3rd degree tears with both DD1 and 2.

As discussed here, it is not just about how well you have healed now but future impacts.

However, decision can only really be yours.

I remembered I was also advised by consultant to read the NICE guidelines as well as the Royal College info.

Thanks to all, very, very helpful.
Ps. I had a analysis done on my back passage and part of the circle of muscles is indeed in very damaged hence the circle doesn't close very well...enough said. I will take this report with me to see the consultant to reinforce my ideas, plus the urine incontinence report!

You shouldn't have to ask - they you should strongly urge you to have a C section. NICE and Obstetric guidelines state so too. I had exactly the same situation after 3rd degree tear, weak muscles and incontinence issues. Just being pg can weaken them without bearing down in childbirth. The majority of women with incontinence issues post menopause is due to childbirth - something to look forward to

Can you dh have any time off at all? How old are your other children? Any nearby relatives to help out? My C section was excellent and recovery fast (wished I had it for my 2nd now)

I think he will just have to take some time off, we'll work it out. My other children are 5 and 7, so able to sort themselves out better than toddlers. We have a tiny house so no room for my mum to stay! Unless she fancies the living room with the cats and dog!
THanks for the advice Kangaroo.

Just to say they have let me have a cesarian which is programmed for 2nd May. Thanks for all your advice.

hi, how did it go? hope all went well for you and you are enjoying your new baby too!

I have a lovely baby girl born at 38 weeks by caesarian. I have recovered quite quickly. First four days rough especially at night but a breeze compared to my other two natural labours/births! My scar is particularly ridged up on one side. I don't know if I am supposed to do something to help it (the caesarian was only 2 and a half weeks ago) but wouldn't want the scar to stay all uneven so any advice is welcome.
All in all a walk in the caesarean has been a walk in the park compared to the other two gruelling, long labours with lasting damage to one's 'undercarriage'!

Congratulations! XX