3rd degree tear, long recovery last time, about to discuss elective c-section for No. 2 with consultant at 38 weeks need advice!!!

[fothergill]

I am 38 weeks and just moved from London to Nottingham (don't ask) to have the baby and have suddenly been offered by the hospital chance to discuss option of elective section at the new hospital. Last time I had 3rd-4th degree tear (she was furious fast birth with a massive head, 8lbs7 whereas I am size 8)which took a long time to heal.
Until today I didn't think a section was even an option so am completely frozen as to what to do. My last experience just took so long to recover from in every way, that my initial response was intense relief - but am also terrified I will make the wrong decision as it is obviously not guaranteed I will tear next time. I am at mother in laws so have help on hand for recovery from surgery so that is not such a factor in deciding but can anyone tell me risks either way??
What to do?!

I had two caesarians, the second planned. It was a great experience and though the recovery took a few weeks I knew what would happen and when so it felt more controlled and better IYSWIM.

Best thing is to go in and discuss it, you can change your mind whatever you decide.

Risks with caesarian are higher than vaginal birth because it's surgery but they aren't that much higher.

Have they told you how big your baby is? Your last one sounded like a big baby for your size, they should do a scan so that they can work out if the new baby is the same size. The risks are the same with any surgery, infetction and bleeding. I would ask about the size of the baby before making a decision though.

QMC has a good maternity unit. I have a friend who's training to be a midwife there, she says they are very good.

I've had one cs and one vbac with a 3rd degree tear. I've decided to have my 3rd baby vaginally because I'd rather risk tearing than going for the gaurantee of a tear/wound/recovery period.

And tbh in my opinion its all b*ggered up down there anyway so not much worse could happen. I'll have to have corrective surgery one day anyway so if I tear again badly so be it.

My dd that I tore with was 9lbs 7oz with a big head but I had a ventouse hence the bad tear. Next time I'm avoiding all interventions, having a water birth to try to minimise trauma to my perinium and am going to try hypnobirthing and breathing the baby out instead of vigorous pushing.

Don't underestimate how bad a csection recovery can be. There will always be someone to say they breezed through it but then someone else who really struggled.

Other things to consider are are you planning any more children coz a 2nd cs can be more complicated than the 1st. Also as well as the complications of haemorage/pph/etc you will be stuck with a scar on your stomach and possibly a skin shelf. Not everyone has this but mine is horrible and I have approx 2in of skin than hangs down over my scar and also I have no feeling from my waist to my belly button.

Its a very personal decision that only you can make but personally I don't want another cs for a variety of reasons.

I have had an emergency c-section (took 3 weeks to recover, but felt fine after 1 week) and a vbac. I agree with what babymt has said. There are stories good and bad for both. I think everyone needs a bit of luck as you never know how a natural birth will go. You generally know how a c-section is going to go (but you also need a bit of luck that there will be no complications).

I was lucky overall for my vbac, but I realise that the recovery time 'down there' has taken longer than ever than with my c-section. Sex is painful I still pee when I sneeze regardless of pelvic floor.

If I get pregnant again, I'll take my chances with a c-section and hope for a bit of luck.

If you want my honest opinion....

I had a 3rd degree tear 1st time around, took me a year to get my "functions" back to normal, and i had a elective section 2nd time around.

I dithered all the way through my 2nd pregnancy as i was told i could have a section if i wanted, and infact i was advised by the consultant to have a section, i really wish i had gone for a natural delivery tbh, i found the section hellish!

Forgot to say 'down there' looks horrific, but I don't really care. I just wish sex was OK. AND apparently I only had 'grazes' - God knows what tears are like if these were just grazes ! Some days it really gets me down.

I had my son at the OMC in Nottingham and agree with Phantom that its a really good hospital for all things maternity related. I had a forceps delivery in the end, after getting to the point where I was asked to sign the consent form for a c-section, but I was still really impressed by the care I received at all stages of the pregnancy and delivery. The Consultants I saw there were great - hope this helps.

I did not enjoy my elective section at all [partly because I had never really actively wanted it, just dithered along like Pucca until dd was overdue; ds was emergency cs]

I found the waiting very very stressful; and I think labour hormones do wonders for coping with pain and getting healing processes started.

Mazzys got something there, the labour hormones do some fantastic things. And I wish more consultants would recommend planned csection once labour had already started because its proven how much better it is for baby and establishing breastfeeding when you've had the labour hormones kicking everything off.

I had a 3/4 degree tear with my first (5.5 hours of pushing, hand and arm presentation, 9'11 baby...) but despite the damage I was very lucky and didn't suffer with any problems.

I was advised to have an elective when I had my 2nd child 18 months later. The birth was a lot better than the previous one (not difficult!) but I found the recovery (physically and emotionally) hard work especially looking after 2 little ones.

When I had my 3rd child nearly 3 years after the 2nd, I knew I didn't want to have another section. I hired a doula and asked lots of questions on here. I wasn't completely convinced however until I saw a registrar to discuss my birth who looked through my notes and said 'you'll be wanting a section then'. At this point I burst into tears and realised that I didn't!

My 3rd child was 2 weeks late, 7 hour labour on gas and air and only a graze to show for it! She was 9'5 so not a small one either.

It's such a difficult decision - there really isn't a right answer. Good luck and feel free to ask any questions.

thanks for all the help. Its so hard as each story is individual...as will mine be whatever I decide. This baby seeeems to be a bit smaller but if I go 14 days over and get induced like last time, could be different story. I opted for QMC by the way, but it is full so am going to City - heard good things about there from midwives and they have been brilliant so far. Cant be any worse than Kings College.
Defnotyummymummy, you didn't say when you had your vbac but I was told it wouldn't heal brilliantly whilst breastfeeding due to hormones affecting skin tissues - it took two years not to hurt so don't worry it should be ok again... ah but then look what happened!
I think main fear is worse complications than last time which apparently is indeed a higher risk if it is another bad tear. Babymt, good luck with your third. Water birth was amazing for pain relief (if I go with nb I will try for another for sure) and I know the secret is all about the pushing (but which I found uncontrollable) so I am sure you will do well if you stay calm. You're right. Its individual, some find tearing ok some find cesarean ok and the polar opposites are there too.
I guess the consultant may be able to help reassure me one way or the other by looking at my individual case. They actually seem to listen up here, it is unbelievable care compared to what I have been used to!

I had a 3rd degree tear (and episiotomy!)first time round, a bit of faecal incontinence for a few months, and it felt like my fanny was around my knees for the first 6 months . DS1 was 10lbs 2oz and although I am tall I am quite a slim build. He was delivered by forceps after a difficult second stage and a failed attempt with the ventouse.

I was warned that 2nd babies are bigger, that I should consider a CS etc. In the end, I read up on the net that second babies' weight tends to revert towards the mean and that 2nd births are generally more speedy and more straightforward. The first time round I had used a birthing pool, which I think actually slowed things down too much and restricted my movement. Second time round I just kept upright and moved around a lot, and had a 8lb-er in about 3hrs at home, with a small tear repaired in the comfort of our own bedroom by a community MW.

I was also put off by tales of complications arising from CSs, and the idea of someone cutting through layers of healthy muscle for no medical reason! Also the mortality rate for CSs is higher than that for vaginal births, although clearly you would need to look at the individual case.

A friend of mine who was left nearly incontinent after her first was recommended and had a CS for her DS2. She was laid up for a month after, but did heal well and although still suffers the same problems, they are no worse.

Hope this helps, if you decide to give the CS a miss.

Hi, we've had a few discussions on this recently, worth doing a search. Also here is a link to the Royal College of Obstetrics guidelines.

royal college obstetrics guidelines

I am in the same position as you but had an Ultrasound scan about three months after delivery to assess the scar. This showed a lot of muscle damage and as a result I was advised to have a CS for my next delivery (which is now booked for next month).

I've looked into this in some depth and there doesn't seem to be much strong evidence either way so I do think that your best bet would be a careful discussion of the pros and cons with your consultant. It would be useful for them to have access to your London notes if there was any way they could get them in time. Good luck

I had the "how will my scarring cope with vaginal birth?" dilemma with DD2. The biggest concern that everyone had was whether I had had any continence issues. If I had then there would have been no question that I would have had a C section. As it was, I hadn't, and after a lot of discussion, I went for a natural vaginal birth. I did a lot of research and spoke to the head of the midwifery centre - I really felt that I could trust her and her team, and that made all the difference.

I did tear with DD2 (now 3 weeks), but I knew that I would as I had a skin bridge from the bad job sewing me up with DD1 . I only had a small second degree internal and small first degree external though, so much better than last time. It's still early days to see how I heal, but things have calmed down sooner than with DD1, so I'm cautiously hopeful.

Good luck with your decision.

I've had 3 elective sections, so I speak only for the c-section, having no experience of vaginal birth.
The birth of my 3 children was the most wonderful experience. The healing process was made loads better by having lots of help and not trying to overdo it in the early weeks. By week 3 I was totally fine again. I do believe that elective sections often means the healing is better, because the surgeon can go in carefully and slowly remove baby (as opposed to emergency where baby got to get out asap). All my bits are totally as they were when I was younger, but that was never a factor for me as I was unsuitable for labouring,.
I breast fed immediately in recovery, and fed the all until 12 months plus. I know I made the right choice for me. I had to have my third by general anaesthetic, and that was a bit hard. But at the end of the day, it's not the means by which the baby is born, it is the end result that matters. Hope that helps a bit.

I am swinging from one side to the other and back again. Kings lost my notes from last time so I just have to be assertive in what I remember they said at the time and in physio. I have been told I was sewn up by a genius so am loathe to undo their good work.
My worry about cs is being able to bfeed after so more reassured by katyamum.
Thanks to everyone for this. It would seem 2nd time natural birth success stories are winning which is swaying me...

Have you thought about asking them to induce you sooner then 14 days over? Maybe that would be better option if you do go overdue?

Sorry, need to hijack this for a mo - Mrstittlemouse - Congratulations on your dd. Did I miss your birth announcement?

I had c section after horrible tear. It was heaven. Demanded, and got immediate skin to skin and dc was feeding whilst they were still sewing in theatre. Still feeding 10 months later.

Healed, much more quickly than my natural birth, really glad I made the right decision for me.

Good luck

Promise you - breast feeding was totally my priority. Just tell the midwife you want to get latched on straight after you are stiched up and in recovery. Lovely time, just lying there, with baby on boob. In early days, very hard to lift baby up without exerting tummy muscles so you need to be prepared that you will have to have help get someone to bring baby to you. I personally just kept mine literally on me ie. either laid on my tummy, or laid on my boobs, or feeding. Was much easier this way as getting up and down to put back into cot was bit sore initially. And I really just wanted the skin to skin. I had a frank chat with my midwife, and siad that I wanted to breast feed, wanted skin to skin and in the moments when they were stiching me up and DH was holding them for me, I just asked him to hold them low, near my head so I could talk/sing to them. And god, they really reacted to my voice, when that was all I had to offer because my arms were not really available.
But honestly, I had no probs with feeding at all. So don't let that be a factor.

lauraloola - no, sorry I didn't do a birth announcement. I put a notice on my labour thread, but didn't think that anyone would be interested. Since then there have been several hijacks as people have found out piecemeal. The delivery was almost a disaster as DD2 also didn't want to descend, but I managed to push her out naturally and didn't have to be transferred to the CLU. Fingers crossed that things heal better this time. Thank you for asking.

So glad it went ok, I have been wondering as I must have missed your post on your labour thread. Im sure you will heal fine. Congratulations again

Hijack fully over

Fothergill - Have they done a scan recently to see the size of the baby now and to predict its birth weight?

Having said that I had a 2nd degree tear, grazes and dd was only 7lb 1oz

Lauraloola I think my birth was so intense and I was so out of control when it came to pushing because of induction first time so I really would prefer to avoid that again if poss. One option I am thinking is I might try see if I can opt for natural birth but request a cs if I end up overdue...
And they haven't mentioned a scan happening at the appt but the baby's size and the state of my scars is on my list of questions.
You know what? Its just comforting reading of other people's stories of survival - has calmed me down.

I must add, the only thing with me was when i had the 3rd degree tear, dd was 8lb 13oz and i was a week over, the reason i had the tear was because nobody told me to ease off / stop pushing as the head crowned.

With ds (elective section) he was born at 38 weeks and was 9lb 6oz, but i did actually go into labour with him, i was booked in for the section on the 11th Aug and went into labour on the 6th Aug, i was 3cms really quickly and had a section that afternoon.

So compared to my first labour, which took me about 8 hours to get to 3cms, 2nd time around was really quick, but the size of ds was a little worrying had i chosen a natural delivery. I do think though if i had gone for natural and i had a wonderful attentive midwife to guide me carefully through pushing it would have been ok and i do regret not going natural now.

My section was awful, i really do not understand these celebs etc who choose to do that, the after care was terrible, i was left without pain killers and with dirty pads when i was unable to move, the pain when i stood up for the first time? well i cannot put it onto words (and i breezed the pain of the 3rd degree) the recovery was so long and drawn out, and i couldn't pick up my baby or do much for him at all, i also ended up with infections inside and out. It took me a good 5/6 weeks to feel even slightly normal.

After my tear... i really didn't find it so bad, i was up and about virtually straight away once my repair spinal had worn off and was fine and dandy, apart from the itchiness of the stitches healing. I found the healing a doddle compared to the healing of the section.

Good luck with your decision, it is a hard one, but i know what i should have chosen.