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ELCS vs Vaginal Delivery after 3 degree tear?

(19 Posts)
locomomma Sat 26-Mar-16 23:20:51

Hi ladies,

I'm sure I'm boring my friends and family and members of this board and I'm finding it very stressful trying to figure out best option for me. Please forgive this long 'outer monologue'!

So DC1 was a small baby and arrived on due date. Pretty tough labour with episiotomy, ventouse and retained placenta. DC2 was 15 days late and weighed 9lb3. I was induced but found the labour very positive, only 2.5 hours, managed on my hypnobirthing and gas and air etc. I did have a 3rd degree tear involving sphincter and had to go to surgery for fairly considerable stitching. Recovery really wasn't too bad and up until about 20 weeks into this pregnancy I've had no symptoms of incontinence. As this baby has been growing, I've found myself in a few emergency situations involving a breach of the back passage(!!!) and that has terrified me. I've also ready plenty of grim stories on this website from people who've had bad tears.

I've seen the perineal clinic and they've said I have a 10% chance of a repeat tear in this delivery and that there's no way of anyone saying what the impact of that would be on my short, medium and long term pelvic floor health. The only way to avoid a repeat injury with total certainty is to have a c-section.

I've also spoken to the midwives about an early induction to avoid a big baby. While they're on board with it in principal, they will only induce me if my cervix is favourable so I really don't know how this will help me if baby decides to stay put like last time and I foresee a stressful negotiation with midwives as due date approaches.

I guess the final option is to take the normal 'wait and see' approach.

In general, I think the hospital feels it would be disproportionate to have a section, that it's not really necessary and the midwife did make some mention of 'mental health' grounds which wasn't very helpful. I know I'll get one if I really want to and perineal consultant is supportive. So I am very tempted to have a c-section. The main negatives in my mind are temporary (being sore for a while, having to stay in hospital longer, not being able to pick up baby for first feeds, not being as well able to play with my other kids etc).

But I fluctuate. There's a 90% chance that I would be putting myself through unnecessary surgery and all the inconvenience that goes with it. I think I am very sensitive to making the wrong decision. The idea that the hospital thinks it's probably not necessary is bugging me. I don't like to make a fuss or swim against the tide.

I would love to hear from people who had natural deliveries after 3rd degree tear to hear what the outcome was.

Has anyone felt that they must be wrong in wanting a c-section when medical opinion and research says I probably don't need one. Thing is, it's my bum and my life and I'm not a statistic. That 10% is so scary to me. Then the little voice creeps in and says 'come on, you'll be fine .... you don't want a section, that's major surgery ... get on with it and stop making a fuss'.

Thanks so much if you've read this far! All advice welcome!

slightlyinsane Sun 27-Mar-16 00:19:01

My first was a third degree with a lengthy recovery.
My next 3 pregnancies were all second degrees. I have a very weak pelvic floor with stress incontinence, probably more to do with number of babies (5).
Personally I think that 10% figure you've been told is rubbish and the actual number is much higher. I was told there was next to no chance of me tearing again, ha! They got that wrong.
I think you need to look at long term outcome rather than the recovery time for the first few weeks. Ask about the long term risks if you had a section v's the long term risks of tearing again.
Not that I'm having any more but there's no way I'd have a natural birth again.

stairway Sun 27-Mar-16 00:22:36

I'd take the section. Surely nothing is worth risking fecal incontinence for.
You might not even find an elec recovery all that bad anyway.

Cakescakescakes Sun 27-Mar-16 00:29:01

I had an relatively easy normal delivery second time round after a horrific first birth (induced, hyper stimulated contractions,inadequate pain relief, back to cal baby, 3rd degree tear, surgical repair, blah blah blah etc). They did a pre emptive episiotomy second time as my scar tissue was looking like it would tear again. But this was stitched easily in the labour suite and I was up and about straight afterwards.
I dithered for ages about a section and in the end I'm glad I went for a normal delivery. But it was all very carefully negotiated about what they would do during delivery etc to prevent a repeat of first time.

Cakescakescakes Sun 27-Mar-16 00:31:07

But yes think long term. My tear healed really well so I had no long term symptoms which helped me decide to go for normal delivery second time. If I'd been having issues I'd have gone for a section.

pinguina16 Sun 27-Mar-16 15:15:33

I'd take the csection.
In the situation you're in a vaginal delivery could make things worse.

2 friends suffered severe tears. One had no symptoms and made a full recovery. She had a vaginal birth for second. Other friend suffered faecal incontinence and is now urinary incontinent. She went for csection for DC 2 and 3.

Personally I was faecal incontinent. I'm continent now but with a prolapse (so can't run/jump). I've decided I don't want anymore children.

Hope they're lining up physio sessions after delivery (whatever mode of delivery).
All the best.

Nicknamegrief Sun 27-Mar-16 15:30:07

I have had 1 EMCS, then a VBAC (with 3rd degree tear), then another EMCS and last one was a ELCS.
I felt better quicker following my VBAC- despite the tear but didn't have any continence problems in the following pregnancies. The ELCS was fine and it meant I could plan my recovery. I am currently pregnant again and my body is feeling the strain! I will be asking for physio afterwards and plan on never doing this again.
I had a friend who had a 3rd degree tear with her first, 4th degree tear with her 2nd. Had further surgery a year post birth to sort everything out then when she got pregnant with her 3rd had an ELCS however the pregnancy did the damage that time and she has needed to go and have further surgery to sort out the problems despite an ELCS.
My SIL had a 3rd degree tear with her first, no other problems with her other births (3) and seems a lot better recovered than me!
It's a judgement call in my opinion. You can only do what is best for you and your body.

Bumpylady Mon 28-Mar-16 14:05:58

I had a 3c tear and am booked in for an elcs. No way on earth would I risk a repeat tear and possible life long double incontinence.

Mishaps Mon 28-Mar-16 14:11:22

Third degree tear with first baby - then two further deliveries with just small tear or episiotomy.

ApocalypseNowt Mon 28-Mar-16 14:12:11

Can i just mention OP that after my ELCS I could hold my baby for first feeds (I held her as soon as i was out of theatre)! They recommend not picking up anything heavier than your baby to start with so you'll need help with other dc but holding your baby will be fine!

Also I was out of hospital within 48 hours after my EMCS and within 24 hours after my ELCS - if everything is straight forward there's no reason why you'd be kept in hospital for a longer time.

In your position i'd go for a c-section.

caroldecker Mon 28-Mar-16 14:36:01

c-section without a doubt

locomomma Mon 28-Mar-16 14:36:17

Thanks everyone- so helpful to put thoughts down and hear from others. Very good point from slightlyinsane about long term risks of CS vs long term risks of tearing. Most of the downside attached to sections seem related to subsequent deliveries eg uterine rupture, I am definitely on my last baby so that doesn't apply. Even in a very anti-CS article I found, there was a piece about how mums who have sections definitely suffer less with incontinence vs vaginal delivery. I think I'm fairly sure about this now.

hazeyjane Mon 28-Mar-16 14:43:33

Personally, after a 3rd degree tear and a second degree tear, followed by an ELCS - i would rather have the tears, but I realise i am unusual in this!!

locomomma Mon 28-Mar-16 15:15:40

Thanks Hazeyjane ... Please share reasons! Was it elective because you'd had tears? Was recovery awful? I'd love to know.

NancyDroop Mon 28-Mar-16 15:24:35

I had a 3B tear and have been recommended an ELCS due to the risk of long term problems in the case of more tearing.

Have you spoken to an obstetrician? The first midwife I spoke to suggested vaginal delivery, but I've been seeing the obstetricians for an unrelated reason (I have unusual blood) and they have all suggested ELCS. I have a letter of recommendation for this from the consultant obstetrician obtained from a perineal review 9 months after previous birth.

Coldest Mon 04-Apr-16 17:25:06

Locomomma I had an EMCS with my first. The first year was quite tough recovery wise but I have had no long lasting problems. Am planning for a VBAC but all the stories of the tears are making me whimper.

A section can be good and predictable if it's elective u can plan things accordingly.

locomomma Mon 04-Apr-16 20:58:40

Thanks everyone. Found some interesting statistics which I'll post links for later. But a BJOG article from 2014 cites that 24% of women who have 3 or 4 degree tear have ELCS so the recurrence rates that are quoted exclude this group so not a true reflection of your chances of tearing again. I was also horrified to read in several articles that the likelihood of developing fecal incontinence after 3/4 degree tear is 30-50%!!!! That knocked me sideways. Nobody told me that. Honestly in my cynical moments I think lots of hospitals compete to have low CS rates to the detriment of genuine cases. I am now fully emotionally committed to CS & emailed the head midwife yesterday to inform her/request it. Be interesting to see if I have to fight hard.

Coldest Mon 04-Apr-16 22:26:14

Wow that's quite a shocking statistic about the incontinence. Hopefully they will listen to your concerns. But my experience with obstetrics sonfar has left me quite cynical. They have quite a low respect for women's bodies.

locomomma Mon 04-Apr-16 22:56:10

I know!! The good news is that the chance of tearing in the first place is really low so good luck with your vbac!

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