ELCS after 2 Third Degree Tears

[PenguinsMummy]

I appreciate that there are lots of very large threads on traumatic births but thought I would ask here anyway to see if anyone has any advice they could give me!

I am 12+6 weeks pregnant with DC3 and met with a consultant this week to discuss my birthing options.

With DD1, I had an episiotomy on one side and a third degree tear on the other. With DD2, I had a third degree tear along the same scar tissue but not quite as large.

Do I risk another third degree or possibly forth degree tear, given the scar tissue is weak? Or do I go for ELCS?

I don't have any family close by and have 2 small DD's - 4 and 2 - so am concerned about recovery time. Also, from stories I have read on another thread it seems like quite a lot of babies from CS end up in SCBU due to mucus and mums have BF issues?

Any advice anyone?

ELCS would be my choice in your shoes. Recovery time means time to get bf established since you have to do a lot of sitting and lying.

Long-term i.e incontinence both pre and post menopause?

Would OH be able to take paternity leave and help out?

Had my 3rd by ELCS, after 3rd degree tear. In on Wed out on Fri, pretty mobile actually, v little pain, well controlled by meds. Consultant said that if baby presented with head angled or arm up by head, I would be in trouble.

DH will have 2 weeks paternity leave which will def help out given that after a few days in hospital and then having him at home for 2 weeks, I should hopefully be ok by then???

I've only had one baby, delivered by emergency CS at 34weeks. I didn't find it took that long to recover, within a day or two I could hobble to and from the toilet, have a shower etc. My hospital made me stay in for the mandatory 5 days. Once I was out, I could walk about no trouble, its just getting in and out of bed or standing for long periods that hurts.

With regards to BF, I found it a struggle, I think because my baby was premature and I didn't have contact with her for 48hrs. I don't know whether the drugs also have an effect, such as the pre-op drugs and I had IV Mg Sulphate and hydralazine for high BP.

There was one overdue woman on the same ward as me that went in for an ELCS and her baby ended up on neonatal with a bacterial infection I think, so there are risks to the baby, though how common, I'm not sure.

Most colorectal surgeons would recommend an elective cs following two 3rd degree tears - as each tear becomes increasingly difficult to repair. It does, however, depend on the classification of your tears, the more extensive 3b, 3c tears are obviously more of a risk to your bowel function as they involve the internal and external sphincter.
Did you have follow up with a physio and surgeon following your last tears? Have you suffered any incontinence of flatus or stool? There are so many factors to take into account............
If it were me, I would definately have an elective CS, the risk of a difficult third repair would be far more serious than and elective cs in my eyes. I'm probably biased though, having seen a woman in a similar situation who required an ileostomy as the repair broke down. Enough to put anyone off!

Think I am going to go with ELCS - risking another 3rd degree tear is just not worth it.

My first tear was quite a serious one - not sure which level - I had over 40 internal and external stitches which took over 4 months to disolve. My second tear was a 3a tear so not as bad but still third degree and required surgery to repair.

I haven't had any incontinence as yet but things definitely aren't as was!

I did have follow ups but they lasted minutes and were with SHO's who only wanted to know if you had any incontinence - if not, then tick you were fine.

Anyone medical I have spoken to thinks I should have ELCS.

Sounds like you have made your mind up.

I just wanted to say that there is no medical evidence linking cs with breastfeeding problems. This is often bandied about as one of the reasons to avoid c-sections, but it's just not true.

I would definitely have an elective cs in your shoes. I have had one elective and one emergency cs, and the elective was a great exxperience so don't get too worried about it!

I had an ELCS and no problems breastfeeding (apart from the pain!), no breathing difficulties and healthy DS (apart from reflux) but not sure there is a link to CS for that! My hospital only do from 39 weeks as this reduces any breathing difficulty risks.

I had a 3rd degree tear with DS. It was a 3b (had no idea what this meant until reading this).

I have been told that it is up to me whether I want a c section this time. I have a choice because I healed so well. If I hadn't healed as well as I did, they would recommend a c section but because the surgery went well, then I can go for a natural birth if I want to. I am going to go for it.

In your situation, with 2 3rd degree tears, I wouldn't chance it and I would have a c section.

I have had 2 ELCS and been up and mobile a lot sooner than I thought both times. My DS had just turned 2 when DD was born, I was home and looking after both DC on my own well before DH went back to work from his 2 weeks paternity leave. I had trouble BF my DS but DD was like a dream - my opinion is each baby is different and it's more down to individual circumstances than it necessarily being a CS causing lack of success.
Good luck!

Thanks Whizzy - that is my main concern - coping with DD1&2 when no 3 arrives!

I agree with QTPie, the main problem is lifting. You'll need to work on getting DD2 independent if she's 2.
After my DD was born I was feeling great but knew that was not important - internally you need to heal and not attempt to lift for a while.
I prepared my DS by getting him to practice everything - climbing into his chair at the table, up on to my lap for a cuddle, into the car seat. He was still in a cot but it had a drop side so before DD was born for a couple of weeks we dropped the side and he climbed in by himself with the help of an ikea kitchen stool (the stool then slid away and side pulled back up!). Worked a treat and I got away with being lift free with him.
However I know it depends on DC's personality - my DD is so feisty she NEVER does what I ask!