C-section after tearing with 1st?

[Tori27]

I have tried to research this but I can't find anyone who has a matching experience.

My first daughter came very quickly - I went from 0cm to 10cm in an hour and a half and she was in my arms after 20 minutes of pushing. She came out in one go (no head then final push, she just flopped onto the bed as the midwife didn't catch her!). This meant she didn't turn and so tore me badly internally (either side rather than back to front, but some to the perineum). I think it was written as 3rd/4th degree.

All the advice I find is exactly what I did - on all fours, no pain relief and following instructions on pushing etc. Plus she was only 6lb 14oz, so not huge.

The only reason I didn't go to theatre for stitching is because my GP happens to be highly qualified in stitching and did it. I think he did a good job, but I was a mess and now have lots of scar tissue - took almost a year to have proper sex.

I am now broody and would love a second baby (my first is almost 3, but it's taken this long to even consider it). I am terrified, not of the birth as that was fine, but of the state I'll be left in. It got me really down. Can I have a c-section? Has anyone else gone this route? I know it is not an easy option, but the last experience was pretty traumatic. Any advice is welcome, please.

Sorry for the essay. x

Hi Tori27.

I'm so sorry you had a traumatic first birth. Sounds like you progressed very quickly indeed - must have been quite frightening for you.

I think it is very likely you will be able to have a c-section on the NHS if you decide that is what you want, explain your reasons and stand firm. You'll need to get your GP to refer you to a Consultant at the hospital - or your midwife can do so - and usually you'd have an initial appointment with them where you can put your case to them. I really cannot see any reason why a doctor wouldn't allow an elective in your case, and even if you get a rogue doc who doesn't agree, you are entitled to ask for a different, more supportive doctor at the same hospital if you want to (I had different circumstances to you - I was pushing fro a VBAC - but saw two doctors I wasn't happy with until finally finding a supportive third doctor!).

Can I just ask, have you had a chance to talk about your birth with anyone? Debrief it with the midwife etc? It sounds like the speed of your first labour was 'just one of those things' - unavoidablly quick - but it might help your emotional healing (sorry for hippy dippy phraseology, but stri=uggling with tiredness and lack of vocab tonight!) if you were at least offered some ideas as to why you might have torn so badly and what if anything could be done to minimise the risk of it happening again.

Anecdotally, I have two friends with very similar stories to yours, one of whom opted for a c-section second time around which worked out very well, and the other who opted for another vaginal birth, which was again extremely quick, but not at all traumatic, no tearing - just a graze (and she had a very bad third degree tear first time). She went on to have a third baby at home, vaginally, with no tearing, either (again, extremely quick birth). Neither of them every really knew why they tore so badly with their first, either. They both 'did all the right things'.

Good luck whatever you decide to do x

Hi Tori, I recently had a baby with bad tearing due to forceps episiotomy and DD coming out with an arm up. I'm not thinking about another baby (its too soon) as such but I do think about the future and consequences of next pregnancy and there is a lot of fear - which I hope will diminish in time.

Anyway, whilst I am still recovering from this birth I am very interested in what happens next. There seem to be a lot of threads about this on here and on netmums. The general consensus is that there is no definitive answer and it would depend on your consultant. I believe that the reason for C section after 3rd degrees is is due to incontinence issues - or how much you are affected by the tearing. There is no reason to assume it would happen again and your body has the stretch memory. On the other hand - it could happen again. Have you read this?

www.rcog.org.uk/womens-health/clinical-guidance/third-or-fourth-degree-tear-during-childbirth

Faaamily - that is a very useful post and just shows that you cannot predict. And also I agree that Tori, you will probably feel better if you can have a debrief.

It's such a difficult decision but perhaps it helps to know that because of what happened, if you did want the ECS, you would probably get it.

Thank you.

I had a debrief, but my notes jump from first signs of labour to the birth so weren't helpful. The midwife was telling me I had a low pain threshold and that I had about 12 hours to go and the pain would get a lot worse. Hubby was also shoved in the corner and kept away which I hated.

The registra had a massive go at the midwife when he realised how far I'd gone as I had wanted an epidural and she had refused to get the registra or call my GP who is a village GP and comes to births (his wife was a midwife and it's his specialty). It's the only time my VERY calm hubby has yelled in front of me when he told the midwife to call our GP or give him a phone. She went off shift as the pushing stated and was very surprised I was 10cm (turns out I have a high pain threshold as I didn't notice contractions until 3 in 10 mins!). The new midwife was lovely. But that's why I had the debrief - notes weren't helpful though.

There is a thread in this childbirth section of those of us who have opted for an elective section following a previous traumatic birth, you might find it useful to skim through.

The main issue to consider (that I found many mw's didn't mention) is your longterm continence. If you already have weakness in the pelvic floor and damage to the muscles there it is really important to consider how another vb will affect you. There are some scans that can be done to assess the strength of the muscles. Pregnancy itself will put more pressure on your pelvic floor and some people who have had bad tears are advised to choose an elcs to protect the pelvic floor from another huge stretch during the vb and to protect from another tear.

You might have a fantastic vb with no tearing, or you might tear again. I had a lot of bladder problems after my first forceps birth and chose an elcs partly for my longterm continence. I was concerned that I might be prone to tearing badly (I tore beyond my episiotomy) and would have deeply regretted becoming doubly incontinent from a vb when I could have had an elcs. (I also felt it safer for my DC as DC1 was badly wedged and in great distress by the time the emergency forceps were used).

I found it exhausting and demoralising to deal with my bladder malfunctions so I was well aware how worsening it would affect my own mental health, my relationship with DH and coping with childcare and work etc. Hormones change at menopause too so any incontinence tends to worsen then.

Sorry if that all sounds negative! I can quite understand why people would want to go for a vb and take those risks, many have easier second time births, but I know others who have torn again as badly the second time and I am concerned that it is sometimes brushed off as 'oh everyone gets a bit of incontinence and they can fix that' - it isn't that simple sometimes.

I had a 3rd degree tear with DS (2.8) and I am 20 weeks pregnant.

The day after I had DS, I was told subsequent births would be by c section. I had a follow up appointment when DS was 8 months with a colorectal surgeon and he said I healed really well and it was much better than they though it would be.

I was left an a sense of urgency to go to the toilet (poo) but this has got better over time. I have never suffered continence issues with weeing and I didn't exactly to loads of pelvic floor exercises. I did after the birth as they helped but I quickly forgot again.

I have a consultant appointment on Wednesday to discuss this birth (and yes the midwife will refer you) to see what my options are. I know that if I really do want a c section, I would get it, as I think anyone with a bad tear would due to future incontinence issues. I would like to try for a natural birth though so I haven't made my mind up yet.

If you really wanted to avoid the same as last time, I really don't think they would turn your request for a c section down.

It's nice to know I'm likely to have the option - but I know a c-section isn't an easy option.

DH and I are going to see our doctor on Thursday. We're not even trying to conceive yet but I want to get it all a bit clearer in my head before getting pregnant. It was actually DH who asked me if I would want to have a c-section as he was so supportive but saw what I went through and doesn't want me to have to go through it again. I was thinking it but hadn't be brave enough to bring it up.

Thank you x

I had 3rd degree tearing. When I went back to see the consultant for a 6 week check I was told that if I get pregnant again I would have an initial appointment with a consultant where we would discuss my options. Whilst I would be allowed a vaginal birth, I would be allowed to request a cesarean.

Thats the appointment I have tomorrow Barbeasty and I still can't make my mind up!

Ooooh, let us know. It's so hard! xxxx

DP- I hope the consultant instils you with trust and it's a positive appointment for you

This brings back unpleasant memories. I had a 3rd degree tear with DS1 - he wasn't huge 7lbs 12 - but had shoulder dystocia so there was a lot of tugging etc.

I saw the consultant at 20 weeks and was offered a c-section, if I wanted one. Evaluating the options, I took it and didn't regret it for a moment. I healed more quickly from the c-section than I did from the tear.

Me too Margherita I'm trying not to expect too much as my hospital doesn't have a great reputation, even though my experiences haven't been too bad, they are lacking somewhat.

My main concern is that my GP - who I really like - has 4 sons. His wife was a midwife and had all 3 at home so he's very into natural homebirths. I'm worried he'll make me feel like a silly child for thinking about c-sections.

When DD was 5 1/2 months, DH and I went to see him about how uncomfortable I left feeling like I was making it up. That's why DH is coming on Thursday - I want to be able to get pregnant feeling happy not terrified.

Thanks for all being so supportive - I was worried a load of natural bith obsessed mums would be mean to me at the mention of a c-section.

Tori76 - I tore badly with my first who was tiny 5lb 8oz, nd when pg with my second had several meetings with obs to discuss cs which seemed their preferred option. talking with my mw really helped as she knew my history, and I made sure I was well informed. In the end had a vaginal delivery with bigger baby. The important thing is that all involved with my care were prepared to listen to my concerns, make sure that you don't allow your gp's own experience influence your decision. As a professional he should be listening to you and treating you as an individual case. If I had wanted a cs I have no doubts I would have been allowed.

Tori, if I was a midwife and my husband a GP I might be prepared to have a baby at home - maybe even four of them! If he is as good as you obviously think he is then I am sure he will understand why you are thinking about Csection. ( As Jetgirl said)

margherita - my difficult one was what I call a superbaby too, i.e. she came out with an arm up, looking like superman! It took me a long time before I was ready to even consider another child, and probably a year before DH and I resumed proper relations, as it were!

Tori, I had this exact conversation with my GP last week. It's too early for me to think of getting pregnant (and too sore to do the, er, necessary!) but she reassured me that bad tearing is enough of a reason to request a c-section.

She suggested I be referred to a consultant before even getting pregnant so I'd be sure of the outcome before even conceiving.

I'm with Lovethesea on this one, I couldn't risk a 4th degree tear.

jetgirl, Im glad you managed to resume proper relations and had another one after your experience of Superbaby!

good luck today DP and tomorrow Tori.

Lots of my friends tore but within the first 6 weeks were healed and back at it with DHs! I felt very sorry for mine and just wanted to want sex again - fell a bit like my old self. He was so patient with me - I know many men would get fed up. Mind you, I think telling him it was because he's too big helped boost his ego!

Jetgirl - thanks, I really felt like I was the only one who took so long to recover.

I think DH is more keen on c-section than me - he really hated watching me give birth, but then the MW shoved him in the furthest corner and didn't let him near me until the end - the cow!

Ok, I had my appointment today. Was exactly what I knew would happen. They went over what I already know and told me the decision is mine whether I want to have a c section or not and they will see me at 35 weeks for my decision.

I asked what her opinion was (she was a registrar and not the consultant) and she said if I hadn't healed as well as I have, they would recommend a c section but as I did heal well, I can have a natural birth if I want.

She said there is no way to tell if it will happen again (obviously) and I have as much chance as anyone else of it happening again. It won't necessarily happen again just because it did the last time. It is up to me whether I want to take the risk of further damage (she did say if it happened again the repair may be harder to do). She also said about them automatically giving me an episiotomy, which I already knew they would, but she also said there have been studies to say that this doesn't necessarily have an effect. I had one last time and still tore so I'm not actually sure what the benefits of it will be.

I don't know. I don't want a c section at all really but I also don't want to be incontinent. It could be completely different from last time. I was thinking about getting in the birthing pool to soften everything up but there is only 1 at the hospital so chances are it wouldn't be available. I was also thinking of not having an epidural this time as I did last time and then couldn't get up. I'm not sure how I would cope with the pain though as I had it pretty early so didn't feel the really bad contractions. I don't want pethedine/diamorphine as I have read about loads of women feeling really bad on that.

Great, now another 14 weeks to stew and constantly waver back and forth.

I have to say, my gut feeling is saying natural birth. I do have a feeling that this time it will be ok, and I do have bloody accurate feelings sometimes. Even DH says when I have a 'feeling' I am right about it.

Well at least you have the choice and it's yours to make. As opposed to being told what you can and can't do. Even if it is a really really difficult one (decision). I was going to say before, go with your instinct. Which can be unhelpful if you don't know what your gut feeling is. But you do!

Yeh, the more I think about it, the more my head just says 'natural birth'. I think about having a c section and its like my head doesn't even think about it as an option IYSWIM.

Last time I wanted a c section as I have M.E./CFS and I was worried about not having the strength and energy to push. They didn't go for that and recommended the early epidural but this time I really don't want to do it that way, as even though it was a bad birth, I don't see it as a bad experience at all and I quite like to whole waiting to go into labour, then it happens and you get sorted and go to the hospital. I find it quite exciting (in a very painful way).

Walking down a corridor for a pre-booked c section seems so clinical and not what I want.

I will dither a lot but I already know in my heart of hearts I will go for a natural birth.

GP remembers all the problems I had but his notes say 2nd degree tears - I am positive my debrief with the midwife said 3rd degree.

Anyway, he agrees that I had a bad time of it and is writing to the consultant to find out what the local policy is regarding elective c-sections and to get my notes checked to see what they say. He has said that if I don't hear by end of October he will chase it up.

We'll see. I think it all depends on what my notes say. I seem to remember then having 2nd crossed out and 3rd written next to it. Should have paid to keep a copy! ;-(

Make sure you emphasize the impact it has had on you, show you have weighed the pros and cons and have read up, take notes into any meetings to help prevent emotions taking over, and especially mention any issues with incontinence and sex - even slight things you might not consider significant (consultants tend to give more weight to those issues).

A c-section isn't a light thing, but neither are the consequences of a bad tear. There is a thread in General Health for those injured badly by childbirth and it is sober reading.

Try and work out your gut feeling on it all - after all my reading up I chose an elective because my gut was shouting at me to do so, and I really honestly believed I would have another unbirthable baby. Can't ever prove it of course, but you need to go with whatever you are most comfortable with longterm. Far easier to recover from a bad vb or a bad section if you feel you chose it with eyes open, rather than being bullied into one or the other by medics.

If you get really stuck choosing I would make a choice in your own head, tell no one, but live with it for a few days and see if you feel relieved or uneasy. It's the best way I know of checking my gut reactions!

I just hope my notes are full - I tore internally up the sides as DD's shoulders came down without her turning - I still think it might be because the training MW used a speculum and when she closed it to pull it out she'd traped my skin inside which made me scream and bleed. Part of me thinks that weakend me inside. I now also dread smear tests because of it - not that I was keen before lol!

I didn't like GP suggesting it might be psycological - some of it probably is as he even admited my birth was a "catalogue of errors".

I feel like I'm going to have a battle and I really don't want that. I told my DH I was worried that having an elective c-section, the mws might be really mean to me... he pointed out that they were hardly happy bunnies the last time - really huffy that I didn't take cotton wool with me to clean DD's bottom (nobody mentioned I needed to!)

Feeling more emotional having seen GP.