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Childbirth

Share experiences and get support around labour, birth and recovery.

Original poster

after 4th degree tear and anal repair op, what you you think is the best way for next birth cs or vaginal birth?

27 replies

carriedababi · 31/10/2009 15:01

anyone been there?

had a 4th degree tear with dd, calm fairly easy labour no pain relief, no problems.
ended up getting a 4th degree tear
had to have the anal sphincter repair op.

now thinking about having baby number two and feel caught between a rock and aa hard place.
risk another vaginal birth and the possible damage that can come with that, or risk having a cs.

OP posts:
bigstripeytiger · 31/10/2009 15:17

It was my understanding that after a 4th degree tear it was advisable to have a CS rather than risk further damage. Were you given any advice last time about how you should deliver in future?

If I had had a 4th degree tear I would have no doubts about having a C Section.

Good luck. A 4th degree tear sounds horrible.

Original poster
carriedababi · 31/10/2009 15:36

yes it was and is horrible.

i wasn't really advised either way, but we have started to talk about a second baby.

i want to get some serious medical advice before evn thinking abut getting pg, but not sure where to go fisrt?
gp?
or somewhere else?

OP posts:
bigstripeytiger · 31/10/2009 15:42

The GP would probably be a good place to start, they would probably know what tends to happen in the area that you are, and if they arent sure then they could refer you back to the consultant you saw last time for advice.

Original poster
carriedababi · 31/10/2009 15:47

could my gp refer me to a different consultant?
the one i saw for the after up follow up was horrible to me.

my gp is a lovely caring man so i could definatley talk to him about my problems an concerns

OP posts:
pinkteddy · 31/10/2009 15:51

AFAIK the way hospital referrals usually work is that all referrals go to lead clinician (consultant) and they will then be divided into whoever's speciality within the team so it might be difficult for your GP to specify a certain consultant. But worth chatting to your GP about anyway.

Sometimes family planning clinics or sexual health clinics have gynacologists attached to them so that could be another way to go to get some good advice. Look for a fp clinic that is based in a hospital or in a big health centre. I am amazed the consultant who did your operation didn't advise you about future pregnancies.

Moosy · 31/10/2009 15:53

A friend of mine was told that because she'd had a 4th degree tear she would have to have a CS next time. He said that if she had a vaginal delivery it would quite likely undo all his hard work!

I'm sure that your midwife or GP would refer you to see a consultant and if you asked nicely you might be able to choose who you see!

Original poster
carriedababi · 31/10/2009 15:54

it seems to me that "they" the medical profession dont really know what to advise in the situaation so they dont want to advise incase they get it wrong.

OP posts:
Lulusbrotherisgettingmarried · 31/10/2009 15:55

what woudl you prefer?

Original poster
carriedababi · 31/10/2009 15:56

i really wish i could have seen the surgeon that did my repair op.
he would know better than anyone i think

i wonder if it would be at all possible for me to arrange a chat with this person?

could pals help me arrange it?
i want to get my notes from last time aswell

OP posts:
Original poster
carriedababi · 31/10/2009 15:57

i would prefer a home birth with no complcations.
but i realise you dont always get what you want

OP posts:
Original poster
carriedababi · 31/10/2009 15:58

i also had a pph and was tacchycardic so i;m not sure i would be "allowed" advised its ok to have a homebirth

OP posts:
bigstripeytiger · 31/10/2009 15:59

It would probably depend on if the surgeon is still working in the hospital.

Does your hospital offer a debriefing service after deliveries, that would give you a chance to go over the notes with a midwife, and if you did that you could find out who it was who did your surgery, and find out if they are still in the hospital?

Original poster
carriedababi · 31/10/2009 16:05

i'm not sure if they do a birth debreifing service.
how would i find out call them and ask.
i've been building up the courage to do this for 2 and a half years and scared i'll get someone horrible that will put me mentally back to square one
[flashbacks and nghtmares]

OP posts:
CarmenSanDiego · 31/10/2009 16:09

There's a little info on tears and home births here which links to some further info. I suspect most doctors will say you should have a C-Section because that's usually the default position for any out of the usual history, but whether that it is the best advice for you is something you'll need to investigate further.

Original poster
carriedababi · 31/10/2009 16:09

also there was no explaination at all, s to why this happened.

nothing went wrong, no epidural, no funny position, no forceps or vontouse.

just a natural drug free birth, went into spontaneous labour at 37+3

which makes it all the more worrying as theres no a single thing i could do differently next time round

OP posts:
mrshotrod · 25/03/2011 22:25

Hi. Me too! 4th degree tear with baby no1, 2nd due in three months.
The birth like yours was all natural, really straight forward and then he just shot out at the end. Due to an old spinal fusion I had to be under a general to be all stitched up, which was a bummer (ha ha) after being totally awake and un-numbed for the birth!
This time round, I'm told they'll support me in a CS if I choose to have it. I've had to see a consultant anyway cos of spinal thing. He says he would rarely not try to talk women out of CS.
I know a CS isn't exactly the way out, but that fear of a long drawn out healing process if I tore badly again and needing to be a mili-second from a loo for months with a newborn and a toddler.....I don't think I want to risk that again.
It's so hard when you can't know how it's going to go.
If i do go CS it'll be under full general and I know I would hate to see my baby be born.
One GP I spoke too didn't even know it went up to 4th degree! We must be well-'ard. Supposed to be rare, but my friend had the same happen to her three months later.
Lucky us.

Northernlurker · 25/03/2011 22:29

Without question I would opt for a c section.

first1 · 26/03/2011 20:46

I had a 3a tear which required restitching three months postnatal. I thought I'd come off badly but have met several women with 3b, 3c and 4th degrees which is in my opinion, shocking that so many women suffer so badly. I was restitched at a different hospital and the consultant there said without a doubt a 3a tear should be followed by elective c sections for subsequent pregnancies. Tbh, there's no way mentally I could deal with problems below again let alone physically, but it's a very personal decision and I hope you find a great consultant who supports you with which ever you decide to do

PenguinArmy · 26/03/2011 21:04

I'm pg and had only a 3rd degree tear with my first. Only had one appointment so far, but he said a lot of came down to if you were having any problems currently. If so then an CS advised otherwise up to me.

Personally I want a CS as the thought of PFs being worse is not nice.

If this is bugging you enough before TTC then I would speak to someone.

mrs I only had a spinal for stitching, but remember thinking it was a shame I had got through labour without anything, only to have a spinal afterwards Grin

pushmepullyou · 26/03/2011 21:12

The Royal College of Obstetricians advise that the risk of faecal incontinence is 17 to 25% following a second vaginal birth if you have previously had a 3rd or 4th degree tear.

I had a 3rd degree tear with my DD 2 years ago and an elcs 2 weeks ago. The difference in the recovery has been incomparable. All my bits are where they should be and bar a little residual soreness I feel pretty much back to normal. I am finding it so much easier to bond with and care for my baby and couldn't recommend it more highly.

deemented · 26/03/2011 21:20

I had a 3rd degree tear with DD.

After the initial stitching, it was never again seen by a HCP.

I then went on to have a vaginal birth with DS3. That time i had a small 2nd degree tear, and it was nothing compared to the 3rd.

This time i am hoping for a vaginal birth again.

But, if i were in your position, i would have no qualms having a c-section.

laInfanta · 26/03/2011 21:23

I think you should really have a c-section. Surely you will be high-risk anyway because of the 4th degree tear? That's some serious structural damage. I would get a c section!

btw, if a consultant is horrible to you, you should complain about them. Some of them just think they're God's gift

Lovethesea · 26/03/2011 22:27

In your situation I would have an elcs. I have ongoing bladder incontinence issues after a forceps birth and chose an elcs for my second as I wished to protect what remains functional. I was also fearful of double incontinence. I intend no further children so for me it was easy as I did not have any concern about future post cs pregnancies or births.

Take a longterm health view. Most people recover well from an elcs though it is obviously serious surgery, but risking your pelvic floor strength and more tearing could leave you with double incontinence. It is worst case scenario but some women do need colostomy bags, never let anyone brush off incontinence as easily fixed or minor. Consider your risks from an elcs, and weigh against a possible lifelong incontience issue. Go with your gut feeling, but consider how further damage might affect all areas of your life if it wasn't repairable this time.

Perhaps read the ragged bits thread on general health - that's post childbirth damage with issues of incontience; many had 4th degree tears. I would say you are extremely lucky to not have ongoing symptoms.

Incontinence issues worsen post menopause as the hormone levels in the body change so be aware of that too.

There are scans that can assess the strength of the anal muscles if you want more info before deciding; I would imagine most consultants would not want repair work undone by the pressures of vaginal birth and potential tears/episiotomy. I hope you get the appointments you need soon, and I would advise chasing up the colorectal consultants as they are the ones who see the longterm impacts and would be most realistic for you.

clareanna · 27/03/2011 18:22

Can only offer my experience- had a 3rd degree tear and episiotomy with ds1 due to shoulder dystocia and had c-section 6 weeks ago with ds2. Recovery is very similar in that you're on pain killers etc after birth, but range of movement and speed of recovery is definitely easier- sore tummy instead of sore bottom. Far more comfortable sitting down etc and bits are fully intact.
Good luck with whichever route you choose and I would suggest finding out details of a consultant you specifically want to be referred to for consultant led care and them name them at your booking in appt so you are referred to them for your care. Don't see the registrars just see your chosen consultant to get advice from someone with the most experience. Good luck Smile

PrincessScrumpy · 27/03/2011 20:32

My birth with dd was dramatic, fast and caused lots of damage (37 stitches). It probably took about a year to heal - a lot longer than friends who had c-sections. Before we conceived dc2 (&3 as I'm having twins), dh and I went to see our GP and asked if a c-section would be offered as I really wasn't sure I could go through natural birth again. tbh this, I think, is largely down to the lack of support the mw gave me by ignoring me at every possible point until dh had to shout at her (really not his nature). GP sent us to see the consultant and he agreed to a c-section.

I want to make it clear that I know it's not an easy option but I really feel it's right for me. As it happens, having ID twins means they'd want to do a c-section at 37 weeks anyway, but we didn't know we were having twins at the time! Grin

Go for what your heart tells you. And, good luck x