3rd degree tear c section

[Rajheath]

Hi. After a bit of advice please.
Sorry this is a long one

Im 24 years old and 34 weeks pregnant with my 2nd baby.

My first is just over 3 yrs old. And i had forceps to help delivery and resulted in a 3rd degree tear (3B)

I obviously knew it hurt and wasnt what all mums have but i didnt and wasnt told the extent of it.

When i went to hospital for scan to see how far along i was with 2nd baby (found out i was 14 weeks at time) doctor kept me behind and explained just how bad it was that i experienced last time and highly recommended me to have a c section as chance of ripping again and being left with colostomy bag. He wouldnt even nod in the direction of natural birth. I was highly against this but he said go away with partner have a good chat and he'll make another app at 34 weeks to check were on track for c section.

Fast forward to today to appointment.

Different doctor and has told me theres slim to none chance id be left incontinent and that if i have a c section it will just be my birthing choice as she cant see any reason for me needing one.

Ive had 20 weeks of warming to idea of c section to now be told i dont need one.

Im confused and completely lost.😭😭

I don't want to be ripped again and have any issues or any problems later in life that the 1st doctor said but i dont want to have a c section if not necessary.

Any advice welcome. Thanks

If you've had a previous 3rd degree tear you have a 7% chance in average of another tear. However your tear would have been likely due to the forceps so your individual risk will be lower than 7%. You are less likely to need another forceps with a second birth.

Did the drs say what grade of third degree tear you had? 3a, 3b? Did you have any problems with either fecal or flatus incontinence following the birth?

3B i had before.
No i never had any problems. I actually think myself i healed really fast and well with no issues. Its now the 1st dr thats got me worried saying could end up with colostomy bag 😣

I had a third degree. Was told conflicting stuff on c section need. I did not have a c section and the consensus is there is not a medical need for one. I did have a 2nd degree tear. My fault really. Midwife told me to go as slow as I could and I just gave the push of my life. Anyway nothing I couldn't handle. Good luck op. I would a for no c section but if you want one you can have one.

I had a 4th degree tear and have wind control and faecal urgency issues, albeit relatively minor ones. However they got worse with the pressure pregnancy put on my pelvic floor and I decided I wasn't happy with the risk of further tears. I had a c section, which despite an infection was definitely the right decision for me - though I did change my mind lots of times when I was pregnant

Can you ask to speak to the first doctor again to find out what his advice was based on? You should be able to have a scan to assess the extent of the damage to your anal sphincter from the first tear and how well it's healed. You do have a risk of another bad tear and incontinence, though that risk would still be present even in a first pregnancy so I guess you need to think about whether you're prepared to take that risk, even if it's small. Personally I wouldn't be, but I think you should try and get further information from your consultant as you've been given very conflicting advice which doesn't seem fair.

I had 3rd degree tear with first, healed quickly no issues at all. Just had 2nd baby, was told no reason I couldn't have natural birth. Did and bad 2bd degree tear that has healed fine again with no issues. I would research best labour issues to avoid tearing and mention it to midwife when I labour. Mine was brilliant in giving me instructions and held flannel I'm to prevent further tearing.good luck!

Hi, no experience of a c-section so can't comment on what that involves but I did have a 3C tear when delivering my little girl (now nearly 2), due to forceps being required as a result of her positioning and size.

My repair was good and yet even with physio I am still having slight issues with controlling wind and faecal urgency, quite often I feel uncomfortable and sex is still painful and feels weird.

Personally I wouldn't want to risk tearing again, or tearing worse, and will try to push for an ELCS if I ever have another baby.

When I was pregnant with DD I was terrified of the possibility of having a CS but the recovery from the tear has been so long and painful that I feel mentally I would quite probably be unable to push out another baby for fear of tearing again..

Good luck with whatever you decide, hope the last few weeks of pregnancy go quickly!

Hi Rajheath!
Sounds like the second doctor didn't really know what they were talking about. Only a fourth degree (and a bad one at that) would result in needing a temporary colostomy and this is so, so rare. (A 4th degree essentially tears into the rectum and therefore you very occasionally need to divert the poo away from the area as it heals).

There is a risk you will get another 3rd degree, but as has been said, you're much less likely to need forceps this time round, so the risk is somewhere between 1-2 in 20 for you.

The main concern is that, if you get another 3rd degree, it can be harder to repair well due to previous scar tissue. Therefore, if it caused you problems which you eventually recovered from, another tear might cause problems that don't recover (or don't recover as well).

If you had no problems controlling your bowel motions or wind, you do not need a scan. It won't tell you anything more - function is the most important thing.

The general consensus among obstetricians is that if you recovered well, with no bowel symptoms, natural birth is probably the best option (all else being equal). If you had a terrible recovery from the tear, and had problems with bowel continence (even if they have improved since), a caesarean might be worth considering to avoid the same issues which could be worse/less recoverable the second time round.

Sorry, I meant the first doctor didn't know what they were talking about! The second doctor sounds sensible!

I would just like to add that having had a third degree and second degree tear, I know they can be horrible, but for me they were nothing compared to a c section. If I could plan my births again I would do exactly the same (apart from when I didn't listen when my midwife told me to go slow). For me I have no further issues and quick and easy recovery.