C-Section with second baby if third degree tear with first?

[smk84]

I have heard somewhere that if you tear badly when giving birth that the next time round you are offered (or even recommended) a C-section. Is this true? We are TTC DC2 and I am very curious! I had third degree tear with DS, but would really hope to have natural birth again next time.....

They can offer a CS, but you don't have to take it.

I'm in the same position (it's likely we'll TTC at the end of the year anyway) and whilst I was dead set against the idea of a CS for no 2 (I originally thought I would want a homebirth for no 2 although given I had forceps, PPH, MROP and 3rd degree tear last time so it may be seen as unwise by some. I believe it was highly likely that all the above were instigated by induction anyway)

However - having read other threads on here recently, the big issue with VB after a 3rd degree tear is the damage it does to the pelvic floor which you don't know about now, but only becomes apparent in middle age when the muscles start to atrophy. That then means you see out your last 40-50 odd years with the risk of faecal or urinary incontinence - or both...which can be avoided by CS.

Of course, CS does carry it's own risks, and damage during a VB is not guaranteed, it could all go well, and it can be argued that the 9 months of pregnancy are just as likely to ruin your pelvic floor as birth itself.

If you've had a 3rd degree tear then you should be eligible for an ELCS, but you don't have to have one and it's obviously a very personal decision.

I was in the same position as you and also very much wanted a vaginal birth second time round (partly I think because I felt that I had somehow 'failed' to give birth 'properly' the first time).

However in the end I have decided to go for an ELCS basically because I read the royal College of Obstetrician Guidance that says that there is a 17-25% risk of some degree faecal incontinence/bowel weakness following a subsequent vaginal birth even if you don't tear again.

in addition I understand from my consultant that the risks of this can be even higher after the menopause.

So, whilst a lot of women go on to have perfectly uneventful second VBs, I know that I would find incntinence incredibly distressing and therefore for me personally the level of risk is too high.

!!!!! Thank you both. I am actually very shocked and for some reason feeling very upset ! I'm not even pregnant (as far as I know) but I am just realising potential consequences. I can't believe no-one told me this after I had my little boy.
FLisspaps - you sure had a time of it with your birth. I can understand why you would want a homebirth but as you and pushme say, natural birth is a risk!
Do you know if the 'degree' of your third degree tear (!) is taken into account. I am wondering if each case is taken individually, or if it's just a blanket 'you can have a CS if you choose'.
Pushmepullyou - completely understand your choice. When is your baby due?

I have 2 friends who had tears 1st time and went on to have soca for no.2
Both agree that the 3rd degree tear was better than the cs
I tore with dd but only had a graze with ds1

If you don't want a cs don't have one, I won't make my feelings too clear but I do think vaginal is the best option

Elcs don't know wher soca came from

I had a 3a tear (least serious) and was offered an elcs, but I think that was because I had soem continence issues after dc1. I had a vb in the end but it was a difficult decision to make. My vb was uneventful but I did tear along the scar from last time (2nd degree)

I had a very strong gut instinct that I could do a vb, I knew the baby was smaller and well positioned. I think I waslucky though second time round i'm not sure i wd do thatagain

I had a 3rd degree tear with DC1 and I am currently 33 weeks with DC2. After review of previous notes with the consultant he recommended vb rather than elcs but with sweeps starting at 37 weeks with induction if necessary before 39 weeks. Reason for tearing first time were due to DC1's size and the fact she was OP, so have a review at 36 weeks to assess size and position with option to switch to elcs if size too big already at that point or repeat OP positioning. Can't say I am not worried, but feel reasonably comfortable that I am being given best advice given specific details of previous birth. Would suggest if you don't already know the reasons for tearing first time that you ask for a review of your notes. For me understanding what contributed to the tear and hopefully being able to take steps to migigate same situation happening again has made me feel reasonably ok with vb option this time.

Had a 3rd degree tear with ds1 and no one even mentioned a cs with ds2, I did tear again but less badly, and it sorted out the painful " too tight" stitching from ds1 ( was a wonder ds2 was conceived!). No incontinence now, even on a trampoline, will let you know after the menopause, am a bit worried now!

I had a 3b tear with DS and was given the choice this time of an ELCS. They told me that as I healed really well and had no lasting effects, it was up to me whether or not I wanted to take the risk. I decided I wanted a natural birth again and was convinced this time would be better.

DD had other ideas and was breech so I had an ELCS anyway. I was so upset and it wasn't what I wanted at all.

I was so wrong and it was an amazing birth and a fantastic experience. If I did have anymore in the future, I would have an ELCS again. DD is 9 days old and I am feeling bloody good, not pushing it but soooo much better than when I had DS.

smk I am having my elcs on 8th March, when I will be 39+6. Unless DS has other ideas! I'm getting quite nervous now, and am mentally recoiling from the thought of major surgery, but I guess that is normal. My recovery took a long time with DD and I feel confident that I am making the right decision for myself in the long term, but I just don't want a section iyswim.

CrapBag I think I posted on your thread before you had your DD. I'm really glad you had a good experience, it's making me a bit less anxious about my own elcs .

pushme - yes I understand - not long to go now, it must be very exciting ! how old is your dd?
spoke to our HV and she said that I can get hold of my labour notes to find out more, and that ultimately the consultant would have to decide if I would be offered CS, but that it would be last resort. quite encouraged by how helpful she was :)

No it is not automatic for C sect if tear with first

I did a lot of research and had 3C tear with first
lots of reasons why tore but I nearly chose a C section and then just felt I had to take that risk as I desperatley wanted my body to give birth naturally
I had no tears at all second time round and just another epis in another place
quicker healing
still cant believe after 4 months that baby came out of such a small area

please ask me any questions as I had a tough time deciding which delivery option to go for so know what it feels like

I had a third degree tear with my first baby (i ignored the midwife and pushed ds out very quickly). when i was pregnant with dd1 i saw a consultant at the hospital and she said because i'd recovered well i should go for a vb. i was happy to. when it came to pushing dd out, two midwives coached me very closely and boy did i make sure i listened!! i only tore a very tiny bit, needing one or two stitches.
i wouldn't consider an ELCS unless i'd had a hard recovery/long term problems with the tear, which thankfully i didn't. when the midwife reads 3rd degree tear in your notes i'm sure they do all they can to prevent another serious tear. Mine did anyway and i was soo grateful to them. it was a massive fear of mine to tear badly again and i actually cried with thankfulness and relief after dd.

I'm recently pg with DC2 and had a third degree tear so this is interesting.

I've not researched the issue yet, but my biggest worry is pelvic floors. These were weak before DD and now running is a big logistical operation.

I'm in the USA atm so am assuming requesting a ELCS will not be a problem

If you had a weak pelvic floor before, an ELCS is probably the better option as they say its not just what happens after childbirth but when you hit menopause as well. I was told this and it was difficult to make the decision and even then I was scared as I was told if I tore again, the damage would be worse than before. It was a good thing that DD took the decision out of my hands. After 2 weeks I am only taking pain meds twice a day instead of paracetamol 4 times and ibuprofen 3 times a day.

This thread has been very interesting reading.

I had third degree tear with DC1. I'm not sure why, I think because he came out too fast (midwife nearly didn't catch him :) )

When I was pregnant with DC2, no-one ever mentioned anything about have a CS, or any consequences of the previous tear, so I had another VB. And another third degree tear.

I am now pregnant with DC3. And the prospect of a third 3rd degree tear is not appealing.

I didn't know anything about the long term risks of incontinence associated with tears, I was happy that I had healed well and quickly after both tears, possibly helped by the fact that both times I had an epidural after giving birth then a session in theatre with a surgical team piecing my perineum back together. I think I'm a little bit in shock now I've found this out.

I have my first antenatal appt on tuesday, I'll be asking then about consequences of this history. But does anyone have any advice/references I can go in armed with? I'll probably be back with more questions when this has all sunk in a bit...

The risk of incontinence is not avoided by having a CS after a 3rd degree tear. The third degree tear already puts you at great risk of incontinence once menopause starts because of the drop in hormones affected muscle tone.

A CS is often cited as reducing further damage and worsening incontinence but the damage to the sphincter muscle(s) is already there. A CS also carries a risk of urinary incontinence and there is evidence to suggest that it is the weight of further pregnancies not how you deliver after a 3rd degree tear that actually causes further problems so a prophylactic CS may actually be for nothing.

That's not to say you shouldn't have a vaginal birth after a 3rd degree tear if you don't want to but just make sure you're basing your decision is an informed one.

You should be comparing the risk of a second tear (which is between 4% and 7% depending on the grade of tear you had the first time 3c-4th) versus the risks from a guaranteed cut to your abdomen and uterus.

Stainlesssteelcat pelvic floor exercises are your friend!

There is no guarantee you will have problems, there is an increased risk of incontinence after 3rd degree tear but no one could tell you when that might happen. You might be 80 with a bit of urgency when you need to go to the loo but not actually pooing yourself in Sainsburies.

But, pelvic floor exercises!!

DirgeinVegas Thanks for the info, very reassuring, and I feel a lot less like I've already doomed myself to life of Tena lady! Will do some googling on it in a bit and see what I can find out, then go and subject my midwife to the third degree (haha) next tuesday.

And I'll be putting the hours I'll be spending in antenatal waiting rooms to good use ... pelvic floor gonna be like iron ;)

Good luck, whatever you decide! x

Thanks for the interesting reading, I'm pg with dc2 and had an epesiotomy and tore with dc 1. I asked my mw at the booking in appt what the chances were of tearing again this time round and didn't give me a proper answer so I took that as a yes. She didn't mention incontinence later on in life or anything about an elcs. My friend had an epesiotomy last time and is having an elcs this time. It didn't click until I read this thread why she was going for the elcs and I think I'll be having a chat with my mw next time I see her! My biggest fear for this birth is having another epesiotomy as last time it took a long time to heal and was left with ongoing problems (although another epis may sort this out!)

Thanks for this thread.

I had an awful birth and a 3rd degree tear with DD. And the thought of going through that again is seriously putting me off having a 2nd, although I would love another one. If I could just skip from due date to the bit where we take a baby home, that'd be great

I still need to go through my notes from last time, as I'm not really sure why I tore. Not sure if I ever will really, but I feel I need to try and find out more.

I was still in pain 10 weeks after DD's birth, and the prospect of going through that again makes me feel sick. The fact I hated the birth doesn't help matters, and I think I'm swaying towards the idea of a ELCS next time and I don't even know if it will be an option yet!

Interesting thread. I'm about 10wks PG with DC2 and had a third degree (b) tear with DS. DS was in an awkward position so was born with forceps after ventouse didn't work. I did a bit of research a while ago but haven't thought much about it since getting PG; am waiting to talk to HCPs about it (got MW booking in tmrw!)But from everything I've read I think I'm likely to go for a CS. I'm pretty sure you (and I) will get offered the option if we really want it.

I think the thing to do is try to find out as much as possible about why you tore and the likelihood of it happening again. The advice has got to be tailored to your specific experience. However, if what people have said on this thread is true about the future risk of faecal incontinence even after an uneventful 2nd VB, then personally I think CS is the way forward.

Someone said they didn't feel they'd given birth properly after a bad tear. I too feel a bit 'cheated' out of that completely positive birth experience others have had, but come on everybody, we've pushed babies out sustaining damage to ourselves in the process. I hate all that competitive birth nonsense, but if anyone were to get medals, maybe it should be us!

crapbag I remember you from the other thread! Congratulations on the birth. A very positive story.

Thanks.

I think anyone who has had a bad tear/difficult birth should/could be within their rights to insist on an ELCS if its what they really want. I can't see the hospital completely refusing it if you have a really good reason and not wanted to risk tearing to your arsehole again is a pretty good reason IMO.

If you go to the consultant having read up and clearly present your arguement, they will probably be more inclined to go with your wishes I think.