C-section after 3rd degree tear?

[locomomma]

Hi ladies, looking for advice. On my 2nd delivery, I had a 3rd degree tear. I was told by the perineal clinic that if i had a 3rd baby I would be assessed for a C-section. In my booking-in appointment, my midwife was a bit dismissive of this idea. I said I'd drop it for now but I might get a private consultation on it. Keen to hear if anyone else who had a 3rd degree tear was advised to get a c-section in a subsequent delivery. Thanks in advance xx

Yes. My mw was dismissive, too. The consultant wasn't, he took the risk of incontinence was seriously as I did and had no trouble in agreeing an ElCS for my DC2.

Good luck!

Thanks for that. Kinda thinking it would be nice to have an elective CS! Good luck to you too.

You can have one. I had one for my first birth because I wanted one. I was scared of giving birth, I didn't want to tear or for anything to go wrong.

I asked for one, showed I had looked into it, and was told "okay".

Watching as was wondering the same thing this week.

Still having physio 5 months postpartum, gynaecologist said I would be fine for a vaginal birth but given I'm still having physio for continence issues and generally fucked up vag so I obvs don't want to make them worse. And it's probably partially psychological too as I can imagine scars re opening etc. Yikes!

I'm not pregnant again yet though!

Sorry, waffle waffle.

Oh dear BreeVDKamp! I was fine after my physio and I've had no unintended 'evacuations' so I might not be a good candidate. I think a chat with a dr is in order! I'm only in first trimester. Hope you heal up well!

Oh OP I was out the house 6 days post section, walking around and pretty much back to normal. I'd definitely recommend it, physically the birth was easy

Thanks TaliZorah - sounds like you had a great experience.

I did physically, it was traumatic due to DS needing NICU/SCBU but my end of the birth was fine! I was very nervous as my mum and her sisters and my nan had awful births, hence why I asked for a cesarean. It was very calm, peaceful, and not painful.

I'm currently 39+5 with 2nd baby. Had 3B tear with Dd1. DD was induced, big baby, had epidural, forceps - all the risk factors for tear, don't remember being warned.... Luckily not left with any issues. Had a consultant appt and was told it was up to me as risk benefit was about equal from c section/vaginal. Opted for growth scan at 37 weeks to check on size of baby, s+s from 38 weeks then on 40 + 1 will be arranging c section within a couple of days if no action - appears this will be the case . It's a plan I'm happy with. Given it my best shot but like others have no wish to risk full incontinence with another severe tear! Consultant was lovely and perfectly happy to do what I was comfortable with. Good luck!

Hi locomomma
You do carry a higher risk of a severe tear again.
www.bjog.org/details/news/6391801/New_study_examines_mode_of_delivery_following_a_perineal_tear_and_recurrence_rat.html

It infuriates me that some healthcare professionals put THEIR agenda above your well-being AND capacity to make your own decisions.

The RCOG does recommend women with a severe tear have the opportunity to discuss what to do for a second delivery.
www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-third--or-fourth-degree-tear-during-birth.pdf

As in your case, it is true that some women who suffer a (repaired) severe tear do not experience any type of incontinence.
Having said that anal sphincter injuries are the leading cause of anal incontinence in women (see Bladder and Bowel Foundation).

I hope you can see an obstetrician so you can ask questions and discuss your options.

Thanks for all the advice. Totty12mum sounds like a totally sensible approach - good luck with the impending arrival!

Pinguina, you're absolutely right! The MW actually started to suggest that it was my fault that I tore - told me I would need to be careful what I ate this time so baby wouldn't get too big and that I had to listen to the midwife during labour about when and when not to push. I wouldn't mind but they let me go 15 days overdue (hence big baby) before inducing me and then the head came out with no tear/no episiotomy but they underestimated the size/weight and his shoulders caused the tear. So it totally was a case of her pushing her agenda. Thank you for the research links, very interesting. I feel if I wanted to push for an El CS now I could with this info. Honestly, the midwife made me feel like I'd imagined the initial recommendation in the first place!

It's funny the pressure I feel to 'go natural' like I'd be taking the easy way out if I got a CS. But what's wrong with opting for a stress-free run up to delivery? I've had two complicated vaginal deliveries now (first involved ventouse, epidural not working properly, delayed labour, stopped at 9.5 cm, syntocin, retained placenta.... the bloody works!). Maybe it's time for a change :-)

Just bear in mind the recovery after a C.sec is so much harder than vaginal. I also had a third degree tear with my first and asked for a C.sec for no 2 which was refused. No 2 was 10.2 and no stitches and 3rd was 8.4 and no stitches. Obviously its your choice but you could do perineum oil massage and stretch with an epi no to help prevent tearing?

I think I will push for something similar to totty for DC3, as with DC1 I had a 3b tear (9lbs 12ozs at 40+6) and with DC2, I had a 2nd degree tear (10lbs 2.5ozs at 40+10).

I'm currently 35+4, and next week I have a camera up my bottom to check for damage, and also a growth scan... so the plan of attack will be after that, but I'd be quite happy to have an at term induction. I'm less keen on an elcs unless the bottom scan gives bad news...

Didn't have a third degree tear, but DS was born via EMCS and it was great! Quick recovery, he was fine etc.

I have just booked my c section after a second, then third degree tear with each of my 2 DC. I found that each if the registrars I saw had a different opinion on the risks, but even though today's one clearly thought I was wrong, she still booked me on. I'm 34 weeks now.

Birdlady it's not accurate to say the recovery from a c section "is so much harder than vaginal". It's harder than an uneventful vaginal delivery certainly but that's not what we're talking about here.

I had a 3a (I think) tear last time & saw the consultant after my 20 week scan this time.

I want to avoid CS really, and the 'big' hospital at all. The consultant said there were things we could do to reduce the likelihood of tearing (perineal support, deliver kneeling they wouldn't let me last time) and that statistically I was far less likely to have any complications this time around anyway.

But, I didn't have any ongoing problems afterwards, and didn't have any physio or follow-up investigations because they arranged them for my first day back at work and wouldn't change it.

If I were you, OP, I'd ask my midwife to make sure I was booked to see the consultant at 20 weeks to discuss it. If you'd be happier with a CS then make sure you're insistent as to why.

Thanks for all the advice. I change my mind every other day. I think I will get a few professional opinions. I figure the chances of recurring are low enough and you get out of hospital fast etc. However, pissy knickers for rest of my days ... no thank you! And to avoid that, CS seems like a relatively safe way to do it.

And yes Iggi999, I agree that is a major distinction which most people seem to miss. My mother/DH are surprised that I'm considering a section but I wound up in surgery after both my deliveries so it's not comparable to a straightforward vaginal delivery.

AmberLav, I wasn't aware that cameras went up bums to assess situation. Delightful, I'll look forward to that!!

Thanks everyone!

I have done a U turn. I am being induced today. Starting from waters being broken as cannot be bothered with waiting for the pessary to not work! In the end decided c section was certain physical interference whereas maybe, just maybe things will be easier this time. Been a really difficult decision and I was in bits yesterday trying to decide. I have been really lucky that all the consultants have been really supportive of whatever route I've wanted to go, they are not all obstructive!

Good luck Totty

Thanks Iggi999 will try to update later after my Zen experience!

Ooooh good luck Totty

I had a 4th degree tear with DC1. When pregnant with DC2 it wasn't until a 36wk consultant appt that c-section was discussed and booked.

Midwives were not able to agree the c-section, so you need to ensure you are talking to the right person.

Good luck.

No camera up bum here!

Thanks Dulli, glad to hear no bum invasion! Totty12mum ... Let us know how you got on!?!