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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

Requested c section - midwife has referred to consultant gynaecologist...possible missed 3rd degree tear last time

18 replies

TakeMeToTheMilk · 12/03/2015 15:26

Long title, wonder if it'll all show up!

I saw the midwives today for my booking appointment (10 weeks). Basically during my first birth I tore. They said second degree but it didn't heal for ages, and I'm talking AGES, years. I told them today that I just can't go through that again (I know it may not happen like that but I can't risk it) and said I wanted a c section. They were very sympathetic about the long recovery and said it sounds like a missed 3rd degree tear. They have referred me to a consultant gynaecologist. Does anyone have any experience with something similar? Is this appointment merely going to be about 'fixing' past problems - which I don't want. 4 years on and I have just healed and don't want any meddling down there. I don't even want to be examined and definitely not internally. Or will this consultant be able to agree to my request for a c section?

OP posts:

Carrierpenguin · 12/03/2015 16:29

I have no idea what the protocol is for this, sorry! Hopefully someone else will have more information. However, ime the consultant you get may be crucial in your ability to get a section, I've friends who have asked for section rather than vbac for example, who have been declined, whilst others have been allowed a second section after a first due to the consultant being more 'section friendly'. It may depend on you local hospital/trust policy too.

Good luck!

snowydrops · 12/03/2015 16:30

Hello. This sounds v similar to what I have just been through. I had a 'borderline 2/3rd degree tear' with DD1, took months to heal and still sometimes hurts now slightly. Anyway I did the same as you and requested at least a discussion on ELCS at my first appointment. I got referred and all was fine. I have seen several consultants (swapped to a different hospital due to a move) and not one has ever questioned my decision. In fact only one ever really pushed me a bit on my reasons but all others were supportive and mostly said they could see why I was choosing that route. Even my midwife has agreed it's probably better after what happened last time for me (failed home birth, 3 day back to back labour, bad tear, looooong recovery). There are other considerations (womb shape) and things specific to my situation but If I had wanted I could be having another VB but I didn't want to risk worse tearing and incontinence. Don't worry yet, they will probably be supportive of your decision. I was ready for a battle but it never happened and in fact I then questioned for a long time whether it was the right thing for me and really made my own decision based on evidence the consultant gave me rather than just overriding fear and apprehension!

My baby is due next week. Good luck!

snowydrops · 12/03/2015 16:31

Also where in the country are you?

Quitelikely · 12/03/2015 16:36

OP when you say it took a long time to heal if you don't mind me asking was it your bottom that you had issues with?

If so then I would really think you had a third degree tear.

If it's been missed you have been failed miserably by those in the know, well they are supposed to know!

Original poster

TakeMeToTheMilk · 13/03/2015 08:28

Snowydrops - there is hope then. I'm going to ask at every appointment for a referral to a consultant who can agree to the section. I'll go to the gynaecologist apt if only to hope they can back me up in my request and to show I am jumping through the hoops they seem to want pre section. Good luck with your section next week snowy! I'm in Dorset. You?

Quitelikely - no, wasn't a bottom issue. Although I do remember having to go and urgently for quite a while post birth. It was the tear internally which didn't heal for years. YEARS!

OP posts:

Original poster

TakeMeToTheMilk · 13/03/2015 08:30

I'm not angry that they missed it. I do understand it wasn't deliberate on their part and accidents happen. It's just in their profession mistakes are more serious.

OP posts:

snowydrops · 13/03/2015 09:50

I'm up north now but was in London previously. Up here I have had no issue at all with the request but I got the impression it would have been more of a battle at the previous hospital just as friends in similar situation have found it harder. Good luck!

GingerbreadHead · 16/03/2015 15:22

OP this is so so similar to my situation! I had a missed third degree tear with my daughter over 3 years ago, and I still don't feel properly healed 'downstairs'. At the time they thought it was a second degree tear and stitched me up accordingly, but after a few months I knew something wasn't right so went to see my GP, who referred me to gynae, who confirmed it was a missed third degree and it will need reconstructive surgery at some point. I am now pregnant with my second child, and have been to see a consultant just this morning to discuss birthing options. He advised, without a shadow of a doubt that I opt for a c-section. He said that the chance of a third degree, or even fourth degree, tear happening again if I went for a vaginal birth is around 30%, and it could be very hard for them to do any sort of reconstructive surgery after that, making the chance of being incontinent for the rest of my life quite high.
I had hoped to try for a controlled v-birth, but after speaking to him this morning, an ELCS seems like the most sensible option. He was more than happy with this decision, he wrote it in my notes, even the midwife who was there as well agrees this is the best option, and I am just waiting to get a c-section date when I am a bit closer to 39 weeks. They both said that most people who have suffered third degree tears tend to opt for c-sections the next time to avoid any further damage.
I should think if they have already agreed that it was a missed 3rd degree tear it's likely that they will agree with you about a c-section. Especially after all the discomfort you have suffered over the previous years, they'd have to have a heart of stone to not consider it! You might have to have some sort of examination though OP, especially if no one has taken a look in the past 4 or so years. It's really not so bad though, and they are very gentle!!

blowinahoolie · 17/03/2015 11:22

I had a third degree tear which was repaired after the birth of my first DC.

At the birth of my second DC, I had a second degree tear.

I discussed C Section before giving birth to my second DC but was told it may not happen again - it did. OK, not as bad as a third degree tear, but I still tore all the same...

I am pregnant with third DC, and I am speaking to the consultant this week and hoping that due to my history I will be able to opt for a ELCS. Fingers crossed.

Part of me also feels like a total failure for considering a ELCS but I also have to weigh up that I don't want to be doubly incontinent for the rest of my life if I take the chance and have a VB third time round....

Original poster

TakeMeToTheMilk · 18/03/2015 20:27

GingerbreadHead - wow, so many similarities there! I'm definitely very reassured that they're likely to agree and suggest a section. It'd be nice to have someone medical agree rather than have to fight for it. I'm petrified about being examined. Being examined by the midwife having my first made me scream it was so painful. I refused to let them check after the first. How horrible is it going to be? (IF I let them examine me!) How long is it likely to take? I need to know so I can prepare myself!!
Congrats on your pregnancy! Hope all goes well.

OP posts:

Original poster

TakeMeToTheMilk · 18/03/2015 20:30

Blowinahoolie - good luck with your consultant appointment. It sounds like you have a good case for an ELCS. We are definitely not failures for considering a section! More like extremely brave for opting for major surgery. Good luck!

OP posts:

blowinahoolie · 19/03/2015 14:33

Had the hospital appointment today and spoke with a member of the obstetrics team and they would prefer I go for another natural delivery, not a C Section....their reasoning is that I pushed out a 8lb4oz baby (1st birth) and had the third degree tear (3a, so I got off lightly as it could have went all the way into the internal anal sphincter. I 'only' tore into the external anal sphincter), and then I pushed out an even bigger baby (2nd birth) 9lb1oz and got a lesser degree tear, 2nd degree tear. Because of this, they feel that I can go ahead and should be fine.

They have weighed it up and feel the odds are in my favour to have another natural delivery, where I may tear again, but she also said I may not even get a tear third time. There are no guarantees.

I don't have any lasting effects since the third degree tear, I can control my bowel and bladder movements and because of this she feels it is working in my favour to let things take their natural course.

I feel slightly reassured from the appointment that she spoke to her superior whilst I was there, just to double check and he said that I am in a good position to go ahead with the natural delivery. She did say that although I'm concerned about incontinence down below but that with a CS when they make the incision there is a risk they can perforate the bowel and/or bladder accidentally and a natural delivery is less risky if you compare the two modes of delivery.

Molotov · 19/03/2015 19:27

I think to say a VB is "less risky" is inaccurate. The likelihood of a fully trained, experienced surgeon cutting your bowel or bladder in a planned operation is unlikely (check green-top or NICE guidelines for exact figures). ELCSs are predictable and there is certainly a 0% chance that your vagina, perineum or anal sphincter will incur damage from a CS.

That said, an ELCS does carry other risks and the most pertinent are ones associated with the surgery itself and with future pregnancies.

In your position, I would be pressing them for the ELCS because I wouldn't want to risk that kind of damage to my undercarriage again - particularly if I wasn't planning any more children.

If you want to have another VB, then do so as you have spoken today and what you have been told is positive. But, it iantr a guarantee and if you feel strongly about this, don't let them force you into a VB.

Molotov · 19/03/2015 19:30

That was to hoolie, btw.

Moreisnnogedag · 19/03/2015 20:08

I had third degree tear (with PPH) after ds1 and I've just had an ELCS for ds2 2 weeks ago. I thought I'd have to fight for it but they readily agreed. Explained the risks but were happy with my choice. In fact, all the midwives who I dealt with (who I presumed would be against it) have all said they understood why I chose C-section.

blowinahoolie · 20/03/2015 09:42

Thanks Molotov for posting. I am now thinking of going for VB but will ask for an epidural so that when I reach the pushing stage, I will feel the sensation but not the pain like I did the previous two times. DH thinks that's the best course of action as well. The "less risky" wording was my own, the doctor did not say this exactly but it was what she was getting at in the conversation....

I think what the doctor was getting at was that I may not encounter another tear and the damage to my nether regions are more likely to recover (they can do repairs to it) than if they accidentally nick the bowel or bladder, it will have last repercussions (think colostomy bag etc). She said it's ultimately up to me, but she has to point out the risks.

I will chat with MW next appointment about my options again and get her opinion on what the doctor said.

At the moment, I think I'm going to brave it and go for another VB.

Thanks for your input too More and I totally understand why you went for ELCS with your 2nd baby. If you don't mind me asking, what level of third degree of tear did you have?

meglet · 20/03/2015 09:53

you need to find out the stats for damage caused to the bladder or bowl during a healthy planned cs section. The midwife sounds like she's scaremongering a little.

I can only vouch for general chatting with friends but while recovery can be hard I don't know anyone who has suffered damage after a section (hard recovery, yes. But no permanent damage). whereas a few friends have had some miserable problems after a vb, and a few more think it's fine they can't run because of their pelvic floor .

blowinahoolie · 20/03/2015 09:57

meglet I have never ran in my life so no chance of that happening after the birth, even if the pelvic floor does get damaged...

I don't have local family support and that's also putting me off having a CS too, as I will have three DC to look after after the recovery if I went down that route. I just can't see how I'd get a break after DH finishes paternity leave, I imagine it takes a bit longer than just two weeks to get back to normal?

Whereas if I chance it with a VB then I may end up running into problems down there, but the recovery won't be as bad as CS, IYSWIM? Ah decisions decisions!

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