SHOULD I opt for a section...opinions really needed please??

[pucca]

Ok, i am 17 weeks pg with no 2, i am going to discuss mode of delivery with my consultant in a few weeks and i need some opinions please?

My dd was 9 lb, and i suffered a top of the scale 3rd degree tear, the pain of the tear wasn't so bad but it did take me 4/5 months to be able to control my bowels again (sorry TMI) andi am quite frightened of ending up with no bowel control at all or a 4th degree tear if i go vaginal again, even i really don't like the thought of a section.

Now obviously no one can predict if i will get a severe tear again so i am in limbo...

I will go with what ever the consultant thinks best, but i will also have a say too, i am quite likely to go over EDD as i did with dd, and obviously the weight of dd, and possible weight of no 2 is also a factor.

What do you all think?

TIA

I'm inspired that you have gone for it - even with your dilemma - i think you've been really brave! How old was your first baby when you got pregnant?

My situation is v. simalar to yours. Currently, i'm thinking of going for an Elec Csec next time (not brave enough to get pregnant again yet!). Reasons are:

1. Risk of incontinence - couldn't face that
2. Risk of heavier baby - mine was 9.4lbs
3. Risk of being over due again - suffered at the end - especially with SPD
4. Speed of birth - my first was v.fast - worried if next one as quick - as can cause lot of damage
5. Recovery took months first time - so even if Csec takes a long time to get over - it would be the same for me - probably better in my case - and may be yours.

I know the risks and reasons for VB over CSEC but, in some cases, Csec may be better.

Of course, this conclusion is based on my ponders today, ask me tomorrow, and i'll probably change my mind!

Let me know what you decide. And best of luck! xx

p.s I'm speaking from personal experience - not medical, you have to go with what is right for you. Keep asking about, so you're happy with the decision which is best for you.

FWIW, both DS2 and DD were smaller than DS1. However, I don't think that size is actually a huge issuer here (snort!) It will depend more on how well the tear healed and how strong the scar line is. With DS2 I had an episiotomy when the scar from the tear began to tear again and, as I said, DS1 was smaller by nearly a pound (and 2cm on the head)

I had a 3/4 degree tear with my first (9'11, arm and hand presentation) but had no problems.

I was pregnant again within 10 months. Everyone (midwife) said that I could have a vaginal birth but because I had a prolapse as well (joy) she sent me off to the consultant.

He said the tear had healed well but that there was a 2% chance of becoming anally incontinent if I had the baby vaginally. And that this wouldn't be able to be 'fixed' because it wouldn't be possible to repair the nerve damage. There was a 1% chance of having an infection if I had a section.

He didn't advise me either way (which is hard) but we decided to go for the section. Written down it seems the obvious choice.

The section was great. It really was one of the best days of my life. We knew when the baby was coming, so could arrange childcare, DH could book time off work, arrange for family to visit, etc. I was scared on the day (it suddenly dawned on me it was an operation!) but the theatre staff were lovely and were so happy for me. I didn't have any problems and didn't have the trauma that I'd had during my first baby.

But... it was hard recovering from it and I found breastfeeding hard. However, the recovery could have been down to the fact that I had a boisterous 18 month old to look after and I think I found the breastfeeding hard because I wasn't anticipating feeding a baby again. My last feed had been to a year old!

If you do decide to go for a section, I would advise making a birth plan. It made me feel like I had some control over the birth and that it was a birth and not 'just' an operation. It was read through several times by staff who explained what they could and couldn't do and it was respected. Small things like I wanted DH to say 'It's a ...'.

HTH.

I've had an elective section and a VBAC and they were both great (in different ways), so I can't really advise you on what you should do (I had the section for a non-repeating condition, so no reason not to try for a VBAC 2nd time round). However, I can reassure you that an elective section can be a really positive experience. Because mine had been scheduled a long time in advance, I was the first one to be 'done' of the day. I went down to theatre at about 9.00 and dd1 was born at 9.41. I had a spinal anaesthetic (the worst bit is the local anaesthetic they give you before they do the spinal, which stings a bit like a bee sting). If you get the chance, get your dh (or someone!) to shave you beforehand. I'd been in hospital for 2 months, so the midwife did it (no chance of me reaching down there myself, lol!) and it was OK, but a bit hurried and impersonal. Be prepared for there to be a lot of people in the delivery room. IIRC there was the anaesthetist and her assistant (up my end, checking BP etc. all the time), the consultant, a theatre nurse, a midwife, another doctor of some sort (probably to wield the hoover thing they use to suck out your waters!!), a neonatal nurse (not sure if this is normal or just because I'd had problems and dd was expected to be - and was - small), plus my dh... it felt a bit like giving birth in the middle of a busy shop or something. But at the same time I felt strangely detached from what was going on at the other end of my body. I remember talking to the anaesthetist, but not much else till dd was born, at which point she was wrapped up (she was quite cold) and then given straight to dh and me. I held her throughout the second part of the op. The stitching up takes longer than getting the baby out, but it was fine. You just feel sort of pulling going on, but no pain at all. I had a morphine injection as soon as the spinal started to wear off, which didn't really agree with me (I was told I'd feel nicely drunk, but I just felt wierdly out of it and got into a panic because I couldn't remember what my baby was called, lol!), but did take the pain away. From then on, though, I survived on paracetomol and codeine plus voltarol for a day or so and then just paracetomol. I was catheterised till the next morning (thought that would be yucky, but it was OK) but they actually got me out of bed that same evening as I wanted to try to express for dd (who was being tube fed... didn't get anything out for a few days, but that's another story!). I was walking about (gingerly) the next day. The whole thing was a really positive experience.

I hope this helps. Your experience last time sounds horrid..., so although I went for a VBAC, I can see why you'd want to opt for an elective.

This thread is really interesting. DD got stuck crowning (DH and his big head and although I didn't end up with ventouse or forceps, I did have an episiotomy and ended up with a stretched coxcyx, on Paracetamol and Codeine for about 3 months. It still hurts 9 months later if I sit on a hard chair for too long and was agony at the time trying to sit to breastfeed dd. I was also faecally incontinent for about 2 months and had to have physio for over 5 months afterwards to try and get things back to normal. So I have been wondering the same thing, although not PG at the moment. If I was told that there was a risk of the incontinence lasting, I would seriously consider the section, as the incontinence I found really put some restrictions on my life at the time, and I don't know if recovery from a section would have much more of an negative impact than that did iyswim.

OMG!! Thankyou everyone so much for all the opinions and replies, it is really helpful to have so many different stories and points of view.

I am going to read over it all again now, and count votes lol.

SPIKEMOMMA...My dd was almost 2 when i got pg with this one. i don't know about brave! lol very stupid maybe, but then this wasnt exactly planned but a very nice surprise

The only thing i will add is the spinal and catheter part of a section wouldnt bother me (was repaired under spinal and had catheter with tear)it is just the thought of being cut open >

I had one emergency and one elective section. Both were totaly fine. I was out of hospital 5 days after the first and 4 after the second. No probelms after either, and was driving 4 weeks after the first and in the third week after the second.

Both times I was up and walking the day after the op

I've had a cs & natural births. Was really worried about cs but was fine. First day is difficult but after it's fine.

If there's a risk of damage to you I'd take the sure route. You'll need to be up & about to look after your dd plus your baby.

best wishes xxx

pucca
I too hated the thought of being cut open-but the good thing was nobody told me I had been until the op was well underway!!!! by which time they were saying "-right here it comes-my it's big..."
Honestly compared to birth experience no 1 the section was just fantastic.
My dd is now 17 months and I would never know that I had had major surgery-even the scar is hardly noticable.

I was so frightened and so wanted to go down the natural route if it was an option-but just imagine how anxious you will feel when you begin to push-about everything staying in tact.

HTH

I thinkI'd go with the section. 4th degree tear and bowel problems is more thaan I'd care to wager. yuck... and OUCH!

I've had two sections. Revocovery is a bit of a bugger for a couple of weeks (painful ti sit up from lying on your back), but if you can get night time assistance to get up and get the baby for say a couple of weeks, then you'll manage ok. Oh, and you can't run any marathons for a least 6 weeks. However, you can [robably drive your car much sooner (contrary to popular midwife stories).

Have a section, all the best. :)

I had a difficult labour with ds1 as he was so big. When I became pregnant again the consultant arranged for ds2 to be induced 2 weeks early so that he didn't get too big. Ds2's birth was far more straightforward.

Saying that, if I'd gone through what you did then I would probably be opting for a C-section if given a choice. It sounds as though the risk of long-term damage from a VB could be much greater than the risk of a longer recovery time from a CS.

Haven't had a vaginal birth but have had two c-sections - an emergency and an elective.

Both were suprisingly calm - despite the emergency.

With the elctive I was able to organise childcare for my dd1 who has special needs and whilst I was in for five days and then supposedly not allowed to do anything for 6 weeks. I can honestly say I was pretty much recovered after about 3 weeks. I was lifting my 2 1/2 yo ( not walking at that stage), driving and generally going about things. I wasn't silly with it - knew my limitations and went from there.

You said you are worried about the op - I had never had any surgery or any serious illness, never been in a hospital until I had my c-section. Yes the thought of being cut open is not so nice but really - I found I focused on chatting with dh and the surgical team - really was a peaceful atmosphere - even though with dd1 she was taken off to icu. In fact I remember I was so anti c-sections when pregnant the first time - mainly cause of it being surgery etc... figured it was not a 'good' option - in the end - the only option.

I would talk it over with your consultant. They were quite happy for me to have a vbac with dd2 but it did not work out that way. Weight was an issue here in terms of impact on my scar.... dd1 was just 6lb 1/2 oz and dd2 was 9lb 7 oz!

I haven't had a vaginal birth so can't give you a comparison but for me - the c-sections really weren't a problem. IN reality - best for me and my baby was what was important to me.

I had a bad tear with number 1 had to be stitched in theatre horrible experience with number 2 I gave birth Naturally with an epidural incase I tore so I could be stitched up in situ but although I had a ventouse delivery I only needed a couple of stitches

I am now 30 wks pregnant with no 3 and will try for natural birth again but at mo baby is breech so I would choose a section then

I know the fear you must be going through I am scared of it happening aswell I still have a few problems controlling my bladder occasionally and when I neeed to go cant hold it (TMI) my consultant was really good but pushed for natural delivery could you be induced early ? I was thinking about asking for this option so baby wasnt to big

don't think that the size of the baby is necessarily the cause of a bad tear. My ds was only 7lb 11oz, but he was lying in a slightly posteria position and the shoulder delivery was what caused the tear.
Also cannot imagine that your consultant would agree to an early induction to spare you an elective section given the risks associated with imature lung development.
IMO natural birth is the ideal but not when it puts the health of mother, baby or both at risk.

Well I have had a vaginal delivery and then next time el section due to problems after 1st delivery. Although I preferred the 'normal' birth as far as recovery goes, it is really only a few weeks at the end of the day. I would go for the section if I was you. Worse case you could end up with a lifetime of bladder or bowel problems.

look at this website:
www.radmid.demon.co.uk/thirddeg.htm#cs

Also this one:
www.homebirth.org.uk

Another vote for the section. I had emergency section with ds and the op itself really wasn't bad at all. I can't believe taht I was so afraid of having one. I am currently ttc and will go for an elective if we are blessed with another pregnancy.

"Also cannot imagine that your consultant would agree to an early induction to spare you an elective section given the risks associated with imature lung development."

Oh yes they would because the first baby was large. Induction 2 weeks early was offered to me by the consultant when I was pregnant with DS2.

Same as Soupy. The consultant offered me an early induction (2 weeks early) with ds2 so that I could avoid a CS if possible. This time around I've been offered one at 39wks for the same reason.

I have had a 3rd degree tear and the gynaecologist has advised me to have a c/s for future births. But i really don't want a c/s! i don't like the idea of being chopped up with a big knife! I think I am going to save up and get an independent midwife and have a homebirth and waterbirth to reduce the chances of having another tear. There doesn't seem to be any information on the exact risks of having another 3rd degree tear only that a tear is more likely following a previous.

sounds like a really good plan Boris - hope it goes great!

Pucca, I've had 2 elective cs followed by a natural birth. For me, and thats all we can talk about really, the natural birth was far, far easier to recover from and presented much less risk for me and my baby. CS is a major abdominal surgery and you need to weigh up the relative risks both to you and the baby of trying to have a natural birth and avoiding a repeat of the horrendous time you had, versus scheduling a cs. A good midwife or consultant (or several of em) should be able to help, but there is also a lot on the net you can read to help make your decision. Just google on caesarean risks, and on repeat third degree tear, and read as much as you can would be my advice.

You may then choose cs, but you may decide like Boris that there are many other choices and ways to reduce the risk of having another disastrous tear which a good knowledgeable midwife will be able to help you with.

But no one can make this choice for you. You will know in your heart of hearts when you have made the right choice, because it just feels right for you, and you'll feel safe.

Personally, I've never had a dreadful natural birth so can't comment, but have had 2 pretty awful elective cs ... and couldn't countenance the significant risks of another but that is just me.

also speaking from my exp, one elective one vbac, 3rd degree tear. I had a v good recovery from my ecs and obv similar to you on my vbac (also had heamatoma so had to be cutopen and restitched - nice). bowels were not the same but they were never completely gone iyswim.

I am not pg at mo but plan to have a water birth come hell or highwater as was advised this would slow down birth. don't know how i wld go about this but plan to have a bit of a fight and might hire someone. if bb was breech again (like dd1)wld have ecs no probs. either way i think i'd just accept my choice and not beat myself up about it. You can have a dreadful recovery from cs, just like you can have a dreadful vaginal birth, it's impossible to tell. sorry not to give definitive answer...