ELCS or not after 3rd degree tear

[BramwellHadThoughtOfEverything]

Looking for some advice or any perspective from anyone who’s been in this position before as I’m not sure whether to go for an offered elective C section or not.

In my first pregnancy (gave birth just under 2 years ago) I had raised blood pressure for a few weeks towards the end and was in hospital due to be induced as a result of that and growth concerns for my daughter when i developed preeclampsia and went into rapid labour very suddenly, giving birth after a 4 hour labour, 45 min active. Everything actually went very well although fast and I felt very positive about it afterwards although I did have a 3rd degree tear (3a) which was stitched in theatre.

I hadn’t been left with any issues after a few months’ recovery and this pregnancy I was surprised when at a consultant appt due to my preeclampsia risk they asked me if I would like to consider an ELCS due to the tear. I said no at first, I was happy not to, as I had no issues, but since then as this pregnancy has progressed I’ve started doubting I’ve made the right decision and wondering if I should revisit.

I do have some bladder weakness occasionally and recently realised I have no control whatsoever over it when I’m sick. I’m suddenly worried about worsening this and running the risk of incontinence.

Had anyone elected for a section after a 3rd degree tear? Or had a second vaginal birth? Thanks so much for any advice.

My sister had two third degree tears in a row. She wasn’t warned that once you have a third/fourth degree tear once you are more likely to have it again as all the research seems to focus on first and second degree tears which can be preventable. She has permanent pelvic floor damage now and regrets not going for an elective.

I suggest, if your consultant has given you the choice, you choose the elective.

I had a third degree tear the first time, was told I'd need an ELCS the second time but when the time came they said it wasn't necessary. I argued for one regardless. Very positive experience and for me a quicker recovery (I realise that's not everyone's experience).

I had a 3b tear the first time with a shoulder dystocia. Baby was only 7lb 4oz but a quick labour and didn’t turn properly. I asked for an elective section with the second as I didn’t want to risk further tearing and possible long term effects. Unfortunately I went into labour a week before my booked date and had to deliver naturally as the team were already doing an emergency section when I arrived. This baby was bigger, 8lb 9oz, and arrived much quicker than the first but I had only a couple of stitches as the midwives were very hands on with the delivery. I’m glad in the end I didn’t have the section as my recovery was much faster but I couldn’t have predicted it would go that way.

I had a 3rd degree tear with my 1st. 13 years later I had my 2nd. CS & previous tear were never even mentioned (poss due to time lapse?) As it was, my 2nd was a shoulder dystocia birth so I'd had an episiotomy (amongst other procedures and manoeuvres) and didn't tear at all. My 3rd was an ECS due to polyhydramnios. That's my lot now, but if I had to do it all again I'd choose vaginal birth every time - the recovery was much easier for me.

I am bias but it'd be c section every time for me. Wonderful experience and quicker recovery but you do get bad sections, just like you get bad vaginal births.

I had a 3b tear with the birth of my daughter almost 6 years ago. It was quite a fast first labour (about 90 mins active). I recovered well and didn't really have any noticeable lasting damage that was any worse than what mum's I knew who had lesser/no tears suffered.
I chose not to have a cs for the birth of my next child as for me the risk of major surgery was not worth it, plus the possible recovery period. Yes the risks are minimal but if there was a chance I could avoid it then I wanted to.

Sadly I ended up with a 3a tear 2 weeks ago. Again it was fast (30mins active labour) and although the midwives were really happy with the delivery (the end was very controlled and slow) I just ended up in the 3rd degree category.
The midwives said that I couldn't have done anything to prevent it, but it obviously meant surgery to repair it (and therefore the risks of spinal anaesthetic which I wanted to avoid)
I'm healing well though, but do lack bladder control at the moment. I'm only 2 weeks pp though and am doing my pelvic floor exercises regularly and hope that I won't end up with lasting issues.
I have physio booked in 4 weeks which should identify if there are any concerns.

You need to weigh up the pros and cons for you personally. Some people (like me) would do anything to avoid major surgery. Others would prefer the surgery to the risks of repeating the past and having lasting damage.

Thank you all so much for your answers and perspectives. I’m still not sure what to do yet but do have plenty of time, only 16 weeks at the moment and so will take the chance to talk to my midwife about it all at next appt. Really appreciate all your thoughts on it, really helps!