Advice on VB or ELCS following 3b tear

[georgie22]

I felt that I had made my decision to have an ELCS with dc2 following 3b tear with dd. I have healed well although this took many many months and many many pelvic floor exercises. I have more urinary and faecal urgency now than previously but I'm certainly not incontinent.
I didn't have any risk factors for a third degree tear and dd was 7lb 3oz. I've been told that this baby is bigger and I can tell that just from how I feel.
I've been to the hospital today to see medical staff with regard to making a final decision on mode of delivery and feel that my rational decision making has been thrown up into the air. I've cried about my situation as I wish I didn't have to make this decision. I'm scared of future continence issues and the need for further surgery. I know there is no guarantee that I would tear again but do I want to take the risk? I feel that this is now impacting on my enjoyment of my final few weeks of pregnancy.
Would be grateful for any perspectives on this. Thanks.

[Kellyp78]

I am in a similar position. I will watch this thread with interest to see what kind of advice you get. I was previously very determined to have a natural homebirth as I hadn't realised how serious a 3b was. Now I know, I am thinking I will ask if I can have a ELCS as I imagine the recovery is more a known quantity and I'm afraid I will just fall apart if I try for a vaginal birth.
I hope you find peace with your decision soon and can enjoy the rest of the pregnancy.

[yetanotherworry]

I had a VB after suffering a 3rd degree tear (wasn't classified with letters, but very nearly 4th degree). I had an easy birth second time round and ended up with a very slight tear which was very borderline as to whether it needed stitching.

[marthabear]

Georgie and Kelly....what were the circumstances of your births? Epidural? Induction? Being told when to push or not? What position?

[Kellyp78]

Oh, circumstances very much conspired against me. Very overdue, back to back, spinal anaesthetic and forceps. I know that all this contributed but can't get past the fear I now have. I also feel pressure, to the point of being quite uncomfortable, right along where the tear happened and I'm only 23 weeks. I really thought I would be using Hypnobirthing and have a lovely birth this time but petrified and feel that, if it's a valid option, a c-section would be the best route for me this time.

[georgie22]

Marthabear - 40 weeks + 2, no induction, no epidural (or other analgesia), not an instumental delivery, was 8cm dilated on arrival at hospital, laboured kneeling up but midwife encouraged me to lie on my back to deliver, was told when to stop pushing etc. She could see I was going to tear as she requested senior midwife to do an episiotomy but it was too late.

[georgie22]

I think the fact I had no obvious risk factors for a tear make me more scared about the risk of a further tear. Just wondering if there are anatomical reasons why I tore. Finding that the worry of the situation is really stressing me out which I could do without.

[Ericadm]

I am in the same situation. With my first baby, water broke 38 weeks but no contractions, induced after 24 hr, epidural, episiotomy and forceps, 3a tear. I did heal OK but recovery was long. Now expecting again and not sure what to do. My OH is keen on ELCS as he is traumatized from assisting to the first birth! I tend towards VB as it will give me the best chances of a quicker recovery. We don't have family around and I hate the idea of needing help for lifting things, not been able to drive etc. However if I had a VB and it went badly, then recovery may be even longer than from a ELCS. So difficult to decide!

[marthabear]

I understand this must be a difficult decision to make. In my experience, things that reduce the chances of perineal trauma are giving birth in water, hypnobirthing, going along with your body's feelings when it comes to pushing rather than being told, a good, supportive midwife who will reassure and guide you through that last bit of labour if necessary, and most importantly birthing baby's head so s-l-o-w-l-y. I am aware that it obviously can happen but I have never personally known a woman who has had a 3rd degree tear for a second time. But I have known many, many women who have suffered this time of perineal damage before, and have gone on to give birth vaginally with either a minimal tear or none at all. Many of these women were understandably very anxious antenatally. I have worked in a birth centre for 10 years.

[georgie22]

Thanks for that marthabear - I know that there is the chance that I won't have another tear but I'm not sure how I will cope psychologically during labour with that fear. Also how can they guarantee I will have an experienced senior midwife present during delivery?
Not sure I want to risk possible continence issues and the effect on my sex life in the future, plus the possibility of requiring further surgery.

[marthabear]

I completely understand your fears. A hypnobirth course/ CD could help with some fears ( belief in your body etc..) and you can request at your obstetrician appointment for ' Experienced senior midwife at birth please' or something like that to be written in a prominent place on your notes. I realise there are no guarantees, as there are no guarantees of outcomes with any birth choice. If you are sure that an elective CS would be best in your circumstances, then dig your heals in. A hypno birth Cd would be beneficial in any case to help you to stop and relax and enjoy these last weeks of feeling this baby growing inside you. You could google 'Planning a good caesarean' for things to think about with regards to caesarean birth wishes. You can always change your mind at a later stage.

[LouiseB2]

Hi all, joining this discussion as I too am afraid and unsure of what decision to make. I'm 24wks with 2nd child, had an EMCS with my first after failure to progress. Had an appointment to discuss VBAC yesterday and although I broke down just discussing what happened last time, I left feeling quite positive about giving VBAC. Although now after reading on other sites about scar rupture and possible tearing, I'm thinking is it worth the risk?

[TwoTearsInABucket]

Similar position to you op. I had EmCS with DC1 then VBAC with DC2 which While I laboured beautifully according to the consultant at my last appointment for this pregnancy it did end up in a 3b tear. I healed better from the c-section than the tear, but emotionally I was much stronger after the VBAC.

I went to my consultant convinced I wanted an ELCS but she said it wasn't medically indicated, at which point I burst into tears and now I don't know what to do...

I am 26 weeks and this time round I feel a lot more pressure when I go to the loo, but not desparate before I go if you see what I mean.

The CS is much more of a known quantity which I am erring towards at the moment.

[georgie22]

Thanks to everyone for sharing your experiences. TwoTears - I can see why you burst into tears at your OPA. I keep remembering the recovery from my tear last time and how I felt that my body was never going to be as it was. It's not how it was but I've healed better than I ever thought I would. I had a really tough time post natally and think I was verging on PND. Just think I'd prefer the 'known quantity' of a section (and I say that being fully aware of the risks).