if you have a 3rd or 4rth degree tear can you tell me if you had a child later through caesaerean or vaginally?

[oranges]

And how you recovered, and what happened? I had a 4th degree tear and healed really well and am dithering now about whether to try again vaginally or go for a caesarean. and did it have any effect on breastfeeding?

Hi Momdeguerre,
No I've not decided though I'm veering towards a c-section. I have a few more weeks to think about it. LEt me know what your consultant says/

Oranges i think you should go for the CS. I had a 3rd degree tear after my 3rdDC 5 years ago and I suffer from a mild degree of bowel incontinence. I was sown up well, but the stitches broke down, and I have permanent damage to sphincter muscle. I dont think it is worth the risk, when an elective section can avoid any further damage. I went on to have two elective sections after that and all fine with breastfeeding. Yes a section is major surgery and shouldnt be undertaken on a whim, but in this case it is certainly justified as a means of protecting your pelvic floor/anal muscles from any further trauma, its a no brainer to me.

Oranges, will do. Am also leaning toward a CS
but just not yet convinced.

My bro is a Dr and worked Obs and Gynae for a while (Brats and T**ts as he assures me it is known as!) and he is overwelmingly pro. In fact, to the point that he feels a CS is generally a better option.

Still feel I need to weigh up my options though.

Will update after Weds meeting.

Hi oranges, and thanks for starting and maintaining this thread.

I'm in a similar situation as you, having had a third degree tear with DD1 (induction, very long second stage, ventouse) that turned nasty (developed fissure on top of repair that gave me over a year of pain and required more surgery). I am now eight months pg with DD2 and always thought I would have to have an elective CS. However, the perineal experts at my local hospital (who are supposed to be the best in the country) have checked me over and declared me good as new, and have recommended a vaginal delivery. After the shock of this, I have really got my head round it, and am planning to go ahead with their recommendation.

What swung it for me was having a long chat with the obstetrician who explained the risk and relative risks of it having happened in the first place and this time round, and he also pointed out that if there was any concern at all they would just book me in for the CS - after all, it would be much the easier option for them than the amount of maintenance I required after last time! And he also said that they wouldn't have spent so much time and effort investigating how well I had healed and what would be the best option for me if they were just going to recommend what they wanted anyway!

My feeling is that this time can't be as bad as last time. Plus by signing up for an elective CS, I am committing myself to a post-CS recovery with all that entails (no driving or lifting etc), which I would find difficult as my DH works very long hours, I have a 3yo and like to be as independent as possible. By going down the natural route, I feel I am at least giving myself a chance of a quicker recovery (and last time, despite everything, I was doing really well until the fissure happened). There is also a part of me that wants and needs to correct the horrific memory of last time, and this feels a better way of attempting to do that for me.

I fully accept that having committed this all to MN, I will have an awful time this time and rue my decision to not push for an elective CS!

Good luck with whatever you decide and I hope you find your appointment with the consultant constructive. If not, ask to see someone else - the doctor I saw last time made a massive difference to how I felt about it all, by dint of taking the time to answer all my questions and not making me feel that I was being silly.

oranges - firstly, you don't have to give birth in hospital, and you will be more relaxed (as will your mw) if you're at home. So if you haven't already considered the home birth option it might be worthwhile discussing it - you could start a thread here. AFAIK it's trickier to get on the HB list if you've not requested it at the start of your pregnancy, but not impossible - so go to your GP (armed with information) asap if you're even thinking about it, because that way you can at least have the choice.

I'd be glad to help you out with medical documents - it will get me off my arse to actually do the research before I go into labour!

Am following this thread with great interest. I'm on my second pregnancy now and this thread has been an eye opener to me. I had a third degree tear last time, and it was traumatic. Probably the reason it's taken me so long to consider having another baby...I am now frightened about tearing again and if it's possible then I may opt for a ELCS. Going to discuss this tomorrow with MW actually. It's given me food for thought.

The aftercare I received was adequate, although I had to insist on the MW who delivered my baby that it WAS a third degree tear, because she was armed with LA and a suture kit to start repairing me assuming it was a 2nd degree tear. I insisted it must be worse than 2nd degree tear and thankfully she got a medical opinion and he said it was 3rd degree so I went to theatre, had a spinal, and had it all repaired.

Why oh why does no one ever tell you these things will possibly happen when you give birth?? Why is there not more information out there? We need to be prepared for all events, all possibilities. I'd rather know the negative stuff aswell as the positive to be best prepared.

Speedy, a homebirth wouldn't work for me I think. I'd be anxious about my 3 year old, and i'll have my parents staying, and anyway the hospital is just 10 mins up the road. I'm not really scared of hospitals as such.
No one's putting me off a vaginal birth. If anything, they are mainly pushing me towards it, but have a blase attitude to possible incontinence, which is worrying me.

I agree midwives are not aware that women with 3rd degree tears need careful handling.

I could NOT sit down at all, and when I asked for help with breastfeeing from my hospital bed, they just pointed me to a low, high backed chair next to the bed, said "we've just bought these - they are breastfeeding chairs - sit on them and you'll be able to feed."

bonkers.

I spoke to MW today about this very topic and she thinks that since I had no continence issues and never have (since the tear) then there's not really any reason why I can't have a vag delivery with second baby. Still, she wants me to speak to a consultant to discuss all this, and see what he/she thinks. It's a difficult one. I just said today I don't really fancy having a traumatic time again after giving birth.

sorry oranges that you've had such a hard time and midwives being so unsympathetic towards your experience. empathy wouldn't go a miss would it.

I hope you have a better experience next time whichever mode of delivery you choose.

I had a 3rd degree tear with Tom and 3 weeks ago had a 2nd degree tear (and labial lcaeration) with Erin. With the 3rd degree tear I was carted off to theatre, had a spinal and was sent home with lots of painkillers. The 2nd degree tear I just had g&a as pain relief untill the localised pain relief kicked in. 3 weeks on, i'm still a bit sore down there.

I knew I wanted to avoid a section where possible (am very overweight so had that against me with recovery) so decided to risk being left incontinent. Thankfully Erin didn't come quite as quick as her big brother and she was 2lbs lighter!

Congratulations on your baby BexieID! glad it all went well. though should you still be sore after three weeks with a 2nd degree tear? Even my 4th degree one healed faster than that.

I'm feeling all over emotional about the thought of a c-section -not helped by my dad rather tactlessly suggesting I get my tubes tied at the same time for the sake of convenience.

I didn't even know such a thing was possible, but its def not something I want to think about right now!

Fair dinkum re homebirth, oranges. Though am amazed and to learn that your 4th degree healed much faster than my 3rd deg.

Congrats to Bexie!

Thanks for the congrats.

I think it's the labial laceration thats still a bit sore. I also did pull a stitch by coughing too much on the 5th day, so had to get midwife out to have a look. Had a cold week before I had Erin and it only went last week.

This time I wasn't sent home with loads of painkillers and was told they don't always suture 2nd degree tears .

Have come back to this thread since I saw the consultant today who strongly advised an elective for the third, in disagreement with the mw, but no surprise there.

Don't particularly want an elective, would like the lovely guaranteed epidural I had last time with no2, but I also know whose judgement I trust.

What is different is that I am being sent for a scan - some 100 miles away - to ascertain the extent of the damage after ds1 and, on that basis, a decision about delivery can be made.

Hi,
Saw MW yesterday. She, like my first consultant was very keen for me to consider a CS. See my usual consultant today for him to make a final decision.

Heated - I have had a similar scan which is why I have ended up considering a CS. Was not so concerned about the tear I had but they noted that I had bladder damage on my scan which is what is persuading me to take the CS.

Am just wondering what my consultant will end up saying. Not sure if I am going to be happy either way now, both seem to have their own risks. Kind of hoping he just agrees with the others and then at least I feel everyone is giving me the same advice.

well rather mysteriously I've received a letter asking me to attend a contiennce clinic for treatment. I made the appointment, but they couldn't tell me what that treatment was.

I did have all those tests to check everything had healed, and was told all was fine, so don't know what this is about. The appointment is a few days after I see the consultant to discuss a c-section too.

Oranges - that seems odd? Had you had any contact with them before?

My meeting went well. Long chat with consultant who basically told me that I appear to be at high risk of serious damage to my bum! He was less worried about the prolapse to my bladder and the other health issues I have had. His concern is based around my bowel movements - apologies if this is too much info - but I have had some trouble keeping in wind and I don't really feel the urge to poo anymore! Gross and very embarrassing for me but he said were clear signs of nerve damage to my bowel which is likely to be aggravated by a further birth.

I cannot bear the idea of being incontinent. He advised me that fecal incontinence can not always be corrected.

As a result I have booked my CS. Am still concerned about the possible side effects and it is not what I would have chosen but I think it is the right thong for me.

How strange Oranges - hope you are well and that your mind is more at rest having made the decision to go for an elective CS.

MondeGuerre - really feel for you. A number of women on my antenatal thread are saying today that they're going for an elective CS and that it was fine for them. I know that nothing is risk free, but hopefully you should be in good hands.

I've been chatting about birth choices with my DH after the information we were given after DD's birth - still waiting for booking in appointment at the moment - and he feels that a choice between being left doubly incontinent and having a CS isn't really a choice at all. I know he's right, just need to get my head around it.

Sorry Oranges, just rereading and see that you haven't made your mind up yet - sorry. I blame my pregnancy hormones! It's not an easy decision to make.

Sorry havenot read the complete thread - I would go for a elective section after any perineal tear which is more than second degree - the reason being it is not that they dont heal - most scars heal very well but it will have an effect on you bladder and bowel function say 10 years down the line.I have had friends who are obstetrians who have had elective cs after perineal tear.Discuss long term complication with the doctor and make a decision considering this as well. Good luck.

Momdeguerre - . I am totally committed to natural childbirth, BUT if I were in your situation I'd have gone for an elective CS, too.

Really glad you have the benefit of gleaning all this info before giving birth to your next baby - I've been sobered by the realisation that millions of women before us won't have been so lucky.

God, honestly - does having a child have to be so hard?

Best of luck with your birth.

I think its tragic that so many women tear, often from badly managed births. I really feel a dedicated midwife and a calm environment would prevent a lot of tears and save the NHS a fortune in treatments and future c-sections

oranges - yes, it's as if it's taken for granted that some births should be managed this way and that as long as the baby comes out healthy, the consequences for the mother are just collateral damage or something. Too many medics appear not to know or accept that in many cases perineal damage is avoidable - which is shocking, seeing as it ought to be a key aspect of their expertise.

I'm sure there are plenty of areas where birth is managed better and they have a far lower rate of tearing - I'll bet that Ina May Gaskin's team does far better - for example her C-section rate (always emergency CS's) is 1% - loads lower than just about every Western country's overall C-section rates AFAIK.

Thanks all. I am still not delighted at the prospect of a CS but I accept that the decision is made and now I just need to alter my ideas about how this second birth will be.

We are keeping the date of the CS generally secret so we can still have our 'surprise' birth announcement etc and my very lovely DH has purchased me an e reader to keep me busy in hospital.

Lots of positives really.

Oranges/cakey - good luck making your decisions.

Momdeguerre - have you seen the thread about positive c-section stories? Anecdotally, every friend of mine whose had one is really pleased with the experience and don't feel it affected their post-birth bonding at all. please don't be downhearted, and good luck!
I'm pretty sure I'm going to have one myself now, given that the medics seem to accept i have had and may still have continence problems.

x

Just posting to say good luck with all the difficult decisions that are being considered on this thread. As you'll see from clicking on my name and the thread I am always on, I had a great first birth (no tearing or stitches) but very unusually had a fistula which was very unpleasant but well-repaired just under a year later.

It hadn't occurred to me that I may not be recommended to have future VBs so when my consultant said he'd recommend future c-sections to ensure the repair wasn't damaged I left the hospital in tears. It just wasn't what I wanted.

That said I am now 3 weeks pre-planned CS and have reached some kind of peace with my situation. I am simply not prepared to risk further injury.

While my case is quite extreme (ie it was clearly a no brainer that further VBs would have every chance of making me faecally incontinent) I wanted to reiterate what some other people have said on here. In my (humble) view it is a disgrace that continence issues relating to childbirth are not a) communicated and b) supported adequately and I agree that it's largely accepted as 'collateral damage'. Many women who have reasonably straightforward births also have continence issues but very few seek help as no one realises how widespread the issue is and I feel this has enormous consequences for self-esteem and relationships. I got amazing support from my physio and I believe that ALL women should get some kind of physio support after birth. According to my consultant the damage that can be caused by birth can take years to appear but having a strong and well cared for pelvic floor can help prevent or minimise these issues.

This was a much longer a post than I intended when really all I want to say is that I really feel for you all. It's truly miserable to face the choices you're facing without definite evidence/risk to weigh up and when the stakes are so high for our bodies. Good luck and I'm sure you'll all make the decisions that are right for you.