Advised to have elective cs after 3rd degree tear

[janester]

I felt very upset/disappointed after consultant advised me today to have an elective cs for baby3. DD1 was an emergency cs after pushing for 3 hours; laid ghosts to rest after AMAZING Vbac experience with DD2, but unfortunately sustained a 3rd degree tear, which I learnt today was quite severe. Both DD1 and 2 were back to back. However, found recovery and bonding much easier with tear than for CS. Today's news has really thrown me as I wasn't expecting it - anyone else been given same advice? Consultant concerned about severity of last tear and I was stitched up beautifully... Can anyone reassure me that planned can be better than emergency cs? Only 20 weeks to go so a while to make a definite decision...

I had 2 third degree tears with ds1 and ds2. Was advised to have CS with dc3 as they were worried that my downstairs bits couldn't take another assault

Whilst I would never underestimate the seriousness of having a section, in my case recovery was much much quicker and easier than it had been for my 2 vaginal deliveries

They offered me a CS after 3rd degree tear but I declined and had DS by V Birth.
I tore again but not as badly
Is it worth getting a second opinion?
My first tear was quite bad nearly a 4th degree and took 4 hours to stich in theatre so unless its the cs scarring they are worrying about I don't see any difference.

He didn't seem worried about the cs scarring - it was the position and degree of the tear after Vbac - he is concerned about permanent fecal (spelling?) incontinence, which doesn't sound very good to me....

He said to get a second opinion but I know that he is highly regarded and the nurse/midwife said outside afterwards that he rarely recommends c-sections so bluntly.

Have you seen a diagram of your stiches it may be that it goes directly to your back passage so they are scared it tears into this?
Perhaps you could have an episiotomy to direct the tearing - although not sure that in my experience it was that effective.

That is what they said to me too DD was proper way round and tore worse than DS who was back to back.

I'd had an episiotomy and then tore into back passage. If I had another Vbac I would have to have a 'significant' episiotomy anyway.. just don't know if it's worth the risk.

Your consultant might also be thinking about future continence when you are middle aged and older, tearing in childbirth is a major contributor.

If there is still time, a proctologist could look at the friability of the tissue. If you have had any significant relaxing of muscle whilst pg and have to get to the toilet quicker is a not-so-good sign. On the other hand, if you've got a springy pelvic floor and muscle tone is good, then possibly he is being over cautious.

I had a bad tear with my 1st pg, advised an elective for my 2nd but had a vaginal delivery but under a very controlled epidural (with no problems). However, if I have a 3rd, I think I would have an elective because my pelvic floor is not as good as it should be & the thought of incontinence pads...

I had a third degree tear with DD1 and had an ultrasound of the scar after about three months which showed a lot of muscle damage. I was therefore advised to have an elective CS for any future births - the consultant quoted about a 30% risk of future faecal incontinence with a vaginal delivery even if I didn't tear so badly again. I am actually due to have my elective CS for DC2 tomorrow and whilst I'm scared I am happy that it is the right decision.

I have no knowledge of the 3rd degree tear or whether or not you should go for the section, but I can reassure you that a planned section is absolutely nothing like and emergency - my experience was 100% better. I had a very long and unpleasant labour (won't go into details) with DD1 ending in an emergency section. Although at the time I was just relieved to get her out safely, I was also in shock as it suddenly all hapened so quickly and was quite nerve wracking. Afterwards, I suppose I recovered well as c-sections go, but I was exhausted and weak and found it all pretty tough for a long time.

With DD2 I had an elective as it was expected that similar complications would arise as for DD1. It could not have been more different. It was such a happy relaxed experience, everything calm and organised, theatre team all joking and laughing and chatting to me - I can't stress how lovely it was, I suppose because DD2 wasn't in danger no one was stressed or worried. Recovery was astonishing. Presumably because my body hadn't endured 36 hrs of labour I was in a much better state to deal with a major operation. I was up and showered and walking around within 6 hrs and about 8hrs after the op I was able to walk out of the wards (unaided and carrying DD2) to the public area of the hospital to show DD2 to DH (who wasn't allowed in due to illness - another story!). I had no pain (stopped taking the meds after a couple of days) no trouble lifting or feeding DD2 and no trouble looking after 2 yr old DD1 once home. In fact I had to keep reminding myself to take it easy so I didn't do myself any damage.

I am well aware that not everyone has such an easy experience as I did, but I just wanted to stress how different the elective and emergency routes are if that is what you decide upon.

I was undecided about an elective section after a very traumatic first delivery with a large scar that healed very badly. The big question which was asked first by every medical professional that I consulted was the continence issue. If you have had continence problems with your previous delivery, then it is strongly recommended that you have an elective section for a subsequent delivery to avoid more serious problems in the future. If you have been lucky (like me) and have had normal continence, then it's a much harder question to answer.

For what it's worth, I have a friend who had a third degree tear and went on to have another vaginal birth that was a great experience with only a tiny tear, and a friend who had a third degree tear and had an elective section that she found much better than her vaginal birth. So you can have a good experience either way!

I have posted alot on this subject, search on my name and you find lots of info.

Have you ever considered hypnotherapy for your elcs if you go that route. I had an emcs for dd1 but am convinced that all the hypnobirthing stuff for my intended homebirth helped me immensely. I had elcs for 2nd dd and it was very relaxed experience in answer to your question.

thank you for all your messages - just got in from work - as I am only 20 weeks I think I will consult GP and midwife (who could actually examine me rather than just look at notes...)and maybe get a second opinion from a different consultant. At the moment I am veering towards elective c-s - although my first c-s was not good, it was an emergency and I was not in control/didn't hold DD1 for nearly two hours/took longer to bond/forced to walk too soon+collapsed etc etc- I could plan it this time, maybe pay for private room, definitely hold baby in theatre etc and make it a positive experience. I will follow up your posts pucca and will look at pros and cons over the next few months. Thank you all - I felt reassured when I needed it last night! x

I thought NICE guidelines said there was no need to recommend a lscs due to a previous 3rd degree tear.

friend of mine had a 3rd degree tear and then had her second baby in just over 12 months and thoroughly ENJOYED the labour, so it is possible. I think that perineal massage, breathing baby out rather than actively pushing and being careful with positioning, ie not on your back with legs akimbo, can make a huge difference.

if you do plan another VBAC ask SoM or HoM for good supportive mw to be assigned to your care

Best of luck with your decision

I also had 3rd degree tear with first birth after a gruelling induction 2 weeks late and now need to decide on induction at term +7-10 or EC. I have the added complication of high BMI, which means much increased risks of infection and clots after surgery. I'm at term + 2 today so need to decide by Monday when I have consultant appointment. Really can't weigh up pros and cons of either option. Don't want to go through another induction that leads to further damage or emergency section but equally am conscious of risks and recovery issues related to a section. Any further advice would be great.