ELCS vs Vaginal following 3rd degree tear

[mamablondie]

I need to make a decision about this and need some advice. I had a 3rd degree tear with a big first baby and never managed to get the follow up tests done (I know, I know).

Any way... I haven’t had any problems and recovered really well. However I am worried about the risks of a natural AND petrified of the csection recovery. Hoping someone can help with my main questions:

-Any tips for breastfeeding after a Csection?
-General recovery advice for CSection?
-Any vaginal second deliveries after a first tear and was all okay?

• Would epidural help to avoid tearing in vaginal?

I could have written this post. No advice but I'm in the exact same situation.

Following hoping to get some answers with you

I had a 3rd degree tear after my first son was born 12 days overdue at 11lbs 10ozs. I made all involved promise I would be induced on my due date with my second. When it came to it the consultant tried to persuade me to change my mind to be induced but I was adamant - i was induced and my second son was born on his due date at a respectable 8lbs 10ozs. In retrospect my older son was probably bigger because I ate badly, i was shattered so we had a lot of takeaways etc. I was equally as tired for the second one but we couldn't afford the takeaways (!) I also had an internal check from a midwife to see if my perineum was elastic enough.
The second labour was very intense with the induction, recorded delivery was 2.5 minutes

@CantKeepSecrets I’m so glad it’s not just me!

@ZigZagIntoTheBlue silly question but at what stage did your midwife examine you to see how much elasticity there was? Your reply has been so so helpful. I’m very early stages but this has been on my mind since first time so I’m keen to work on a plan. Did you have an epidural for second?

This was literally me a few weeks ago!

Had to make the same decision after 3rd degree tear with first, convinced myself I was going to go for c section then at the last minute changed my mind.

I've not yet given birth to this one so I can't guarantee that labour will end better this time round but the way I ended up seeing it is sometimes it's better the devil you know.

You're guaranteed to have a longish, painful recovery with a c section whereas you've got a 4-5% chance of having another tear.

My consultant advised me that this time round I would monitored more closely and they're confident we could have a better outcome this time. If I opted for a c section I can guarantee not being able to care for baby or DD solely on my own for 6 weeks, I wouldn't feel like me, wouldn't be able to drive, I would constantly be worrying about the scar and risk of infection so vaginal delivery just ended up seeming less risky.

I have also been advised to opt for an epidural this time as it allows you to be more in control when it comes to pushing and will allow the midwives to make a cut as soon as they think I could potentially tear as we can take everything slower.

It's completely up to you though and you should go with whatever feels best. I described it to people as the same choice as someone asking if you want your left foot stamped on or your right foot - there's no clear good option so I really do sympathise! X

This was me.

I ended to having an appointment with a consultant midwife, who explained high risk things eg avoid water birth as they have less visibility and all the things they could do to minimise another tear. She wrote my birth plan based on my concerns so that any midwives would first read that.

That hospital had a particular program for VBAC (which encompassed third year tears)

She gave me the confidence to avoid CS and I’m really glad I did. They did do a small episiotomy (tbh I preferred the spinal for the year 😂).

I think my original was being allowed to push for too long and then midwives encouraging me to try harder to avoid bringing in doctors as i was long over an hour. The plan also included what would happen if times were breached a second time.

I hadn’t realised how long it took me to recover the first time until I was able to run across the road within a few days the second time.

I did have pelvic floor issues from the first time which I didn’t discuss until second pregnancy and I was booked into women’s health physio before DC2 was even born.

Interesting you say that @Amaura as I was meant to have a water birth with my second, it just went so fast they didn't even get the taps on 🙄🤷‍♀️

@mamablondie I was about 20 weeks I think, it was 4 years ago so I can't remember exactly however I would echo what @Maxamill has said, the C Section is a guaranteed recovery time and I wanted to avoid that with a 4 year old and a baby plus school runs to factor in.

Good luck with whatever you decide!

Thanks so much everyone this has been so helpful, :)

You're guaranteed to have a longish, painful recovery with a c section whereas you've got a 4-5% chance of having another tear.

Not true. I had an EMCS and my recovery was really quick (e.g. driving and walking around normally within 2 weeks, with medical approval).

My milk did come in slightly later which I understand is common after c section, but I still managed to exclusively breastfeed without any issues and still BF now with DS coming up to a year old.

I think the stats show that having an epidural slightly increases the risk of tearing in a vaginal delivery, though not sure why that is - maybe because you can't feel it and therefore respond as intuitively to the midwife's instructions for when to push/stop pushing?

Good luck with whatever you decide OP

Hi op!
I also had a 3rd degree tear, but unfortunately alot of other birth complications followed it, so felt for me, that the whole experience was so traumatic!
I lost so much blood that my recovery was slow, even with a transfusion, and my tear I found painful for a good six weeks I'd say. I couldn't sit down! So this time, I'm opting for an elective, which I know isn't the easy option by any means, but I'm hoping the birth experience will be calmer for me this time around, and more controlled.
Also with my 3rd degree tear I had an epidural, and I also thought the chances of tearing are higher with epidurals too, though I'm not 100 percent... But I also had forceps, so was most probably that that did me.
Hopefully you could go on to have another vb and all would be OK, it's great that you haven't had any complications following it. I still suffer with pain almost three years later, and very weak pelvic floor muscles... Also few issues with going to the toilet! sorry if tmi! I think another vb for me would finish me off! but for you, it sounds like the chances of another tear are slim, but also I guess it depends on how much that first experience effected you. Also accepting it may happen again, although a very small chance, if you feel you could cope with that, and the very small risk that you could tear again, then I'd certainly go down the vb route.
Also they say the longer you leave it between your next birth the better, as you have had longer to heal.
Good luck which ever option you choose!

@Nicecupofcoco you sound like you really went through it! You’ve pretty much summed up why I was entertaining a CSection, I think for me the key difference is that I did seem to make a very good Physical recovery last time - I was up and about after a few days etc. But I don’t want this to sway me either because ultimately I need to be fit and healthy in the long term. I’m still very early on so going to keep researching and see. Good luck with the CS and your new baby!

@rottiemum88 thanks that’s super helpful. Any tips on breastfeeding after? This is one of my main concerns as DD1 was latched within a few minutes. I worry about delays in skin to skin etc

I had a third degree tear with my first which healed well. 2nd I had a graze then my 3rd (last week) I had a second degree tear but can't really tell that it's there.

There was a delay in terms of skin to skin while I was sewn up after the surgery, maybe 45 minutes or so and then I was wheeled into recovery. So DH held DS initially, although I'm sure I was asked if I wanted to even in the theatre, but I didn't feel comfortable as the anaesthetic made me a bit shaky). As soon as we were in recovery I was encouraged to feed him if I wanted to and we had a good hour of skin to skin, left alone by the midwives (although they were always nearby if we'd needed help with anything). All round it was a really positive experience and knowing what I know now I'd opt for a section without question if/when we have another

I had a 3b tear with my first, fortunately no long term issues once healed & healed fairly quickly. I was concerned when we found I was expecting again as to whether I'd tear & if so whether I'd be lucky enough to have no lasting damage a second time round.

To be honest a c section was never even discussed with me, first tear was very much written off as caused by induction & then forceps delivery so no reason for it to occur again. This made me never even question whether I should opt for c section or try a vaginal delivery again. This worked for me as I figured if medical professionals weren't bothered then neither would I be.

Anyway, my daughter arrived virtually 2 years to the day after my son. She was 39+4 compared with 37+2 & weighed 8lb vs 7lb 1oz. Had a waterbirth with just gas & air, 2nd degree tear this time but again an easy recovery & no lasting damage.

Personally I'm really glad the idea of a c section was never put into my head as I didn't have a choice to make, a vaginal delivery was perfect for me & I recovered well second time round.

Like someone else said, the chance of a tear is still only 4-5% so very small.

Good luck making a decision.

@Jsh125 there was never a real explanation for mine, I had spontaneous labour, involuntary pushing and baby was 9lbs+ ... in what way did the induction contribute if you don’t mind me asking? This is something I would be open to next time as I’m hoping that I could avoid going over 9lbs and have an epidural so I’m a bit more aware of what I’m doing. Though I’m interested in the idea that epidural increases tearing risk.

I recovered much easily after my c-section tbh.

Plus people understand you’ve had major surgery and you actually get to rest more rather than the ‘get up and get moving’ people expect you to do after a natural one.

I had no problems breast feeding

@mamablondie I never had it explained to me either, this was just my community midwife suggesting that was probably why it happened & no reason for same thing to happen again.

Personally this approach really worked for me, didn't give it a second thought after she was so casual about it & really glad I ended up with a waterbirth. It's such a personal thing though that the same doesn't work for everyone.

I don't think the induction directly caused a tear but induction is more likely to lead to assisted delivery which in turn is more likely to cause a tear. That's my understanding anyway.

I had a 2nd degree tear for my second birth as well (they did query whether it was 3rd at one point) but recovery was super quick & uncomplicated. I'd do it all again in a heartbeat

@Jsh125 I see! Yes that makes complete sense. Really helpful, thanks so much x

I had a 3rd degree tear with first baby. After that, a 2nd degree tear (along scar) and then skid marks for the rest. I think I was fighting labour too much with my first. But with the later babies, I knew better to let go and let birth happen.
I would rather risk a tear than do an elective cSection.

My first was born with no tearing (6lb5) and I had a 2nd degree with my 2nd (8lb5)
I had a 3rd degree tear with my 3rd - he was 9lb induced at 41+5.

My 4th was born 23 months later weighing 8lb7 and I didnt tear at all.
I dont think there is a pattern to what happens but I wouldn't have considered a c section just in case.

@PlanDeRaccordement that sounds like the opposite of my problem the first time, I think it just shows that you learn a lot from the first time. Did you find your Labour was similar if that’s not a silly question? And with the induction did that make a difference? I’m going to push for growth scans etc as they let me go 10 days over last time and I’m convinced that may have been a factor. X

@PlanDeRaccordement apologies I’ve just reread and realised it was @HalfBloodPrincess that was induced - baby brain!

I had a 3dt and 3.5litre pph and infection/sepsis following dc1. Had an elcs with dc2 11 weeks ago - a much better experience! Calm, controlled, easy! Recovery was much better and quicker than with my 3dt which I found very painful and it hurt for months afterwards. I wad taking zero painkillers by day 10 with my c section. If I ever have another baby I will definitely go for an elcs - definitely the right decision for me. Good luck with whatever you choose.

I had a similar situation...first birth resulting in suspected 3rd degree tear (they won’t do the checks until this pregnancy is over)

The physio’s I’ve seen have advised c section for me as due to first birth theres no elasticity and Perenieum is short so have advised that a tear/worse tear is likely and would see worsening of my current after effects (incontience issues and suspected bladder prolapse) that could be permanent.

So for me I’ve decided on an ELCS. The risk of making my current situation worse or permanent is something I can’t stomach.

I’d suggest trying to see a women’s health physio and ask to be referred to a consultant to discuss options

My physio sent my consultant a letter stating the situation and I walked in ready for a fight and he suggested c section before id even put my case across