Severe tear in first birth, what to do next time round??

[TheGrandOldDuke]

I had a bad tear first time round and was told in follow up I could have an elec c-sec next time if I wanted.
Neither option appeals. The incontinence I suffered after the first time, if it were to happen again and be permanent would just be hideous. But then a c-sec is major surgery not without risks either.
Anyone know any stats on bad tear first time and what happens with subsequent births?
Anyone had this problem before and what did you do??
Thanks!

My friend was in this position as she had a 3rd degree tear with her first. Due to other problems with her second pregnancy, she ended up under the care of a consultant who happened to have a special interest in subsequent pregnancies after bad tears. She was offered an elective C section because of the risk of permanent incontinence. My friend was gutted as she had a home-birth with her first and wanted to do the same again. She had an ultrasound of the muscles in that area and they found a slight defect, which although she had no symptoms from, put her at higher risk of future incontinence, whether or not she were to tear second time round. She opted for the CS as she decided incontinence wasn't a risk she wanted to take. However, had she just been under the care of a midwife, it would probably never have even been discussed.

Tbh, for me even discussing this is a step forward, I was so traumatised last time I didn't think I'd even be able to consider another child.

Teacup - it's about how far up to and including your anus the tear is. I know 4th is up to, the sphincter, and then can be up the passage too.
3c is up to and the sphincter, but not up the back passage I believe.

HI everyone, watching this thread with interest (thanks OP) as in very similar position. 3b tear with ds, now 20 wks with DC2 and have to decide what to do. I am reading / hearing conflicting advice so it's really confusing. My consultant told me to be entirely symptom led - i.e. if I have no symptoms, go for VB, but any whiff of symptoms would mean worse after VB (esp if tear) and so to have a CS. He said there was no point in scanning for scar tissue, or to check size of baby. He also said there was nothing we could do to reduce the chance of tearing (e.g. perineal massage, waterbirth, birthing positions etc). In my heart I want another VB. The main thing that worries me is breast feeding. I really want to do this, and with DS I just couldn't feed lying down, so am interested to know if it's possible to sit up to feed after CS? (sorry to hijack your thread OP!).

I had no problems bfing after my Elcs. Really none at all I expected recovery to be much much worse than it was. It was honestly fine - after discharge I didn't even bother to take thd pain killers I was sent home with. I did self inject the heparin I was given though as i regarded this as essential (this came as a surprise that I had to do this and I was a bit squeamish about it - even my mother who is a nurse admitted she would have problems self injecting).

similar story to iggly really. I had a third degree tear with my DS1 (pushed him out too quick) and was umming and ahhing to have a c section but decided to do it naturally again, and ended up with a (thankfully!!) second degree tear. I was not left incontinent after the first birth so perhaps that was the deciding factor for me. Major surgery would have meant it would take longer to get back on my feet. I was anxious about it all the way through my pregnancy but turns out it wasn't as bad as I had imagined it was going to be.

For me, I don't mind the ELCS recovery time, I couldn't lift my son anyway for weeks after having torn pretty much through, I couldn't put any weight on my pelvic floor. And physically and emotionally longer term I think the recovery for me was worse than my friends recoveries for CS. Maybe they've all just been lucky!!

I had a third ( altho I actually suspect fourth ) degree tear as dd had shoulder dystocia, episiotomy and ventouse. They cut all the way through to my back passage include the muscle! Missed all the baby weighing etc as was in theatre, also lost a lot of blood.

Was in agony, couldn't stand for long, not comfy sitting which made bf harder. Laxatives for about four months, and would feel like i was pooing glass! sex wasn't comfortable until about six / seven months but lucikily is ok again.

Thank God no incontinence but hoital (uclh) have recommended c/s this time around which I'm soooo pleased about. I know it's major surgery but couldn't face the same as last time.

Had a 3rd degree tear first time, after forceps delivery and large (10lb+) baby. Temporary incontinence. 2nd degree second time,healed much quicker (less bruising) - but delivered without assistance and smaller baby (8lb). So I guess that the size of the person exiting via your vagina might have something to do with it - something you'll never know and may only get some clues during your second pregnancy.

smk84 I had no probs bf after ELCS. Was able to sit fine with the help of the hospital beds, and managing fine by the time I left hospital. Established bf much more easily as I wasn't run down by the trauma and shock. Still bf at 8 months

Got a BFP, so need to think about this seriously now!!!!

I had an em CS, my friend had a vb with 3 degree tears. She was up and about and well healed in 2-3 weeks while I was in vast quantities of pain. The CS sec opened up and got infected in a month, antibiotics for that have me UTI.
We are both as afraid of coughs and colds due to incontinence. (both had first baby btw).
I would not wish a C-sec on anyone unless essential. It plays a vital role in my decision to stop at one baby.

I did not answer your questions directly though