2nd birth advice required - tear or episiotomy after first birth incontinence?

[pinkypig]

Hi,

I had a forceps/episiotomy delivery with DS1 which left me with no sphincter control for several weeks/months. (I still don't know whether it was the epi or forceps which did the major damage - what do you all think?)

I am due #2 in 11 weeks and want to avoid further incontince issues. Should I opt to tear or have another episiotomy (should either be necessary).

Thanks

my sister had an induction 1st time with episiotomy. Sadly 3rd degree tear with 2nd.

Have you spoken to anyone about it? Maybe it would be obvious from your notes what happened last time so that you could avoid it this time.
To be honest, I would also consider an elective C section as an option.

nope, an episiotomy can increase risk of more tearing and damage.

you should speak to your consultant and talk through the options, if your sphincter control was regained without surgery, then it might not be as much of an issue second time.

did you have 3rd/4th degree tearing or episiotomy last time? forceps can cause issues, i would talk it through urgently and find out what happened, and what is best for you next time

I had two 3rd degree tears with ds1 and ds2.You can still tear with an episiotomy and chances are the epis. scar will be harder to heal. I had sphincter problems after ds2 which, though they were not completely dreadful, would almost certainly have gotten worse if I had had another bad tear.I had a very realxed controlled home birth with ds2, and made the decision that even if such a great labour like that could still end up with a tear, then I wouldn't do it again. I had a section with dc3, and even though, for me, I prefer vaginal deliveries, I couldn't face the thought of worsening spincter problems or god forbid, surgery.
Take advice from your consultant, and don't be pressurised into a delivery you don't want.Good luck

Pinkypig, did you regain control without surgery and how long did it take?

I had incontinence issues after a forceps birth with my first which involved a large episiotomy

Went on to give birth to a 10lbs 11oz baby second time around - small tear, no stitches.

Third time around 9lbs baby, no tears no stitches.

Over the years the incontinence issues haven't got worse, maybe a bit better. It's not bad enough to affect the quality of my life significantly so I'm not motivated to do anything about it. I suspect it'll all come back to haunt me when I'm an old lady and end my days sitting in a piddly armchair, or spending all my pitiful pension on tena lady pads......

Recently I brought one of those gadgets that's supposed to help you improve the tone of your pelvic floor. It involves an 8 week programme of use and I've been too lazy and disorganised to do it. My friend used it though and said it made a big difference. Don't know how bad her problems were to start with though.

I reckon you need to talk this through with a consultant. Have you been to a perineal clinic and had the damage properly assessed? (lovely experience involving fingers up your back passage and anal probes..)

My understanding is that if there are continuing significant problems with continence issues following a third degree tear then c-section is often advised.

Agree, discuss with your consultant.

Personally would go for a planned section

Pinky Pig, I would have an elective section if i was you. I had an episiotomy and it split and I ended up with a 4th degree tear. personally i wouldn't ever chance a vaginal birth again with all the issues i have after that.

But then again it is your choice and i would def talk to the consultant and get an examination to see what they think etc

Good luck with what ever you choose!!!

Firstly can I say that many women go on to have a normal vaginal delivery with no tearing despite a radical tear and/or episiotomy the first time around so I would urge you not to consider an elective C-Section just on those grounds alone.

Secondly, women in this country are given an episiotomy which is at an angle so as to avoid a radical tear towards the sphincter. An episiotomy when coupled with a forceps delivery is done (always) to make room for the forceps and the cut made will have been made in your perineum only and should not have caused more damage. The forceps and indeed the baby, may have caused the more radical damage to your sphincter.

Unfortunately it is common - more than people think - for women to have this type of injury following birth and it can be horrendous to live with.

I would definitely talk to your midwife/consultant and express your fears. However, do not assume that this will happen again. I know many women who went on to have a second baby (and third) with no problems.... good luck.

If you have suffered with incontinence issues after the delivery of one child, there is a great likely hood that it could happen again. Get an ultrasound scan done and your consultant should be able to give you good advice, if your tear wasn't too bad and your pelvic floor has regained strength they will prob advise a VB.

Have a look at the article below

findarticles.com/p/articles/mi_m0CYD/is_22_34/ai_61621238