have a planned elcs after nasty 3rd degree tear but now having a major wobble

[yummytummy]

hi all. i think am just really panicking and cant figure out whats best. i know theres been a couple of threads like this but i am driving myself mad at the moment!

basically had 3rd degree tear last time which did eventually heal but took a long long time. had to have lots of physio and also counselling. had decided even before getting pg that would have elcs next time after discussions with consultant etc.

however even though its all planned i am just thinking whether its definitely best. i mean in an ideal world if i could have a straightforward 8 hour gas and air labour would prefer that but i know you just never know. and apparantly as i had a lot of scar tissue it wouldnt stretch like a normal perineum so likely could tear badly again? it would be nice to have a vaginal birth but the experience was so awful last time i feel like i cant do it and if i tried there wouldnt be enough support?

also always incontinence risk etc etc. am not worried about the section itself as i believe elcs is different than emcs? aargh just dont know really and am worried that people will think i am a wuss for not trying vb.

anyway not sure what am saying just after anyones thoughts or advice?

A difficult descision. I have supported two women to have vb after 3rd degree tears. Neither tore with their subsequent birth. One birthed in a pool. Have you considered a doula?
Selina

Hello, so sorry you're having a wobble. I had an ELCS last year after a previous fourth degree tear and I also though that I was possibly copping out of doing it the 'right' way. But the fear of being left doubly incontinent really clinched it for me. The ELCS itself was a breeze and recovery was fine.

If people think you're a wuss for not trying a VB, just ask them if they'd fancy being in nappies for the rest of their life? It's what I ended up doing. People will be judgey, but it's not their decison to make or after-effects to deal with.

You should do what you think is best for you and your babies - everyone else can go hang. Good luck!

Personally I loved my c section for dc2 after horribly traumatic dc1 natural birth. I was v v nervous before as I thought it would take ages to heal but honestly it was easier than the vaginal one. Good luck :)

really raejj and cakeywakey? thats good to know. in what way was it easier?

I found it much more civillised, I knew exactly what was going to happen and when, I was talked to throughout and the atmosphere was really calm.

I think the main benefit was not being absolutely drained by a long labour. I was home after two nights and just took it easy getting breastfeeding established and getting to know my new baby. I had help with me for four weeks, but was driving again after three after my insurer ok'd it.

I seem to be posting this a lot recently, but I am in the same position as you.

I didn't (and still don't) really want a CS, but did some research in to it and was convinced that it was the lowest risk option for me.

If you have had a previous tear there is an increased risk of a second tear. This risk isn't massive - 10% versus about 3%, but it does exist. If you do tear the again the chances are that it will be a bad one and could do damage to your sphincter and pelvic floor that is not repairable.

In addition (and this is what clinched it for me) the Royal College of Obstetricians advises that if you have had a previous third degree tear you have between a 17% and 25% chance of developing some degree of bowel problems eg incontinence/urgency following a second VB even if you don't tear

I spoke to my consultant about this last week when I booked the date for my CS. She was absolutely clear that a CS was the lowest risk option for someone in my position. Continence problems often don't show up until after the menopause so even if you feel fine now you could still have a slight weakness that would be made worse by a second VB.

wow pushmepullyou thats really helpful thanks, i wasnt aware the risk was there even without tearing. its just hard to come to terms with i guess but as you say it does seem like the lowest risk option. and it must be nice to be able to enjoy your newborn rather than being traumatised and in shock after a nasty tear.

I had a 3rd degree tear last time and was given the choice this time. I did opt for a natural birth given that I healed really well but this baby is breech so I am booked to have an ELCS on Monday.

My consultant (actually the registrar) told me I had no greater risk of tearing and it was up to me whether I wanted to take that risk again.

Interesting to read what push said. I didn't know any of that.

I know I was lucky and did heal very well but in your position OP, I wouldn't worry at all about having chosen a CS. Bollocks to what others say, they are obviously ones who haven't had to deal with a bad tear and how painful it is. I was called a wimp by a mum at my toddler group for sitting on a cushion for weeks and saying about how painful it was. She had a CS and was ironing the next day apparently. (More fool her tbh).

I'm booked for a section next week after a 3rd degree tear three years ago. Last week I had exactly the same wobble especially as the previous episode of OBEM was full of ladies making it look easy. I was feeling like I was taking the easy option and was failing in some way. However, I talked it all through with a good friend and am back on track (mostly).

With my dd I got to hospital at 7cm, went into birthing pool, only had gas and air etc. Then it went wrong - never got the urge to push, pushed forever then ended up on a birthing stool. Dd came out so fast, I tore very badly. Sadly, because I also had a retained placenta with the cord still hanging out they didn't notice for an hour and a half despite me screaming at them! They just thought it was the placenta and carried on pumping me full of hormones.

With all that and extensive surgery I didn't see my daughter for about 3-4 hours. When it comes down to it, I cannot risk that again. I also would rather feel like a bit of a failure than be incontinent - also to big a risk!

Excuse the rambling post but I really think there is too much pressure on women to be 'good' at giving birth. As long as you and the baby are safe you've not made a wrong decision.

After a 4th degree tear first time out, I was strongly recommended to have an ELCS second time, 8 weeks ago. Definitely the right choice for me! While the recovery from surgery was v.painful the first few days, it was SO much less awful than recovery from the tear and surgery to fix it. And most importantly, my first few weeks with DD were much smoother, and we bonded earlier, got bf sorted, and generally felt more like a 'proper' mum. That assuaged a lot of my guilt at being crap first time around! It's different for everyone, but hope that helps.

Hi,

I had a 3 C tear which is nearly a fourth degree tear, midline episitomy too with first pg
important to remember that pg affects pelvic floor regardless of delivery

I also had perineum restitched 3 months after 1st baby, not fentons

so had scar tissue from tear, epis and then inside a bit and outside

I was given hormone cream to put inside but did not use it

its supposed to soften scar tissue
I did perineal massage but could not see any changes and did not do pmassage every day

anyway my scar tissue did stretch but they had to cut me in a different place as had a larger baby who popped out quicker
had just gas and air in the end

it healed fine within 2 weeks I was better

I would recommend vb but be prepared for anything

I think if you practise pelvic floor,have good results from anal ultrasound, have a good diet, avoid constipation, perineal massage, competent mw, breathe/pant when they
say, dont suffer from incontinence during pg then you have a good chance of having a vb

feel free to ask any q's

have a look at nice guidelines for csection -

if you have a section then it may affect future delivery options and pg

looks at risks from csection too

speak to your supervisor of mw who can go thru your notes

Risks from c-section are of course something you have to take into account - but in my case the risks of a second vb outweighed them! Risks of ELCS are considered lower too, for a variety of reasons, expecially if you are fit and healthy.

My ELCS with DS2 was wonderful, I'll be having another in August!

risks of ELCA are lower compared to EMCS I mean.

I had an ELCS last year (due to low placenta) and I was terrified before I went in but it really was an amazing experience. It was all incredibly calm, the staff were fantastic - plenty of light-hearted jokes and clear explanations - and the moment I looked up and saw (and heard) by gorgeous DS being held above me was wonderful. Of course things are pretty sore for a while after but to be honest it wasn't that bad. I was walking around the park within the week. I don't feel as though I missed out not giving birth naturally.

I had a 3rd degree tear with dd1, and healed fairly well.

With dd2 I had a vb and had a second degree tear.

I had a few continence issues after dd2.

When I was pregnant with ds I suffered double incontinence, and was advised that any further damage could lead to further problems, and that even with a cs I would probably need some extensive physio and possibly surgery to improve things.

I had an elcs, which was fairly traumatic, I lost a lot of blood, my bp crashed and ds was born with signs of prematurity, including a respiratory distress syndrome. He was in SCBU for 8 days, and he and I have taken a long time to recover.

I don't mean to scare you because all births are so individual, but even an elcs can be a rough ride.

HOWEVER whether I made the right decision or not is another question. Nothing is black and white in these situations and there are no guarantees, but the thought of being doubly incontinent for the rest of my life makes me feel as though the decision to go with an elcs was the right one.

i don't know if my experience is on point for you, but our circumstances sound a bit similar.

for my first child, i had a bad vaginal delivery and infection which damaged my pelvic floor.

during my second pregnancy, i had trouble with continence but was going to try to deliver naturally. i ended up choosing an elcs. however, finally got to see the consultant at 35 weeks and was basically told:

• the damage is currently severe but fixable. i will likely never be 100% but with physio, could be close.

• however, another bad delivery may well mean that the damage would be too severe to be fixable.

• i could try to labour naturally and see if the delivery was normal, and then if it didn't, go for emcs. however, emcs could not be guaranteed, and i might have had to deliver by forceps again if the baby was in distress.

so, i agonised for a while and then went for elcs. i figure i really don't want to be incontinent for the rest of my life, and if i am going to have a section, i am going to have it during the working day with all the consultants around and not at 2am on Sunday morning with a junior registrar or student when the delivery suite is completely packed and there's a queue for the operating theatre.

i will say the section was not the easy option, as it took fully 6 weeks to start to feel normal and i got an infection in the wound that took quite a while and lots of antibiotics to heal. the pain lasts a lot longer than a vaginal birth and i felt quite helpless during the recovery period as i couldn't manage my toddler. also, my blood pressure plummeted during the operation, and i freaked out and became hysterical had to tell the operating doctors to please sort it out. i found it all very sterile and medical and felt i had no control whatsoever over the process.

also got a few bitchy comments about how apparently in the Uk they will "give you a section for just about any reason" (my foreign MIL) and "not to feel like less of a woman because you can't deliver naturally". dh and i thought fuck it, and ignored the lot of them.

good luck, and i hope you make the decision that you feel safest and most comfortable with. i sympathise as it is not an easy one. in the end, for me, an elcs was definitely the right decision.

god this post is long, sorry.

making my post even longer!

ps am worried my post was too negative about the section. i think most people find it easier to heal after the section than i did. my scar has actually healed very well and 9 weeks out, i am completely back to my old self. i had a doula help me with my toddler during the recovery period.

I had a fourth degree tear with my first, a ELCS with my second and I'll be having another ELCS next week with my third.

The ELCS was so calm and lovely compared to the complete horror of my first experience. The recovery was also much easier.

I felt that I had absolutely no choice other than the ELCS - emotionally I could not have tried for a VB and physically the risks were just not worth it.

very very difficult descion

Please don't see a cesarian section as a "failure".

I have moved here from the States and I find the birth differences so very, well, different at times....

there is soooo much pressure here.

Yes, we all know a natural delivery with no drugs would be great with the baby immediately latching on to breast feed. But life just doesn't work like that sometimes.

My mom (a nurse) still asks me weekly why people aren't just offered epidurals here as routine when giving birth. "Why on earth would you want to be in pain when they can give you something for it?" I try to explain about the risks of intervention etc but she just sighs, "welll... ok"

My best friend had a CS when things failed to progress. She said it was a great experience and had no problems.

I'm going to have a bash at a water birth but my birth plan clearly states that if things aren't going well I don't even want to have a trial of assisted delivery. Nope. Not at all. Just get me to theatre.

Will I feel like a failure?

NO.

Do whatever you think is best for you and don't look back... A safe CS delivery of your baby where you aren't stressing the whole time about tearing might be better. But only you can really know.