Elective C section after 3 degree tear - or not?

[Georgimama]

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?

I had a third degree tear with my first son and an elcs with my second. The cs was a walk in the park compared to the lengthy painful recovery from the tear and the sheer trauma of 4 hours of pushing, hemourage (sp) and then a spinal and theatre. I should have been holding my baby not going through all that and im sure his feeding problems for the following month were due do him being so traumatised, when he finally came out his face was so swollen and bruised

When DS2 was born, he was straight on me, latched on straight away, it was beautiful I am due again in August and its elcs all the way.

HTH x

Hi Georginamama,

I was in exactly the same situation as yourself and after months of research and consultation with health profs I went for vaginal delivery which was fine

I can't believe how different it went and how faster I recovered

picture yourself with feeling how you might feel if you had a c section or another tear

I was hell bent on proving to myself that I could give birth naturally and knew that first pregnancies can be more difficult than second pregnancies
my GP and colorectal surgeon all said c section no question - remember they only see the bad cases -
I even won my mum and grandmother over to the idea that I was deciding on a vbirth
it's entirely personal
if you can;t face tearing again or having an epis then go for a csection but then you may never know what could happen
If you had a really rough time first time round with the tear then I can understand perhaps a c section but then it might mean a csection in the future
Even though I decided on vb delivery for second I still would have accepted a csection if there was any problem with the baby or my health right at last minute

In my case I had first time
nearly 30 hr labour, epidural, chemical induction, forceps, third degree tear classed as 3 C which is mm away from a fourth degree tear and episotomy

you don't say what type of 3rd degree tear you had?

I was scared that my scar tissue from my tear and epis would split but they did not second time round
it has nothing to do with age if you tear
I also had a follow up operation after my first childbirth as the tear was not healing together so they did perineal revision as well but after that it healed fine like yours

second time round I got into hospital and had baby within 4 hours, no intervention
I had considered a water birth but to be honest I found that research said it can soften up the perineum too much and cause the skin to tear so I had baby on dry land!
I wanted to be on all fours but could not move in the end so was on the bed propped up
I remember asking the mw as I thought being in this position might mean I tear more easily but this was not the case. I wanted to breathe the baby out but ended pushing with contraciton which I thought would cause a tear but it did not
people were telling me I looked big in pg and that I would have a large baby
I had a 8llb 7oz baby which for me is quite big but I did not tear
I did not want an epis as I was scared it might lead to tearing but they did on in the end as the head was crowning and in a different place
things healed within 2 weeks and not really much discomfort at all

feel free to ask me anything as people can get very paranoid about fecal incontinence
pg in itself can cause incontinence remember regardless of delivery mode
if you practise pelvic floor then you can protect yourself

sorry for waffling

oh look up NICE guidelines on c section versus tearing

you have to think short and long term for each type of delivery

it's your own decision not anyone elses
yes some people may do what the consultant says but this is what they do
do what your instinct tells you to
also speak to the supervisor of midwives at your hospital and get them to go through your birth notes etc
also look up Dr Abdul Sultan at Mayday hospital
perhaps get a referral to see him or colleague as they are well know for research in this field

got to tell you that it has been 3 months since I had my second baby and it was the best decision for me to have a vbirth after tear as it helped me heal over the first one

choccybar and tractor, thank you for sharing your (completely different) experiences - I wish someone could guarantee that I would have a ECS or vaginal birth like yours were, but of course they can't.

I can say 99.9% certainty we will not have any more children after this one so cumulative C sections are not a concern, this would be my one and only C section.

I see my midwife in a fortnight and I am going to ask her to refer me back to see consultant again and go through it with him properly.

that's okay

I am a scaredy pants when it comes to hospital things and having had a bad tear people thought I was crazy condisering a vbirth again

sorry if it sounds like I'm bragging but you need to make a careful decision about it

not even the consultant can tell you what to do
statistics can;t be relied upon either

with myself I rather I tore again than be cut open on the outside and on the inside and have the risks of a csection as well
but having said that if I HAD to have one in the end then I would have gone along with it

sorry there are risks with any mode of delivery but I think subsequent pg carry less risks

I had a third degree tear with my first following protracted second-stage labour, ventouse and episiotomy. Lots of surgery but - like you - no subsequent problems.

Second baby (23 months later) I opted for VB and was a totally different story. Quick and easy birth, with only a second degree tear.

No continence or muscular problems since.

Good luck, and congratulations!

do you know what you are having by the way

if you will have two of the same gender then you may consider having a boy or girl in the future?

just a thought anyway

people say you need to wait longer before having another baby if you have had a csection and especially if you consider a vbac in third childbirth
sorry if waffling again - hope I am helping

I had third degree tear with first DD. Was hideous and required follow-up surgery. I was adamant I'd have an CS with DD2 but came round to the idea of VB and ended up being induced (again) and having ventouse delivery (again). And no tear. Not even a small one.

It can be done!

another point you may wish to consider is this

people may keep telling you that you are having a big baby and if you go overdue you may worry about having vb

so was worried about tearing with baby

I refused to have a sweep at due date and went into labour naturally at 40 weeks plus 4 days

I think if I had gonepast 41 weeks I would have possibly reconsidered induction or sweep but they say that increases the risk of intervention and tearing - something you may wish to think about near your due date
don't wish to scare you just want to be realistic

my personal reason for being worried about ELCS was baby not breathing that well which may not happen at all but you can read about respiratory things vis a vis vb where the baby's lungs are cleared out better so I have read

As a follow-up to choccy, I was lucky enough to be under Mayday anyway for childbirth (both times). Well, for labour etc it's not great. But for perineal care, it's amazing. I had so much follow-up after my first, it wasn't even funny! Miss Thakar is Dr Sultan's compatriot and she is also brilliant. They really know their stuff. I truly believe I couldn' have been in a better place to tear the first time!

I also felt the second labour (though also fraught, but for different reasons - if I said I had to deliver with my knees together, would you believe me?) helped heal the trauma of the first. I never thought I'd get over it and was terrified about being pg again. And that was part of the reason I went for VB the second time. I know it's not a biggie, but it was a factor for me.

I could go on about this but will stop now as it's personal decisons at the end of the day but am open to anybody asking me questions!
good night all!

Again, following up on choocy (I think we're x-posting). I was induced both times. Episiotomies both times. Epidural the first, not the second (that's a long story but involves an unusual reaction to pethidine that saw me go from 3cm to 10cm in less than 20 minutes - on an antenatal ward).

And no tear-related problems since. Miss Thakar told me I was as good as new despite the first tear, and that my risk the second time round was as if it had never happened. And she was right.

Me too choccy!

Oh it's such a hard decision. Although, oddly, for me it was very straightforward.

I had a very serious 4th degree tear with my first birth. 10cm hole, internally and externally, repaired post birth and a colostomy was peformed. I was advised not to have more children if I had a hope of reversing the colostomy,but I got pregnant by mistake.

I had an elective section by order of my colorectal surgeon who told me it was my best hope of ever getting rid of the colostomy. He told me, and was confirmed by a second opinion, that a section would protect my pelvic floor (or what every little was left of it) although even the weight of a second pregnany would likely cause damage and even a section doesn't protect your pudendal nerves.

The problem, to my mind, is that the damage being done is so hidden at this stage. You might be fine right now, as indeed I am after 2 babies and having got rid of the colosomty, but it's almost inevitable the colostomy will be back (for me, given my horrendous damage). When you hit menopause your muscles will all start to waste, due to hormones, and that includes your pelvic floor muscles. So if they are already compromised, as those of use with serious tears are, the effect could be devastating.

I know it's different for me with a 4th degree tear but, honestly, I would go for a section. I recovered SO much better and faster from my elective/medically required section than I did from a 4th degree tear.

Good luck with what ever you decide xxx

As I said, I can say with almost complete certainty that we won't be having any more children after this one. I'm glad you both had such good experiences at the Mayday but Croydon is a bit of a drive for me so not really an option!

The problem, to my mind, is that the damage being done is so hidden at this stage. You might be fine right now, as indeed I am after 2 babies and having got rid of the colosomty, but it's almost inevitable the colostomy will be back (for me, given my horrendous damage). When you hit menopause your muscles will all start to waste, due to hormones, and that includes your pelvic floor muscles. So if they are already compromised, as those of use with serious tears are, the effect could be devastating.

Spud has completely summed up my concerns: it's not six months after the birth I'm worried about, it's twenty years.

You've all really really helped and I really appreciate all the personal stories - let's face it this couldn't be more personal. As long as I can still get one, I am definitely going to ask for a section.