Granulation scar tissue in 2 degree tear with DC1, poss issues with subsequent labours?

[NeedlesCuties]

I suffered a 2nd degree tear with DS (2 years ago) but it didn't heal well, had granulation scar tissue and took over 6 months to heal and multiple visits to Drs to assess it. Basically I was told that some people just don't heal well in that area of their body and that I was one of them. I was referred for surgery to burn the bad scar tissue off, but thankfully it healed itself a week before my surgery date!

It still aches a bit and I'm aware of it if I sit awkwardly. It doesn't negatively impact on sex, which was a big fear of mine and I'm scared that something bad will happen to our sex life if the same happens again.

Am 17 weeks pregnant with DC2 and scared about this labour. Community midwife said that I might need a senior Dr present and to stitch me up afterwards. The way she worded it was a matter of 'when' not 'if' I tore this time :( She is very experienced, with +30 years service, so I do trust her judgement.

I would like to speak to someone in the hospital about my notes from DS's birth and to discuss options for this labour - I wouldn't rule out a c-section if it is deemed to be safer. When is the best time to approach the hospital about this? I have my 20 week scan next month and will be having another scan at 34 weeks, which is normal in this part of the world.

Advice please. Up to now I've been burying my head in the sand, but know I need to be proactive about seeking out help and guidance.

I had a second degree tear with my first pregnancy and had a lot of stitching. I had some granulation burned off with silver nitrate as it was causing me discomfort. I also had a second degree tear with ds but was not stitched as there was no bleeding (maybe it was the existing scar tissue that tore rather than normal skin). I felt so much better quicker with the second birth and still think the tear/stitches with dd was much worse than the birth itself!

Hi there, it would probably be a good idea to try seeing a consultant to coincide with your 20 week scan. That's when I first went to see one concerning an ELCS. I'm 34 weeks pregnant with my second baby and feel that ELCS might be the best birth choice for me, after developing coccydynia (awful tailbone pain) after the birth of DD1 in 2009.

My experience has been that the consultant was keen for me to go for another vaginal birth and I was warned about the risks of CS. I was only informed about one of it's benefits, and not told about the comparative risks of VB! In retrospect, he couldnt have possibly known about the risks involved for my particular case (I have since seem a chiropractor to get this side of things). So I feel that I received skewed info from the consultant, info which frightened me, my husband and pushed me towards a birth choice which has a high risk of damaging the same area of my body.

There might be a similarity in our situations in that we have both 'successfully' delivered babies vaginally in the past. Yup successful in the sense that they were/are healthy babies/children (thank goodness) but the issue is the toll that it has taken on our bodies, which hasn't really factored into the OB's assessment of my case. You might be different, but as there is no certainty that you'll tear again, you might be encouraged to labour in water to soften the perineal tissue; do perineal massage a few weeks before the birth; adopt particular positions during delivery, etc.

But the bottom line is that if you want an ELCS and that is your prophylactic choice - then you should be allowed an ELCS because of the new NICE guidelines. I can go into more detail if you'd like to talk more, but I don't want to assault you with the processes of my decision-making over the last 14 weeks!

Oh, and congratulations on your pregnancy :)

Thanks for getting back to me :)

Seona is good to hear your 2nd experience was much better than your first. I also feel that the stitches were worse than actually giving birth to DS :( They didn't freeze me properly and I felt every single stitch. I remember looking down and seeing a trail of blood across the floor and down the corridor from when they moved me from the delivery room to the room for stitching.

lunar I do think I'll ask to speak to a consultant at my 20 week scan, or at 34 weeks. I think it might work in my favour that DH is a Doc who used to work in that department and knows some of the staff.... He will know a lot more of the medical jargon than I will. I just know that I don't want a shredded fanny and to be leaking wee, thanks very much.

With DS's labour I had been in the birthing pool for 9 hours, wasn't progressing much so they moved me out of the water at the pushing stage and on to a bed. It was when I swung my leg out of the pool that I tore, I can remember the sound of it :( but not the pain as I was beyond myself at that stage.

I think I might do a bit of research myself on CS versus VB and discuss it with the hospital staff. A bit worried about looking after a 2.5 year old and a newborn after having a CS, but I suppose looking after them with a torn-apart fanny would also be hard work....

A couple of thoughts.
An obstetric/gynae physio might be able to assess/advise/treat your perineum. It might be worth paying for a private consultation if the waiting list is long. If there is no serious damage and vaginal birth seems a reasonable choice, then perineal massage can improve elasticity a lot (from 34 weeks). In my experience, there is usually a lot more natural stretch the second time around. You can also plan for a very controlled delivery of the head rather than it suddenly popping out like it seems to have done first time.

Thanks mayhew I do think that I'll ask for a controlled delivery of the head this time round.

Will make some notes now and over the coming weeks about my ideas, fears and things people advise and take it with me to the hospital when I go.

I also had granulation tissue after 2nd degree tear with DC1, I ended up having overgrowth removed under GA.

While pregnant with DC2 I was terrified of the same happening. I ended up with a fab homebirth, 1st degree tear, no stitches needed. I had been warned I might tear along the same lines but happily not.

I did tell midwife I was scared of tearing and needed coaching through pushing - I certainly held back a bit and DS didn't come shooting out like DD! So it can definitely be better second time. Hope your birth goes well, whatever you choose.

Thanks Sox that is encouraging, would love a great 2nd experience.

Not really keen on a homebirth, am happy enough to give birth in hospital, but just petrified of tearing badly again.

I would see if you can get a consultant to look at you anyway, just so that you know what your scar is like now in terms of future vulnerability. I had granulation and some other probs to do with damaged muscle which needed surgery in the end and for that reason am opting for cs this time round. If your scar tissue isn't too thin and there is no muscle damage from your last delivery then you might be fine as most people seem to agree that that things will stretch better the second time anyway.

Thanks all!

I have been making notes on what you've been saying and from a few other threads I've seen on here.

You're all very wise :)