3c tear with DS1, could you help me decide what to do with DC2's birth?

[smk84]

Hi, I am 28 weeks with DC2 and had a 3c tear with DS1. I only just found out it was 3c (as my notes were a bit confusing and the consultant reviewed them yesterday and said it must have been 3c). When I thought I had a 3b tear, the registrar told me that if I had no symptoms (which I don't), then I could choose CS or VB. But now with 3c the consultant thinks a CS would be better, as if I tore again they may not be able to repair it fully. I know that my chances of tearing are less this time, but that no-one can really predict the chance. I really want a natural birth, but am quite scared of long term incontinence. Have been told that they don't scan for scar tissue at my hospital. So I have some questions ........
Do you think I could get a scan for scar tissue done somewhere else? (I live in Devon).
Do you think knowing the size of the baby near term could be helpful? (they told me they won't do growth scans for me at my hospital)
If I tear again and they can't repair it properly, what are the chances of being beyond help and doubly incontinent? And is there a chance that I could be literally doing complete poos in my pants ?? !!
If I tear and they try to repair it and the outcome is not very good, can they do more ops in the future? What would they do?

Sorry for such a long post, but I really don't know how to start getting info about this !! Thanks for reading :)

[cravingcake]

Hi there. I had a 4th degree tear 20 weeks ago with my first DC, and from my understanding 3c is not much less than that. I personally will be opting for a C-section for my next baby as recommended by the consultant i have recently seen. Not that I'm planning on another baby just yet as that would involve sex

Part of my reason for opting for an elec section is due to my whole birth experience being traumatic for myself, my DH and baby as well (episiotomy, forceps & shoulder dystocia). However, if we'd had a 'normal' experience and I was just unfortunate enough to have torn during the process then I would be in two minds as to what to do.

Yes there is the possibility of long term incontenance but I think there are ops that can be done to correct this (but not sure at all as to waiting times and how serious it has to be before they'll do anything).

Dont forget, you can choose right up to the day what you want. Sorry I cant be more help.

[first1]

I had a 3a 21 months ago and I am definitely definitely having a c section next time. No way I'm running any risk of incontinence. And yes sections carry risks but much less so when they're planned. And to the previous poster, sex will happen again. It's taken me this long to enjoy it and want it but you'll get there

[Lunarlyte]

Hmm, I'd personally opt for an ELCS as I am told that a damaged pelvic floor is more difficult an operation (in terms of repair) than a straightforward ELCS. There is no certainty that you would tear as badly as you did again, but if you did, how would you feel about that?

I don't know if it's possible to scan for scar tissue; perhaps you could find this out from your hospital/ midwife/obstetric team? Is it the degree of scar tissue that you're trying to find out about?

It might be useful to have an idea of baby's estimated weight nearer to term but it's not just their size which affects the risk of tearing. How they are positioned, whether a little arm or hand are across their face, whether you are able to control the speed of the head's delivery all factor in. You might need an episiotomy (for whatever reason) and tear down the old scarline.

I don't know if you'd be 'beyond help' if you tore extensively again, but how would you fare looking after two young children whilst facing extensive reconstructive surgery to your pelvic floor? I think that if damage was extensive enough to the anterior pelvic floor, then there is the chance that you would lose bowel control :( I don't know what the specific risk factors for this are, though, in your individual case.

I thinkthat the procedure that you are thinking of to repair an extensively damaged pelvic floor is a 'colposuspension'.

Good luck with whatever you dies to do an I hope that everything works out for the best x

[cravingcake]

Just want to add that knowing the babies weight before the birth is very inaccurate. I had two late-ish scans (one at 27 weeks & one at 32 weeks) and both showed my baby was going to be 7 - 7.5 lb at most. My DS arrived at 38 weeks at 8lb 2oz so do remember that scans are not accurate.

Also, just as a personal view, I would much rather have a few weeks of discomfort & recovery than a lifetime of incontinence.

I hope someone can answer your questions soon though.

[smk84]

Thank you for the replies :) I was fortunate enough to have a fab birth with DS, and a good recovery from the tear afterwards. Cravingcake sorry to hear you had such a rough time with your birth. Lunar thanks for the info - I will look up the procedure you mention. Ds will have just turned 3 when DC2 is born, and i had never really thought about recovery from pelvic floor ops as being difficult (as it was no trouble last time), but you make a very good point (all I have been thinking of is how hard it might be with the 2 children having had a CS!). thanks again.

[Angel786]

Hi there,

I had a third/ fourth dg with dd 15 months ago, all healed now but terrible for six months! Am due in aug with dc2 and having elective c/s. Couldn't face going through what I went through last ti e again!

craving I had the same, episiotomy, third/fourth (thru the anal muscle!) tear, ventouse and shoulder dystocia too. The mental strain is worse than the physical pain I think! And dd wasn't a large baby either, 6'14.


Good luck op.

[muslimah28]

I just wanted to give you an alternative perspective. I had a horrible time with dc1 birth and had a tough physical recovery. But a cs doesn't have to be the only option or even best option. I am doing hypno birthing this time and in a relaxed and calm state combined with weeks of perineal massage the chances of tearing are smaller. Tearing is not just about size of baby it's to do with some of the factors mentioned by a previous poster above and also the method used during the actual birthing/pushing out of the baby.


By all means have a cs if you feel it's the best option for you. But please don't think it's the only option.

[cardamomginger]

Hi smk84. Firstly, well done on going for a second DC! As someone who had a traumatic birth and who sustained serious birth injuries, I know that this is sometimes not a step to be undertaken lightly!
I can only talk from my own experience, but hope that what I can add might be helpful. I sustained multiple prolapse, damage to the coccyx and tearing. I'll just focus on the tearing here as this is what's most relevant to you. I had 'only' a second degree tear, but this went all the way through my deep pelvic floor muscles and has been enough for me to experience double incontinence - although the bladder prolapse and tearing to my urethra definitely had something to do with the urinary incontinence. So the first point is that you don't have to have a serious third degree tear to end up with continence issues. Have you had any sort of scan at all to assess the anal sphincter and how well it has healed? I'm guessing no, as you said they don't scan for scar tissue. As part of my investigations I had an anal manometry, which is where they assess the strength of the muscles in the anal sphincter - these can be damaged and weaker even if they have not been torn - and an ultrasound to assess the extent of the tearing. If you have a weak sphincter which is further weakened through childbirth (even if you don't tear again) you could still face trouble.
The second point is that a tear to the sphincter is harder to repair, according to my wonderful urogynae surgeon, and sometimes it doesn't work completely. As my sphincter was intact, I didn't ask any questions about rates of failure if a repair is attempted, and what 'failure' means, but it would be worth you asking and trying to find out those statistics.
The third point is that not all obstetricians/urogynaes will attempt repairs of the very deep pelvic floor muscles either immediately after delivery or subsequently. In my case I ripped through the puborectalis and this was not sutured. In the reply to my letter of formal complaint the hospital I delivered at told me that they do not attempt to stitch this if a tear occurs. Fortunately my urogynae surgeon is a specialist in pelvic floor reconstruction and is willing and able to undertake the repair.
I guess the message I'm trying to get across is that it doesn't have to be a third degree tear to result in continence problems, repair to the sphincter can be tricky, and not all hospitals will fully repair a tear if it occurs. I'd also echo the other poster who said that you don't need a big baby to tear - a hand at the side of the head and long finger nails of even a smallish baby could rip you in an instant.
BTW - colposuspenion (one of the procedures I've had) is where they hoik your bladder and urethra up placing stitches round the urethra. It's done to correct a front wall vaginal prolapse and to sort out urinary incontinence and is performed through a large CS type incision. So it's not a pelvic floor repair as such. Can't comment on recovery from pelvic floor repairs - I'm still recovering from my first lot of surgery and won't be having the next lot until the summer).
It's a horrid decision to face. Good luck XX
(Waves at first1, muslimah28 and lunar)

[muslimah28]

hey cardamom waves back! xx

[first1]

Hi carda! Hope you're healing well xx

[goingeversoslowlymad]

I had a third degree tear with DC1, which required stitching in theatre. As a PP has said, I also was very tender for about 6-9 months afterwards. However, I went on to have a homebirth with DC2 and just suffered a graze that didn't require stitching. Nobody even mentioned this when I opted to have a HB, CS was definately never an option either myself or consultant even talked about.

[goingeversoslowlymad]

Forgot to mention that DC1 was 8lbs and DC2 was 9lbs 3ozs. I had an epidural in with DC1 and had to be given an episiotomy, with DC2 I had a very relaxed homebirth with only a TENS machine. One of the midwives was also holding a moist gauze on my perineum as I was pushing. Sorry if that was TMI lol but I feel that definately helped.

[Lunarlyte]

Hiya Cardamom, waving back and hoping that you're healing nicely xxx

[smk84]

thank you for all the replies everyone, and for all the detail in the messages. I think I have a lot more thinking/research to do ! Cardamom sounds like there is a lot that can be found out through scans - i can't understand why my hospital doesn't offer any of this and don't really know how to go about finding out as I would have thought if the consultant knew about it he would have pointed me in the right direction anyway. Going - do you know the type of tear you had? (i.e. a/b/c) And not TMI at all - it's good to know about it - I will mention it in my birthplan if I don't have CS. Muslimah thanks for your advice - my ideal would be a relaxed natural birth, was considering homebirth but consultant recommended hosp just in case i tear so that they can examine and repair me asap !

[cardamomginger]

Anal manometry particularly is quite specialised - mine was done at a tertiary urogynae/pelvic floor reconstruction clinic in London. It may not be appropriate to do one now during pregnancy - don't know. But if I were you I'd ask to be referred for one. And for an ultrasound too. If not now, then after you have this baby. Fair enough if your hospital doesn't have the kit or the know-how to do it. but they should refer you to somewhere which does.

[cardamomginger]

Hi lunar and muslimah! Thinsg up and down - been in q fair bit of pain last week or so [sad} but otherwise ok . Don;t want to hijack thread - but how are things with the two of you? X

[first1]

Carda I had mine done at st George's (tertiary referral urogynae unit) is that where you went? Hope you're ok? Xx

[PrincessScrumpy]

after 32 stitches with dd1 ("only" 2nd degree tear but down the sides not front to back if that makes sense). I was offered cs (asked before ttc) then pg was twins so definitely opted for cs.

For me it was a lovely experience and I healed really well. Was right choice for me!

[muslimah28]

PrincessScrumpy and cardamom i do find it frustrating that people tend to judge the severity of your tear by the 'degree'!! you must have found this very annoying. i think mine was 'only' second degree too, but that tells nothing about the healing process.

cardamom sorry to hear about your pain :( all well here, i must drop you a line soon!

[goingeversoslowlymad]

Mine was a 3a tear. Hope all goes well for you.