C-section or natural after a 3rd degree tear?

[lauradotp]

Help, please?
I'm 34wks now, and have been umm'ing and ah'ing over this for, well, since I found out I was pregnant again! I had a pretty rough time having my ds two yrs ago. Although it was fairly straightforward to start, once I was wheeled down to delivery things started to go a bit wrong. My waters were broken, which is when they discovered that ds was a mec' baby. He'd tied a knot in his cord, there was no time to get me knocked out for an emcs (I have a back problem, and they couldn't risk trying to get an epidural in) so it was a case of sitting up on the bed, grabbing hold of the backs of my knees and pushing. Thankfully, he suffered no ill effects after his very speedy entry into the world! I ended up in theatre for 2.5hrs though, getting a 'severe' third degree tear and an episiotomy mended and needed 4 bags of blood to top me up. The repair job was less than great, and I have been told that i'll need that tidied up...basically, skin was stretched over the tear and the epi' site and stitched the other side. Not only has it made things very uncomfortable (it's amazing that I managed to get pregnant again, seems that those extra 'oh go on, it's Christmas' glasses of red wine must've helped relax bits that the exercises and physio failed to) but it's also left an odd little hole that my Consultant would like to fix during the early stages of labour...
So, I'm facing being cut again and the possibility of tearing through/around scar tissue. I have asked about having a Section, but my Consultant seems to think that i'll be able to 'breathe' the baby out without any further damage - unfortunately, I'm less than convinced that this will be the case! I know that a Section is a fairly major op, but it took me a long time to recover last time and I can't help but wonder if opting for a controlled delivery by c section would be better than waiting to see what Mother Nature has in store for me. I'd be interested to know of anyone else's experiences, whether a second natural delivery was better or worse or how a Section and subsequent recovery fared in relation to healing from a tear. Thanks in advance!

[SweetSummerSweetPea]

I know that a Section is a fairly major op, but it took me a long time to recover last time and I can't help but wonder if opting for a controlled delivery by c section would be better than waiting to see what Mother Nature has in store for me

I am sure others wil have successful second delivery stories but for me, I had a small not stich tear after first and it was so painful! Apart from that other niggles etc...and issues around CB I had a section and it was scary for ten mins in theatre...but over all it was a JOY and a PLEASURE! I have warm and cosy feelings about the birth!

So I say section no question if you can have really excellent hands on help for at least two weeks pref three weeks...AND get a co sleeper cot of some sort.

Its not a risk I would take and to me - I far prefered inscion across lower tummy than one down below.

[onlychildinreality]

My friend had a 3rd degree tear with her first and opted for a planned section with her second and was adamant about it. She's found the recovery v tough though and I was surprised that she now says she wouldn't recommend women choose one lightly. Another friend had an unplanned c section with her first and spontaneous vaginal with her second, having been considering a planned section up until other medical issues made it unadvised. She says she's glad she didn't have a 2nd c section as recovery has been much easier this time around.

I think c-section recovery must be easier after a first baby, even if not elective, as you don't have an older child to worry about. That said, first labours are usually much longer / more exhausting which must also affect recovery if c section isn't planned.

[lauradotp]

Thank you, SweetPea! I have to admit, the more I read the more I'm leaning towards a Section. I know girls/women that have had them and said that they hurt and recovery takes weeks, but they've not had anything to compare them to. I could hardly walk for a fortnight after last time, and the thought of that whilst trying to look after a toddler? Nooooo! Luckily, my ds will be in nursery during the day and my dh will be off work for three weeks after the new arrival so, with my parents just ten mins down the road, I'm lucky enough to have a pretty good support network ready to jump into action!
I hadn't thought about a co sleeper cot - dh has already said that he'll have the moses basket on his side of the bed (bless) but I shall look into it, thanks for the tip.

[onlychildinreality]

Friends who used co-sleepers rave about them. I'll definitely be getting one if we have a second.
You'll definitely need help for around a month after the c-section, if my friends' experiences are anything to go by, but having your parents close is a real advantage.
I hope all goes well for you.

[lauradotp]

onlychild - thanks, also. I was on the ward with a woman that had a Section and has gone on to have a natural birth with just an episiotomy, and she said that was a lot easier than getting over the Section. Interesting to find out that someone with a 3rd degree tear would still rate recovery easier than a Section...seems I still have a lot of thinking to do (and not a lot of time). I was very lucky last time, I got to 10cms without the midwives even realising that I was in labour and, from ward to delivery, they had my labour down as lasting a little over an hour and twenty mins. It has been suggested that the quick labour and rushed delivery may have been to blame for the damage (oh, and the forceps), but the midwives and Consultants that I've spoken to are yet to suggest a way to slow labour this time to allow my bits n pieces to catch up with the exiting baby!

[Gruzinkerbell]

I had a 3rd degree tear with DC1 (also due to fast delivery - under 2hrs for me too!) and, although not as traumatic as yours, I lost a lot of blood and it took me a fair few weeks to recover and many months plus a gynae referral before it could have pain-free sex again.

I was adamant I wanted a natural birth second time after seeing how difficult the recovery was for friends having CS, and I'm so glad I did! I still had a 2nd degree tear, but it healed very quickly and I recovered from the birth so much faster than I did second time round. The birth was very quick (25 mins) but I was expecting it to be quite fast after last time so I wasn't panicking (unlike 1st time!) and I think the fact I was calm helped a lot. I also think that your body knows what to do second time too and I found I felt pretty much back to my old self (apart from wobbly tummy!) within just a few days.

[notoasthere]

I posted about this a few weeks back and there was about a 60/40 split leaning towards elcs. I'm choosing an elcs - the 1 in 4 chance of continence problems even with no tear was a big deciding factor, plus I still have some issues from my tear

[PlumpPartridge]

I was scared of having a natural birth after having a 3rd degree tear with my first, but they told me that I would be fine as I wasn't damaged enough!

As it turns out, I was fine. DS2 only gave me a 2nd degree tear

I have heard good arguments for natural (no surgery to recover from) and c-sections (you feel like you have more control and are more able to plan ahead, so psychologically it might be for the best).

[cloudywithachanceof]

I had a 2nd degree episiotomy in my 1st birth, stitched up by the Obs. It was the single most painful thing I remember going through in childbirth, imo, and I still shudder at the memory of getting cut down there. But the amazing thing is that I had 2 natural vaginal homebirths after that 1st bad birth experience, without painkillers, and ended up with no tears, no stitching, just a bit of bruising. I never thought that would be possible, but it happened twice, and maybe it would happen again if I had a 4th DC - if I should be so lucky. But I'd rather not bank on it, so not having another DC any more if I can help it, even though I'd love to have another. I have so many family and friends (non-UK) who had C-sections in private hospitals abroad, and their experiences were so positive, so I really don't think it's so bad as long as you don't keep having many C sections (I heard that more than 2 or 3 C sections in a woman's lifetime is not recommended). If you can get help from family after the C-section, etc. it might work out nicely for you. Like SweetSummerPea above said, I'd rather be cut on my lower tummy than down below.

[chipstick2810]

I also had a 3rd degree tear with my ds and quite a traumatic experience as we had shoulder dystocia which was quite scary. I had (and still not entirely fixed) some faecal urgency for afterwards though thankfully no incontinence. My consultant gave me a choice of having an elcs the second time around and really guided me down that route to avoid further issues with toilet urgency (plus I was quite traumatised by the birth experience if the same issues re-occurring).

Anyway, I was initially quite adamant that I wanted a natural birth with my second child to heal my experience the first time around, but eventually went with the elcs. I made peace with this before the birth and was happy that I hoped I would have a bit more of a happy experience. In the event, it was a good decision and such a lovely and exciting birth. I felt like I left the theatre as the same person mentally as I went in and fed my daughter immediately on being taken to the recovery room. I did not find the recovery any worse than that of a 3rd degree tear, though obviously very different. I didn't have any regrets or guilt this time around and ironically feel that I have healed the issues I felt after my sons birth. Should there (highly unlikely!) be a 3rd child I would not hesitate to opt for an elcs again.

I hope you come to a decision that you are happy with and have a lovely birth experience this time around whatever you choose. Good luck x

[lauradotp]

Gruzinkerbell - sounds like we had pretty similar experiences with our firsts! If this one only takes 25 mins though...I'd better pitch up a tent on the hospital grounds, as it takes about half an hour to get there!
Thanks to everyone for sharing your experiences though. I've seen two Consultants - my primary one says that i'll be fine (after being cut) and that this birth is likely to be easier. Her sidekick, however, is of the opinion that I stand a greater chance of tearing due to issues with scar tissue... hence the need to find out what sort of experiences others have had. She also raised the issue of incontinence later on, as I needed a couple of months of physio to sort things out last time - not a pleasant experience, and not one that I'd care to repeat.
So, looks like I have a bit more thinking to do! The thought of a vb doesn't bother me - the scary bit last time was because of my ds's situation, and the need to get him out quickly. I didn't have any pain relief though and it was all over pretty quickly, so not a bad experience really. It's just the thought of maybe going through the months of healing again that's got me a bit worried. I know that, like any surgery, sections don't come without their risks but I s'pose I just need to weigh up the pro's and con's of a cut in my tummy compared to the possibility of tearing again. Anyone have a crystal ball handy?...

[eurochick]

I had an unwanted but planned section three weeks ago (baby wasn't growing properly and so needed to be born early). I found the section itself and initial recovery awful (I reacted badly to the drugs so was shaking uncontrollably during the op and puking in recovery(pulling my stitches), and the spinal didn't take well so I regained sensation before the op was finished), but the recovery after that has been great. Apart from what I was given in theatre and recovery, I didn't take anything other than paracetamol and ibuprofen afterwards (mainly because I didn't know what had made me puke and I wasn't taking any chances of repeating that hideousness) and I was ok. I was up and showering about 8-9 hours after the op, and got the catheter out then. My baby was in NICU, so I was walking down to the unit (in another part of the hospital) about 16 hours after the birth. I was discharged after 40 hours. I got signed off to drive after 11 days and was walking about a mile without problems at that point. Three weeks on and I can't stand anything pressing on the scar and am still a bit tired, but otherwise feel physically fine.

So my experience has been mixed. I wouldn't rush to repeat it, but I don't have a VB to compare it to.

[makesomenoise]

I had a 3rd deg tear with dd1 and a planned section due to this with dd2.

At a consultants appointment around 28 wks we went through options and risks of tearing again similar or worse. I felt that a planned section was the better option. I don't regret it for a second. I hadn't realised until the section date was in the diary how much I had been dreading another difficult birth and the side effects.

The elective section was brilliant - scheduled for a Monday morning - we dropped our older dd at nursery and went in. Dd2 born mid morning - breast feeding established far quicker than dd 1 (when I'd been in theatre for 2 hrs after she was born) and dd1 able to visit later that day.

Felt so much better recovery wise than first time round. Just had to be careful with dd1 and not carrying her.

There is a section in the NICE guidelines about subsequent births after tears and I found this really useful to clarify my feelings and to firm up my decision.

Good luck!!

[lauradotp]

Chipstick - i had to have words with myself on a few occasions after having my son, as i couldn't quite shift the "what if's" feelings. I know that there was nothing i could've done differently to make his entrance into the world a bit easier, besides insisting on the Section that my orthopaedic surgeon told me I'd need when i was 15...as 20+ years had elapsed though, he had long since retired so was no longer around to help fight my corner! So i followed the advice of my Consultant, went for the vb and, yeah. Not the best decision I've ever made. So maybe this time, there is a part of me that is scared of putting baby no 2 through the same thing - if this one gets stuck, even without the knotted cord issues, i know that i'll be kicking myself for not learning my lesson! Also, I'm not sure my parents could cope with the shock of walking in to find my dh with baby, and me nowhere to be seen, again!

[onlychildinreality]

The last poster made me think. I got faecel incontinence after a forceps / episiotomy birth and very long back-to-back labour with extended pushing of a badly positioned baby. The incontinence was probably a result of them all combined but was as much due to the duration of labour and pushing, as much as the episiotomy in my view. I still have a much weaker pelvic floor than pre-baby but the main lasting effect is less satisfying sex: less sensitivity and weaker climaxes. Anyone else had that?

[NovemberAli]

I had a 3a degree tear after DC1 but was repaired really well in surgery and didn't take too long to recover, although the trauma of that first bowel movement!!

I discussed VB v CS with the consultant but they said it had healed so well and I had had no further complications there was no reason to not go for a VB.

Unfortunately had another 3a tear (along scar of 1st one) I think chiefly due to a quick 2nd stage and DC2s head circumference being on the 95th centile, ouch! Again repaired well in surgery but I do now have trouble holding in wind - flatal incontinence as the consultant puts it, oh the glamour! I guess it's a question of risk/benefit to you, the consultant told me that if we went for a DC3 (unlikely!) I would have to balance a CS against possible increase in incontinence with a VB.

[onlychildinreality]

I meant chipstick's first post!

[lauradotp]

Right, i think I'm gonna have to toughen up and tell my Consultant that I'm gonna go for the elcs (I'm about a foot taller than she is, so i should be able to pull it off...).
Eurochick - on the offchance, I've ordered a Caesarian belt from Mothercare, i don't know if that's something that may help you? It's a bit like a reverse bumbag, you put a cushion in it and it comes with a hard plastic insert then that helps to stop things pressing on the wound. Also has an insert that can be chilled or warmed to help with swelling or muscle aches, which i thought sounded like it may be useful.
Makesomenoise - that's pretty much the scenario that I'd like to hope for, so i'll have a read of the NICE stuff and go in to see my Consultant with guns blazing, if i have to!

[makesomenoise]

I was really quite surprised at how supportive the consultant was about an elec section. I knew I could request one due to NICE. Guidelines but I didn't need to go there - he said that the chance of tearing again was fairly similar to first but the likelihood if I did tear would be that it would be worse. Didn't fancy that at all! I'm 2 yrs on now and my c sect scar is tiny - barely noticeable at all. Good luck!

[skitter]

I'm only 16 weeks pregnant with my 2nd, so no experience of a 2nd delivery to share, but I had a third degree tear with ds about 4 years ago, repaired immediately in theatre. I recovered very well, but had some flatul incontinence for the first month. I had various tests about 6 months after the birth (they did them am standard at my hospital for anyone with a third degree tear) and while I had no symptoms or problems with incontinence at all, the tests showed my sphincter pressure resistence was weaker than normal and as a result the consultant said they'd recommend a caesarean for future deliveries, but it was up to me. He said the issue was not just tearing again but that another vaginal birth even without tearing may result in faecal incontinence because my sphincter muscles were already compromised. I am planning to have a caesarean this time as I'm really not comfortable with risking the incontinence in my case and have some residual fear of my ability to push a baby out easily after last time!

[lauradotp]

Just in case anyone else looks at this thread whilst weighing up their options, I ended up being induced at 37wks. Although labour was a lot more painful (I ended up with the drip to get me going), it was a lot slower than last time and I only had an episiotomy - no tear at all - result! However, whether the minimal damage was due to the slower labour (three hours, still quite quickly but a lot slower than with DS) or the fact that DD was over 2lb lighter than her big brother, I don't know. The midwives put it down to the timing, but I know DD's head and shoulders were a heck of a lot smaller than her brother's!
So, a pretty good result in the end but, had my consultant been more open to it, I would've probably gone for the Section. I spent two days in hospital worrying over the birth and, until labour kicked in and I just had to get on with it, I spent most of the third day going over it in my head too - possibly not the best frame of mind to be in whilst being wheeled down to the delivery room. A Section, although carrying its own risks, would've spared me the worry of wondering how my bits n pieces were going to fare, that's for sure. Still, a good result and I can rest easy in the knowledge that I won't be going through it again!

[iamstegosaurus]

I had an elc after a 3rd degree tear, this was advised by my consultant after a perineal scan? not sure if that's the correct name, it's basically a probe up your back passage that does a 360°scan so they can assess the extent of previous damage. sounds worse than it is sorry if tmi.

All the midwives doc's etc were that I wasn't already suffering any incontinence as my scaring was very severe. I was relieved tbh as had been dreading the birth and I found recovery from the section much easier.

[Chalalala]

I think it's called an "endoanal" scan? as someone said upthread, it examines how well the sphincters healed, which can't always be assessed by looking at your symptoms only.

I had a 3c tear with my first (not sure if the level of the 3rd degree tear makes a huge difference), and my midwife just referred me to someone to "talk about my birth options". I'm open-minded about which way I'll go, but I am dead set on requesting an endoanal scan. I want to have all the information possible about my personal circumstances before I make a decision.

[divingoffthebalcony]

Hi Chalala. It makes sense to be fully informed before making a decision. I'm pregnant with my second child (after a 3b tear with the first) and I'm dead set on a section, for psychological reasons as much as physical.

You might want to have a look at this:

www.rcog.org.uk/globalassets/documents/guidelines/gtg2911022011.pdf

Points 11 and 12 discuss recovery and future deliveries. The key thing for me is that even a perfect vaginal delivery, with no tears, apparently brings with it a risk of faecal incontinence in the future.

Not trying to sway you one way or another, obviously, but I found that information quite startling.

[Chalalala]

Thanks divingoffthebalcony, I'm actually thinking of printing this off and bringing it with me to the appointment! I'm a bit paranoid about them not taking me seriously, because I had a bad experience with a dismissive midwife at my afterthoughts session. (she was very nice but clearly had no idea about the potential long-term consequences of bad tears, and seemed to think I was just imagining things when I brought it up!)

The key thing for me is that even a perfect vaginal delivery, with no tears, apparently brings with it a risk of faecal incontinence in the future.

sorry for being a bit thick, but could you point me out to the exact place where this is discussed? I'm not seeing it in points 11 and 12... is it one of the papers they're referring to?