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Have pretty much decided on an ELCS after 3rd degree tear 1st time around. Tips for a positive experience please?!

(22 Posts)
eastegg Wed 22-Jun-11 15:54:50

I'm 25 weeks with DC2. Had 3rd degree (b) tear with DC1 2 and a bit years ago, have pushed to speak to a consultant about mode of delivery this time around as I was umming and ahing. I have some symptoms of faecal urgency and things just not being as well contained down there as before.

Have seen consultant obs today and basically been recommended to have an ELCS. She said that any subsequent vaginal delivery carries a risk of future worsening of my symptoms, especially as I get older. And that if I were to tear again it could be pretty bad. I felt fairly positive about Csections anyway so I think that's that, although the news is still sinking in.

I've included all the above info because there tend to be a few threads about these issues knocking around and what I've been told might be useful to someone. A lot of the threads talk about the risk of a bad tear happening again, but the real thrust of what I've been advised today is that even if that doesn't happen, there is a risk of my currently fairly minor symptoms getting worse just through a run of the mill VB.

Anyway, my actual question is, who's got positive CS stories or tips to help me get over this nagging feeling that I'm going to miss out on laying ghosts to rest by having that great VB I might have had?

icravecheese Wed 22-Jun-11 17:25:40

Hi Eastegg, I've no experiences of CS, but just wanted to say that I think you're doing the right thing... I had a 3c tear with my DC1, then went on to have a natural vaginal birth with DC2 20months later - nobody even mentioned possibility of a CS 2nd time round. I suffered a 3a tear with her.

I'm now 23wks preg with DC3 & I have pushed and pushed to see consultant / have investigative work (an 'endoanal' scan, sounds delightful, not had it yet!) to see how bad the scar tissue is in my bottom area. If I hadn't mentioned to my midwife at booking, I think they would have just let me go on to have another vaginal birth (and, most likely, another tear - apparently my second tear was along the old scar tissue, so I believe highly likely it'll happen again).

I totally appreciate that you feel you could be missing out on a wonderful VB experience... however (and these were my husbands exact arguments when I raised my feelings about not having a VB 3rd time round!) you won't be thinking it was so wonderful years down the line when you have to wear tena lady or worse, & have to locate the nearest toilet just in case of emergencies whenever you go out anywhere! I really think CS is the best decision when you already have continence issues down below.

Good luck, am sure some other ladies will be along soon with lots of positive CS hints & tips!

alliwant Wed 22-Jun-11 19:52:23

I had a 3a with my first and had a long recovery with piles, anal fissure etc that lasted 8 months. I still have the odd leak blush.... My second baby was a C section and so will this one (due in 6 weeks, my last baby).

The C section was calm, I felt in control and more importantly the area that is healing is no where near your bum! I had a little infection at the end of the scar and yes the healing took time but believe me it was so much easier than the tear.

For me it was the best decision, I asked the consultant if they would be prepared to risk their continence in their later years and I was quickly given the approval to go ahead. I also felt that if I tried to deliver naturally I would be too terrified to push and end up giving myself more issues due to not being relaxed and going with the flow.

Its very personal, but go with your gut instinct. Good luck x

RingEir Wed 22-Jun-11 20:42:46

Sorry to butt in on this thread, but can I ask everyone who tore, what position did you give birth in? And whether you think this was significant?


PrincessScrumpy Wed 22-Jun-11 21:12:28

Can I join - I'm 26pg with twins and having a cs this time after bad tear with dd1.

RingEir I was on my knees leaning up against the headboard-type bit if you know what I mean. I had 15 minutes of gas and air and no other pain relief. DD arrived 2 hours 5 minutes after my waters broke with only 1 hour of contractions that started with 3 in 10 minutes with no gradual build-up, just full on. I believe dd's speed was one of the major factors as she came out in one go (mw said one push and we'll have a head - I push and dd went flumph onto the bed without being caught), but I also believe that I wasn't mentally ready. MW told me I had at least 12 hours to go as I was only in the early stages etc - dh requested a second opinion from a senior member of staff (mw was senior so she got the registrar). The registrar arrived quickly and discovered I was 10cm, 20 mins later dd was in my arms. I "only" had 2nd degree tear but dd tore down the sides and had 32-37 stitches. Took 10 months to recover so 6 weeks sounds fab. I'm not unrealistic but I feel very happy with my decision.

Hope you have a good experience Eastegg

GibberingGinger Wed 22-Jun-11 21:14:46

I had a planned section after having a 3rd degree tear first time round. The section was wonderful. Both DH and I agreed that it was much less stressful than the first time, and for me it was a much easier recovery. I was actually given an ELCS as this time it was twins, and twin one was breech, so I never had to "argue" for one, but had it been just one baby, I would have begged my consultant for a c-section.

For those nervous of birth do not read the following....
RingEir, I was induced, and although dialated well, DD just wouldn't budge, after various examinations they decided she was actually looking over her shoulder. She then started getting distressed so I was rushed to theatre for keilland/rotational forceps. Despite the episiotomy, DD cuaght her shoulder on the way out, tearing the cut up into my anus. The surgeon did a great job and apparently I've been stitched up really well, but I so do not want to ever experience that again.

branstonsandcheese Wed 22-Jun-11 21:18:35

I had a really lovely ELCS with DC3. It was a 'natural' cs where they did it quite slowly and DC3 was 'born' onto my chest so I could skin to skin right away. They also dropped the screen so I could see him coming out, it was amazing.

I felt a bit... wistful about there being no chance of a 'healing' vag birth after a very very traumatic first delivery of DC1 (DC2 EMCS and I suspect that was because I was too scared for labour to progress, seriously), but was over that as soon as DC3 was born.

Was easiest recovery too.

For me, what sealed it was - I'm young(ish), the traumatic birth was 10 years ago and issues are still arising associated with it (not saying this is true for all of course). Of course CS has its own risks but I didn't want to make things worse in um that area. My pelvic floor had paid its dues, you know?

Bumbellina Wed 22-Jun-11 21:33:29

I had a traumatic first delivery along the same lines with a broken cocix and all after an induction as i was overdue. When DD2 didn't fancy turning up either within two weeks of due date, I had a massive fight to get an ELCS. Really happy I pursuaded them and fought for it. The CS was a wonderfully calm, positive experience which all three of us were happy with. So much much better than the first time delivering! In itself that was a healing experience as I now have at least one positive birthing experience.
The healing after CS was a piece of cake compared to the first. I also strongly believe that as the birth was less traumatic for DD2 she was much easier to deal with in the early weeks.

alliwant Wed 22-Jun-11 22:12:33

ringeir I pushed for 4 hours so was close to an emergency C I think. I tried every position in the book but at the end I was in stirrups and the midwife said " what do you think is stopping you really trying?" angry I was so bloody mad I pushed even though my contractions were slowing down (internal bleeding) and tore. I was bleeding behind him and when he came out so did a whole lot of blood. Cue surgery, complete exhaustion and to be honest trauma and shock. Like gibberingginger said I just don't want to go through that again.

alliwant Wed 22-Jun-11 22:14:05

bumbelina I also found that my second child (ELCS) was much more chilled and fed easily. He was just a calmer happier baby. Was it due to a relaxed birth? I'll never know I guess.

mrshotrod Thu 23-Jun-11 01:30:09

I had a forth degree tear (My GP didn't even know it went up to 4!!) It does!
Labour and birth went really well up to then I'd though. Was leaning over the bed head so sort of kneeling up when he came out. Just had biggest two pushes though, and I swear no one told me to hold it or pant etc. Violently sick, reckon this was when I tore. Had to be fixed up under a general Anesthetic due to back complications. Not risking it this time. c section booked for five days time. So hard when you don't have a crystal ball. It could all be fine 2nd time round, but the risk of not healing again so well next thanks! Good luck to others in same position. (Men get off so bloody lightly!!!)

BagofHolly Thu 23-Jun-11 07:27:44

I've never given birth VB and have had 2 very calm, lovely, positive, fast, painfree c sections. I wouldn't change that for the world. In ELCS the burden of risk is on the mother, and given how hard I'd fought to get, and to stay pregnant, that suited me. I was nervous before each one but never scared. I had the same surgeon, and he did a v neat job, and was totally unruffled throughout. V best of luck.

emoo777 Thu 23-Jun-11 09:12:53

Thanks so much for this thread! I wanted to post almost exactly the same story as the first and am trying to make up my mind. The difference for me with my 3b tear is that recovery was quite good (I allegedly was stitched up well). However, due to a back-to-back labour was in labour for 3 1/2 days (from the contractions being 5 mins apart) and had had 3 1/2 nights without sleep by the time I actually gave birth. This baby is back to back too so far (am 31 weeks). The closer I get to labour, the more I am aware of the trauma of the first time (although I have to say baby was never in danger and I was lucky in that). I have to say that if I had had any of the long term incontinence problems mentioned here, the choice of ELCS would be so clear. I am just worried I am considering it for the wrong reasons - to escape the trauma of the first time in terms of exhaustion rather than for long-term damage which is why I am actually offered one.

I felt cheated last time as I had a natural (+gas&air) birth then needed a spinal anyway afterwards. If its going that way, I would like the pain relief from the start this time!

So lovely to hear so many positive ELCS stories.

eastegg Thu 23-Jun-11 09:13:48

Thanks everybody so far. Got to dash off to work but Ringeir it was nothing to do with position for me, was because of an instrumental birth which necessitated an episiotomy which extended. I've been given a patient info leaflet about bad tears - basically they can't be predicted, but risk factors include instrumental delivery, having to be induced, a long 2nd stage (I was 5 hours from fully dilated to birth), a big baby, shoulder distocia. I also hear acecdotally that having a very quick birth can cause tearing, although not necessarily I don't think bad tears, because gradual stretching is better although more agonising at the time!

princessscrumpy we were both on a September thread although I haven't been on for ages. Good luck with the twins.

icrave cheese I remember you from another thread. I think you must push (excuse the pun) for a CS if that's your feeling. They've talked to me about endoanal scanning but Dr wasn't sure whether could do it now I'm 25 weeks gone and in any event they're advising CS. They're going to get back to me after speaking to the relevant gynae person. I think I'm going to be adviseed to have it after this birth. A big factor with me is the fact I'm having some symptoms; consultant said that for women with bad tears but no symptoms at all they let them try VB if that's what they want. But even they, as far as I can tell from the RCOG guidelines, should be offered CS. Good luck. I wouldn't get too bogged down in the endoanal scanning; if you're scared for your future continence and you want a CS, go for it.

icravecheese Thu 23-Jun-11 10:17:09

Hi eastegg.... thats interesting re not sure about whether its possible to do endoanal scan now you're 25wks - I was meant to have mine before 20wks, but took forever for appt to come thru & then had to reschedule because we're on hols, so I'm not booked in to have it til i'm 26 wks.... I didnt think to ask secretary at hospital whether it'd be ok to have one at 26wks (although I did wonder whether it was 'safe' that far pregnant). Will now ring dept to check before hand... thanks for heads up. But you're right - I basically want CS (regardless of outcome of endoanal scan) & now need to push for it with consultant... think she should be ok with agreeing to it (I hope!). GOod luck with the rest of your preg & CS.

RingEir Thu 23-Jun-11 10:24:37

Thanks so much for sharing your stories. Some of them are a bit scary, but I think it's better to be really well informed about what can actually happen. I am pregnant with my first and live in Spain. My hospital only allows women to give birth flat on their back with legs in stirrups and the more I read, the more I worry about how ineffective this position is and how it is much more likely to result in induced birth, forceps delivery, tearing etc.

To Eastegg, PrincessScrumpy, and all of you who are planning an ELCS after a traumatic experience, I think you are absolutely dead right. I hope everything goes well for you. Thanks again for the informative posts

icravecheese Thu 23-Jun-11 10:34:08

RingEir - dont worry too much about position to give birth in, both my preg's so far I pushed on all fours (leaning against head of bed like some ladies have described above) to absolutely NO AVAIL!! We were told at our NCT classes that pushing on all fours was THE way to give birth as you had gravity helping....appears not for me!!

After 2 hours pushing on all fours for first babe, I was told to lie on my back to push... ended up with stirrups, episiotomy & forceps & 3c tear (but still got that gorgeous, post birth high & look back on my long labour with very fond memories, even if it does sound a little traumatic when written down!).

With my 2nd labour, I pushed for 20mins on all fours, again, to no avail. Laid on my back to push, baby daughter arrived within 10mins!

I think it can depend on your pelvis etc, but I certainly found pushing on my back was much easier than pushing on all fours, & got my baby girl out nice & quickly. Good luck for labour, it'll be a wonderful experience whatever!!

RingEir Thu 23-Jun-11 23:47:37

Thanks, Icravecheese, very reassuring words!

PenguinArmy Fri 24-Jun-11 06:39:39

Glad you started this

I had a third degree after a 3day plus labour, back to back, 3 hour pushing (was sitting upright on bed, tired other positions and was too tired to stand). No GnA as it induced a asthma attack the day before. Anyway it didn't feel traumatic at all and I felt in control. I felt I healed well, never had any problems with that but then again I don't have a comparison. Like someone else said I felt cheated to have done it with no pain relief and then need a spinal. I did go from 4-10 in a couple of hours after my broke my waters (but had been at 4cm for over a day) I wonder because the pushing stage had been quite long the MW wanted to get the baby out so pushed it a little bit.

Am currently 23+5 and want a ELCS as my PFs awful, I really tried to get back into running but just couldn't because of it. Have IBS anyway so don't about sense of urgency as had that anyway, but do have gas control issues. My problem is that I don't arrive in the UK until I'm 30 weeks and then we need to find somwhere to live. The stress of not knowing whether I can have one or not is quite unsettling. Plus I am the kind of person that downplays stuff as I know it can be worse. I am not afraid of VB at all but just can't deal with the idea that things could be worse as it does affect everyday things. Things have also got worse with pg and now have to wear pads everyday as it is.

Sorry not helping OP at all

eastegg Fri 24-Jun-11 14:32:57

Don't worry penguinarmy I sort of intended the thread to be about sharing similar stories anyway.

So sorry you're having this worry. I know everyone's situation is different but from what I've been told if you've got enough of a problem with continence to be wearing pads you should be able to have an ELCS. I don't know anything about the other side of your problem i.e. that you're not going to be in the country until 30 weeks. 30 weeks still leaves plenty of time to have an ELCS agreed but it's the worry until then isn't it? If you know which area you're moving to could you get the number of the likely hospital and start with a phone call? Meanwhile try to relax because I do think you'll get an ELCS. Just make sure you don't downplay anything when it comes to it! My symptoms are relatively subtle but I was careful to get them across accurately without exaggerating.

emoo777 Sat 25-Jun-11 12:09:56

penguinarmy - I spoke to my midwife about timing as I want to make a late decision (based on baby's position - if back to back I am inclined towards elecs). She said, off the record, you can change your mind at one day's notice if you want so I am sure you have plenty of time.

For those going for VB, I meant to say that I met a lady (an ex banker!) who specialises in hypnobirthing and she said perineal massage the month before can make a massive difference to how easily you tear. She had a massive baby and got away with grazes.

jojosmaman Sat 25-Jun-11 20:49:53

I have had a crash section and then an elcs and have to say my elcs was a bloody doddle!

After my first section I did feel like I'd missed out on that right of passage and if I'm honest didn't bond immediately with my ds. However after a few years I got over the feeling of failure and when number 2 pregnancy came round I was sure I wanted a cs so I could be in control and be awake for my dd's birth. It was the best decision I made, surgery was fine, dare I say it enjoyable and within half an hour of her being delivered I was breast feeding in recovery.

Yes it would be nice to say I had an amazing water/ home/ natural/ quick birth but I am able to say I had a pleasurable birth experience and don't regret it one bit smile

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