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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

Elective C section after 3 degree tear - or not?

42 replies

Georgimama · 29/01/2011 09:00

I am in a bit of a quandry all of a sudden, having thought I was not. I went to the ante natal unit for my dating scan and my midwife had booked me to speak to the consultant as well at the same time. She just breezily said "to talk about the tear you had last time" and I didn't really think anything about it. I assumed it was a (very belated) check that all was functioning properly and that I have had no problems with continence or sex since (which I haven't, fortunately).

I was pretty pole-axed to be told by the Consultant that my tear had been very serious (it was very well treated immediately afterwads but there was no follow up whatsoever except an entirely pointless appointment at six weeks at which a student doctor asked when my baby was due and another female doctor basically refused to examine my stitches) which I had never really appreciated because I made a good recovery. He said that there were two options - attempt vaginal birth in the knowledge that I was no more likely to tear than anyone else, but that if I did it would be a 3 degree tear and there could be serious complications such as fecal incontinence, or I could have a C section.

I was stupidly, probably, quite dismissive of the idea of a C section and said I didn't want one. He said if I changed my mind I should let my midwife know.

I discussed it this morning with my mum for the first time (she's on a long term holiday in Oz for another month) and she was very insistent that I had dismissed the option too quickly, and basically should change my mind.

I have always been nervous of the idea of a C section, but hadn't properly appreciated the risks of another vaginal birth. Has anyone been in this situation, and what did you do? What do you think I should do?

OP posts:

Flisspaps · 29/01/2011 09:04

I had a third degree tear with DD. I also have had no issues since.

I will not even consider an ELCS if I have any more. It hadn't even crossed my mind that I would be offered one until reading posts on here recently.

As the Cons. says, you're no more likely to tear than anyone else.

Readytoburst · 29/01/2011 10:05

When I had my daughter I was adamant I could do it again with no problems. However, when I fell pregnant the fear took over! It's not strictly true that you are no more likely tear for the general population it's a 3% chance and for people with previous 3rd degree tears it's 10%. I was worried that, though I have no problems now, the care at my hospital is questionable and knew they couldn't assure my safety and well-being. Another tear could lead to problems with continence for life and that's not a risk I was prepared to take. I have decided on an elective section and the minute I decided was full of relief. I have the occasional wobble about being a 'wimp' but know that this is the best option for me. I have my section in just over a week.

Original poster

Georgimama · 29/01/2011 11:07

Thank you both for your views. My viewpoint was exactly like yours Flisspaps (good name btw) until my mum said that elective C sections don't get handed out like sweeties and if the Consultant was suggesting one it must be for a good reason.

I don't want to end up with a colostomy bag, frankly. I am only 32.

OP posts:

enimod · 29/01/2011 11:21

i didnt have tearing with my first but he was an emergency caesarian at the last minute- when i was pregnany with my second i just asked for a caesarian said i had had problems dealling wiithh the first birth horrors and hadnt got over it etc- was granted caesarin straight away. it was fantastic- knew the time,could chhose music etc-was muchh less harrowing thann thhe fiirst nearly natural birthh and was up and mobile withhin 12 hours.

GruffalosGirl · 29/01/2011 13:36

I'm 34 weeks with my second and had a 3rd degree tear with my first after keillands forceps. I'm booked in for an elective section this time.

I was booked for a home birth this time but had to meet with the consultant. I have had slight faecal incontinence since my last birth and have no control over passing wind and although it is manageable the consultant recommended a section as they said they cannot guarantee I won't tear any other way and that the sucess rate for repairs of this kind of problem is pretty low so if I was damaged further they can't say that they could ever fix it.

Having already had problems and knowing the effect this has had on my self image and self esteem there was no way I was risking it getting any worse.

It's a really hard choice though and even now I have found myself thinking about changing to having a natural delivery and just hoping it would all be ok. Good luck with whatever you pick.

Original poster

Georgimama · 29/01/2011 16:37

thank you both - Gruffalo that's exactly the scenario I am now afraid of.

and bump

OP posts:

CoteDAzur · 29/01/2011 16:47

"attempt vaginal birth in the knowledge that I was no more likely to tear than anyone else"

Are you sure about that?

I had a large episiotomy with DD. Three years later, when pregnant with DS, consultant told me that there was a 50% chance that I would need another big episiotomy because "scar tissue does not stretch like normal perineal tissue". I doubt if your scar tissue would stretch any better than that of an episiotomy.

I had an elCS, by the way. One of my top five bear decisions of all time.

SoupDragon · 29/01/2011 16:56

I had a third degree tear with DS1 (he was huuuuge and OP). I did subsequently tear with both DS2 and DD. Neither was a third degree tear and I've healed well. I did have a lovely follow up appointment after DS1, complete with ultrasound (didn't get any pictures of that I can assure you) and was told then that there was no reason not to give birth "naturally" to any subsequent children.

obviously, no one can make this decision but you so I can't tell you what choice to make. Are you planning any further children? The choice you make now will affect the choices you have in the future.

Original poster

Georgimama · 29/01/2011 17:09

I'm not at all sure that's true either Cote, but that was what he said. I need to hear some good C section stories, I think. Most people I know had them as emergencies due to problems during labour and found them hugely frightening (although that's not to say they wouldn't have found vaginal delivery frightening either).

I'm pretty sure we will be stopping at this one. This pregnancy is actually a huge surprise after taking nearly 2 years to conceive DS and having had 2 MCs since he was born. I can barely get my head around having to make decisions about delivery because I can't quite believe it is going to get that far tbh.

OP posts:

Azure · 29/01/2011 17:21

I had third degree tear with my first (op, ventouse and finally yanked out with forceps) and elected to have a CS with second. The CS went really well - I knew exactly when I was going in so could arrange for my parents to look after DS1; the procedure was as relaxed as it can be; I wasn't exhausted dealing with a newborn as I hadn't had a 20 hour labour and missed a night's sleep; and I recovered really well. I was in hospital 2 nights - the same length of time as with DS1 - and driving the car less than 3 weeks afterwards. Obviously a CS is a major operation and not to be taken lightly, but I'm glad I made that decision. Best of luck whatever you decide.

CoteDAzur · 29/01/2011 17:37

best decisions! Stupid Apple auto-correct.

CoteDAzur · 29/01/2011 17:44

Oh and recovery from elCS was much quicker than VB.

I got up the night of CS (OK, it was hard), next day was better, and on third day I was completely fine, although of course still being careful when i got up from bed etc. No need for even paracetamol.

Contrasting this to the three weeks of tear-wrenching dehumanizing pain that followed DD's VB, I can honestly say hand-on-heart that both the operation and the recovery from elCS was easy.

pushmepullyou · 29/01/2011 17:46

I had a 3rd degree tear first time and will have an ELCS this time. I don't want an ELCS, but for me the risks associated with a VB are too great a chance to take.

The Royal College of Obstetritians (sorry, appalling spelling!) cites research that indicates that if you have had a previous 3rd degree tear you have a 17 - 25% risk of faecal continence problems following a second VB even if you don't tear the 2nd time

Much as I don't want an ELCS I want faecal incontinence less!

blueshoes · 29/01/2011 17:47

Georgi, if you don't plan on having many more children, I think it is a no-brainer - elcs.

PorkChopSter · 29/01/2011 17:47

look here They make the point that a ELCS guarantees a cut/stitches/recovery, but that a VB does not.

blueshoes · 29/01/2011 17:50

porkchop, as regards your link, reading the comments from women who suffered 3rd/4th degree tears is enough to make me go for elcs any day.

The recovery was smooth.

Fleecy · 29/01/2011 17:51

My sister was booked in for a c-section with her second after a horrific first birth. She was told she could try for a vaginal delivery but there was a relatively high chance of permanent incontinence.

Her DS had other ideas and arrived a week before her section with a very fast labour - no time for an emergency section.

She did tear again but they gave her specialist care this time round and, although it's early days, she's delighted and it looks like she'll be better than before!

I guess what I'm trying to say is that it's easy to get nervous about labour and feel frightened into a section whereas the alternative might actually be easier. I understand because I had a bad tear last time too and am now TTC DC3 so I will have the same dilemma

Having said all that, everyone I know who has had an elective section has had a positive experience.

Do you know why you tore last time?

pushmepullyou · 29/01/2011 17:52

That's true but the chances of later and possibly life long continence problems are so much greater with a VB than a CS. A lot of continence problems only show up after the menopause so there can be an existing weakness that you are unaware of that can be damaged by a second VB even if you don't have any current symptoms.

Original poster

Georgimama · 29/01/2011 17:56

I think the point is Pork that the VB apparently carries a significant risk (in my case) of fecal incontinence, which CS does not. And I note from your link (which is very interesting) that whilst labouring on the back in commonly blamed for tears, several of the MW reported tears when women were birthing on all fours. As one of the MWs on your link said "some women will tear, some won't". I already have once. I don't want to again.

Next worry - have I cocked this up? I haven't got another app with consultant as discharged back to MW, and I know lots of MWs are all for the birthing balls and water. When I booked in she looked askance when I said I'd rather birth on a bed than a bouncy ball. I suppose I could go crying to my GP if necessary.

OP posts:

Original poster

Georgimama · 29/01/2011 17:58

I don't know why, other than it may well have been my own fault (my feeling, not anything anyone has said). I had lbeen in established labour for over 12 hours, pushing for 2 hours, and I was bloody exhausted. I think I jut pushed too hard at a point when I shouldn't have. I can't guarantee desperation wouldn't lead me to do the same again.

OP posts:

pushmepullyou · 29/01/2011 18:06

Ask your midwife to refer you back to the consultant. I am pretty sure they can't refuse to do this, particularly as the consultant said that you could tell your midwife if you changed your mind.

I know what you mean about feeling that it was your own fault, but please don't blame yourself, I think it is just one of those things. I can't imagine that all the 90-odd% of women who don't have third degree tears have managed a perfectly controlled 2nd stage and the rest of us 'did something wrong'!

CoteDAzur · 29/01/2011 18:07

"ELCS guarantees a cut/stitches/recovery, but that a VB does not."

Err... Cut/stitches on tummy won't affect her sex life and make her wear diapers.

Original poster

Georgimama · 29/01/2011 18:12

He wrote in my notes "risks: previous 3 tesr asymptomatic no probs since delivery. discussed with her options for delivery and she can have vaginal birth - as long as continues asymptomatic" which I hope means I can change my mind and have a C section even though I am asymptomatic.

I feel a right indecisive tit now.

OP posts:

SoupDragon · 29/01/2011 18:14

"Err... Cut/stitches on tummy won't affect her sex life and make her wear diapers."

But neither will VB, necessarily. There are significant health risks with a CS as well.

SoupDragon · 29/01/2011 18:16

TBH, if it were my last child and I had no fear about CS, I would opt for that.

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