Advice please - labour decision after perineal tear

[emma983]

Hi,
I'm just looking for some different opinions, I'm struggling to make a decision, I am 20 weeks and have my consultant appointment just after Christmas.
With my DS1 I had a normal delivery, but unfortunately it resulted in a 3C perineal tear. I also hemorrhaged, lost a lot of blood and my HB level dropped to 7.6, which I believe is quite low. I was diagnosed with PND soon after his birth and overcome this through counseling and medication. When DS1 was 4 weeks old I also had to have my gallbladder out in an emergency operation. All in all, I don't have particularly positive memories of that time.
I have had numerous appointments with my consultant with regards to my choice of birth for my second child (I wasn't pregnant at any of these, the Jan appt will be my first with him whilst pregnant). The trust I am in has an extremely low Caesarean Section rate, and they have already made it clear that they would recommend a VB to anyone who has had a 3C tear.
I am still symptomatic from the tear, and obviously tearing again carries the risk of lifetime incontinence, which is horrendous. But obviously there are risks from a caesarean too, and I will have a 23 month old and a newborn to take care of.
I am not expecting anyone to make a decision for me but I would like some opinions from others that have been through a similar experience. I would like to know my own mind before I go for the appointment so that I can be prepared with a list of questions, etc for him.

Thanks in advance,
Emma x

With the potential of being left with lifelong damage and the very traumatic/negative delivery the first time round I would be probably be asking for a c-section. Your body hasn't recovered from the first go round.
Everyone I know who has had a c-section has recovered well and quickly.
It is a major operation and so not a decision to be taken lightly but don't be railroaded into a v-back just cos they want to keep their lovely statistics.
Obviously that's just me!

I had a 3b tear with my first, went to my consultant appt and he looked at my notes and said he'd advise a section, I agreed (without really exploring alternatives!) and booked a date. If you have any problems at all from your first tear, don't be embarrassed about talking about them a they need to know. And problems are not just physical.

Forgot to say - my recovery with the c-sec was easier than the tear, even with an infection 3wks post birth in my c-sec scar.

I had a 3B tear (with long recovery and PND) and if I have another, I'm going to insist on a section. The long term implications of another severe tear are just too great. And also, I wouldn't be able to go through labour in a good frame of mind. The fear of tearing again would be immense.

I had a 4th degree tear with DS and am 32 weeks with DC2. I've opted for an elcs, mostly due to the physical side of things but also for my own peace of mind. So much of what happened to me first time was out of my control and as this pregnancy is progressing my anxiety about going into labour naturally is rather high. This is the right decision for me. If i was to go into labour naturally i feel like i would freak out and not be able to focus on breathing through contractions and i would definitely be too scared to push properly. I've recently started getting braxton hicks which are quite painful at times and its enough to make my eyes water and get panicky. I'll have just over 2 years age gap.

Thanks everyone. I really appreciate you sharing your stories, I think I have pretty much made a decision.

x

At my trust a 3C tear would be recommended csection.

With a previous third degree tear your chances of another are 4x higher the normal risk. Normal risk is anywhere between 1 and 3% depending on the study. So that puts your risk at between 4 and 12%.

That fact was told to me only a few weeks ago by one of the country's leading perineal trauma specialism obstetric consultants. After a day of teaching from him and a colo-rectal surgeon personally I'd be wanting a section.

Good luck with the appt.

Yes I have heard that a lot of other trusts would automatically offer you a CS. At my other appointments my consultant has maintained it would be my decision, although made it clear they have a 'low CS rate', etc etc.

I have my husband coming to my appointment with me, and I know he will back me up, especially when those dreaded pg hormones kick in!

I also had a 3 c tear with my first child. I had some bowel urgency which got better after a while but then became worse again when I was pregnant again.
I was surprised to be referred to a obstetric consultant who discussed me having a C section. I had assumed I would just have a VB as before.
However, due to my ongoing urgency issues, I was then refereed to a gastro/ intestinal/ bowel consultant who had a poke about and checked how strong my sphincter was or wasn't and then advised me that there were no major issues and I could have a VB with no problems if I wanted to.
You could ask to at least be referred to a gastro consultant before making any decision. You have plenty of time to decide!
I then went on to have a quite quick and very straight forward home birth with just a small 2nd degree tear which healed well and I have had no issues with. My bowel urgency is pretty much non existent except for the occasional bought of urgency if I have loose stools.
Good luck with your decision.

I Enma

I had a 3B tear with DS and was told I could opt for a CS next time but unless I was symptomatic they would suggest a VB.

Since you said you are still having symptoms I'd probably be asking for a CS in your shoes.

Good luck whatever you decide.

I just wanted to add my own story, ds1 was EMCS after 25 hour labour, failure to progress and a baby in distress. It wasn't the birth I wanted but it was the birth I got.

Recovery was good and I could drive after 2 weeks but chose not to (I did a test drive just in case I needed to get ds1 to hospital -lots of issues with him)

Roll on to ds2 and I chose a CS, the decision was made just after my 20 week scan when I saw the consultant.

First time round the CS was rushed, it wasn't a crash section but they were very hurried about it all (jogged down the corridor when they wheeled me down the theatre) second time round, it was all very calm, a careful operation and seemed altogether more peaceful.

I did get a slight infection at one end of my scar which was sorted out and recovery was slightly longer probably because I had a almost 3 year old and a newborn and not a huge amount of help (DH was amazing but family too far away)

I think mentally you would be worried the entire time you are in labour about tearing, and if you did tear again would you regret not choosing an alternative? I prepared myself for a c section first time round as ds1 was breach until 34 weeks and was relieved to be having a VB when he turned. Who knew? Ds1 is now 10.

Thanks for sharing your stories.
I think I am more concerned over the mental side of things as opposed to the physical. Control is a big factor for me this time. I have had an ultrasound round my tail end and there was no major damage, but as I said in OP I am still symptomatic which is what concerns me.

I had a 3B tear which healed well. Second birth was a VB and didn't tear at all. No one ever discussed the possibility of a C section with me. Hmm.

I think if one thing is clear from pp's is that the advice given from trust to trust varies massively.

See if you can have an endoanal ultrasound? You may need to be referred elsewhere for this. Best of luck!

I had an unassisted birth with 3a tear apparently "just a few fibres tore" 3.5 years ago. Dd2 is coming in April and I requested an elcs at 16 weeks which was approved straight away by a very supportive consultant.