3rd degree tear last time - VB or CS this time?

[Biscuitsandtea]

Hi,

I hoping I can pick a few of your lovely brains. I'm currently 36+4 with DC2. When I had DS (3 and a half years ago) I ended up with forceps, and episiotomy and still had a third degree tear. It seems to have all healed ok but naturally enough I'm worried about further damage this time around, both in terms of immediate healing and the potential for incontinence problems later in life.

Up until yesterday, nobody had mentioned the possibility of an ELCS, so I had assumed it was off the cards. I think earlier in the pg I might have even been quite relieved if perhaps the baby had been breech or something so that they might advise me to have a CS without it having to be my decision iyswim?

Anyway, yesterday, one of the doctors at the hospital said that they had to point out that if I have another vb with any damage that I'd have a risk or problems later in life, and made it seem as if I was 'choosing' a VB. I asked if ELCS was even on the cards and she said 'of course, if you wanted one'.

She then went on to say that they couldn't really advise me which way to go because there were obviously risks and pros and cons with each method of delivery.

In essence, I guess a vb would be easier to recover from if I can do it without any more damage. But of course no one can guarantee or even predict if there will be any damage. A planned CS might have a more 'predictable' recovery, but of course it is still major surgery.

Other things I have to factor in are firstly that DS came 3 weeks early (this weekend equivalently!) and was already 8lb 3oz. My family line seems to have early babies so I may not have long to wait for this one? Also growth scans have shown this one is probably a whopper too, so the longer I'm pg for, the bigger it's getting!

So really I just wondered if anyone had been in the same sort of position or had any thoughts I should bear in mind.

Sorry this is so very very long, and also apologies for any typos - am posting on my phone and it won't let me review the first post f a thread for some reason!

Thanks for reading :)

I ended up with suction cup, and episiotomy and still had a third degree tear.

I am only 9 weeks, but I know I am going to have a VB.

Milk - may I ask why you want a VB? Or is it something you want or just think will end up happening? Does further damage worry you at all?

I'm not saying you should feel any of those things, I'm just interested in other peoples' point of view

Congratulations on your pregnancy by the way

I had ventouse (failed) plus forceps with Ds. Resulted in 3rd degree tear, and while not too bad now, I definitely have bladder weakness and sphincter (sorry) muscles not what they were. It was also most uncomfortable and took me a while to recover. I asked for a Cs for DC2, and frankly it was a great pleasure- recovery was a million times easier. I was so worried about becoming doubly incontinent I just didn't want to risk it.

I had a 3rd degree tear with DS1 - he was huge at 10lb 1oz. After having him, I had a lovely scan to check how everything had healed and was pronounced for for having future babies "naturally". Naturally I laughed and told the consultant there was no fucking way I was having any more children.

Anyhow I had DS2 and DD naturally 2 and 7 years after DS1. Both were smaller and, whilst I did tear with both, it was far far less severe and all has healed well.

The problem is, of course, that you can't guarantee how things will turn out. There are posters who have had bad results and now need major repair work but there are others like me who are fine.

Hi I had pretty much the same experience as you, and spent the first hour of my ds life in theatre without him. For the next pg I will choose a CS. I won't put myself or my dh through that again. At least with a CS it is more predictable and the pain isn't in quite so, um, delicate an area.

OP, I had pretty much the same experience as you, and also had problems with recovery and healing of the tear post-partem. As a result, I've definitely noticed more difficulty in "lasting" (sorry, TMI) before I have to pass a stool, which is massively inconvenient (think 10mins between first realising I need to go till suffering immense pain trying not to have an accident.)

As a result, I would never, ever, ever risk VB again. I know that every birth is different, but unless someone can guarantee that a second VB won't make my existing problems worse (which no-one can do) then it's not happening. I'm just not prepared to be an incontinent woman in my 30's for the rest of my life.

Should I ever decide to have more children (not going to happen) I already have it agreed in my medical noted that, because of DS' traumatic delivery, I am guaranteed an ELCS.

MW will say you can have a successful vb - and yes you can, as 2nd babies usually deliver easier even if they are bigger. However, vb does stretch and stress ligaments that have already torn under pressure. So whilst you may not tear again or tear again to the same degree, you do risk further damage to your pelvic floor. 75% of women who suffer from incontinence issues post menopause is down to damage caused in childbirth and this is why consultants advise CS as they are thinking long-term and often work closely with the colorectal and urinary services. My consultant said the NICE guidelines changed and did say that women who suffered a 3rd degree tear and urinary or fecal problems should be offered a CS as a matter of course.

fecal urge incontinence counts as criteria for a CS

NoWayNoHow, have you seen a colorectal surgeon?

Haven't seen anyone as have just assumed this is how it is now and I just have to make sure I'm near a loo! Doesn't impact my life massively at the moment, TBH, but I certainly wouldn't risk anything that would make it worse...

Thank you for all your comments - that's been really helpful , although of course I'm sorry that so many have had a bad birth experience!

Nowaynohow, I do notice I have less time before a bowel movement too. Since I'm a SAHM, I'm not normally far from a loo, as I tend to find even if I'm out, most places that I visit with DS are pretty well catered for loos. But I don't think I could hold in the same way I could before. I don't have so many problems with wee's, other than obv needing to wee frequently because I'm 36 weeks pg!

But it does worry me that I'm gambling and might regret not having a CS. Of course I might regret having a CS! But as someone said, at least it wouldn't be in such a delicate area!!! DH said if I have a CS that all the time I can't do things after the birth I might wish I'd tried a VB, but then every time I'm having incontinence issues I might wish I'd had a CS!!

Oh, I'm still betwixt and between! More mulling over to do tonight I think!

"DH said if I have a CS that all the time I can't do things after the birth I might wish I'd tried a VB, but then every time I'm having incontinence issues I might wish I'd had a CS!!

But which time of regret would last longer?

As I said, I had 2 VBs after my tear and am fine. However, having sad some of the stories on here I think may have opted for a CS - this was never offered to me anyway so never crossed my mind.

I had a 4th degree tear with my first after epi and forceps. I had an elcs with my second baby, there was no way i was going through any of it again. At least the risks are known with cs. I have no major lasting issues from the tear,,except urge and sometimes incontinence passing wind. Am expecting my 3rd and have an elcs in 2 weeks. The elcs was a wonderful experience compared to my first delivery, hoping this one will be the same. Good luck with your decision, no brainer for me!

5 years ago I had a 2 degree tear and since then I've had nothing but problems related with that area. I'm now 27 weeks and so nervous about the whole labour thing again x

I had the same experience and dilemma as you and I'm now 39 weeks and having elective c section on Tuesday. I just didn't want to risk any more problems in later life after what I have been through following birth of ds1 who is now also 3 1/2. It's a personal choice of course but the consultant was definitely keen for me to choose c section this time......

OP thanks for this post, I could have written myself!! I am 34 weeks with DC2 after a 4th degree internal tear with DD1. She also was a 36 week gestation baby weighing nearly 8lb who decided she couldn't wait

Growth scans show this on is a big one too one. All through the pregnancy I have been offered CS and this is planned in now but I still question this every day and whether I am doing the right thing.

I had urgency issues and also noticed I can't hold urine at all during pregnancy!! But have recovered well other than that. One poster put she could put her DH or herself through that again, I really can relate to that and that has made me realise CS is best for me. I was put under a GA for repair within hours of birth and I suffered PTSD after the birth- this affected everyone.

What eve you decide good luck!!!

I had a VB (3 degree tear and shoulder dystocia) with DS1 and chose a CS with DS2.

I found that the recovery time was less after the CS than after a VB and more importantly I was able to have a birth (with the CS) which I felt in control of, as I knew what was happening to me.

I think people totally underestimate the effect of a serious tear on your physical ability to do things, as also the lasting physical and mental effects of it.

Interesting thread. I had a 2nd degree tear with DD 2.5 years ago and now pg (only just!) with number two. I took a very long time to recover and physical/emotional aspect is something I can't bear to go through again. Reckon it set me back months rather than weeks.

Is CS offered or considered as a result of 2nd degree tear in 1st preg? Or is that expecting too much do you think? Would they just laugh at me for the very suggestion? Interested to hear others' experiences.

When I first went for the booking in, the fact I'd had the third degree year was enough to make me consultant led rather than mw led. However, at the first cons. Appt the doctor we saw (not a cons.) just said 'have you had any problem with it? No? You'll be fine then. Off you pop back to being mw led.'

I just meekly nodded and I don't know if I'd said how worried etc I was, they might have taken it further then? I think maybe i actually got more worried about it The further on I got through the pg and the more I thought about it the birth though.

I've subsequently gone back to being consultant led as we've had to have extra growth scans and they've identified a kidney problem with the baby. I think I was kind of hoping someone would suggest a CS but no one has up until this thing on Friday, and then it was more of an inference of 'did I know the risks I was taking by wanting a VB?' Well I don't really want a vb!

I would say, if it's something you feel strongly about, mention it to your mw (or consultant if you're already consultant led) - don't be as meek and mild as me and wait for them to offer it on a plate!

I've been almost surprised by the fact that now we've been considering it and I started this thread, the number of people who have just said 'no way' to a vb. I wish I'd asked on here earlier as I thought maybe I was making a mountain out of a molehill and if I needed a CS surely the doctors would tell me. Of course they can never know how stressed I was feeling about it if I don't tell them. But I know that what I was feeling isn't totally loopy!

As to whether they'll let me do a CS, I'm going to try and speak to someone tomorrow about it and hopefully get the ball rolling. I'm 37 weeks on Tuesday and with DS having come three weeks early I rather feel that I am up against it time wise! I'll let you know how I get on!!!

Hope that helps, oh, and congratulations on your pg

Good luck! Let us know what they say. Don't talk yourself out of it, write down what your issues are first so youre armed with the info. No one has ever questioned me having/had an elcs. The consultant said thats what they would recommend.

As for 2nd deg tear projectg - Of course they will take you seriously. Again write down all the issues you have past and ongoing and do some research to show you know the risks of both cs and repeat vb. because mine was a v bad tear i was stitched by a consultant who did a great job IMHO. Perhaps if your was 'just' a second it wasnt repaired so well? Its all very individual.

I had a 3rd degree tear with dc1 just by bad luck no forceps etc baby was 8lbs. Opted for ELCS with DC2 as had continence issues and read that as I had torn previously I was 20% more likely to tear again.

Csection was horrible, anisthetic stopped working and I had to be put under. Recovery was long and painful and debilitating (I got an infection), especially with a toddler to look after. I am absolutely fine now scar pretty invisible (9months). Hated hated the stay in hospital.

If we have a third I would have a vaginal delivery and make sure the midwives knew my history so I had all the help to try and not tear.

By the way I know I was unlucky both times and most people have great recovery with ELCS. Good luck everybody whichever way you go neither option is the easy one!

I would just like to add I am just back from hospital since I last wrote on this post, having had my c section.
It was a dream compared to my vd, it was so calm and civilised and i felt it was a completely different experience to my first delivery. I am so pleased I made that choice, and I've been up and about since 2nd day, scar healing well and feel great, a little tired though!!! I know not all c sections go as well as this, but I just had to let you know it was great for us.

Hope all goes well for you, whichever route you go down

Ah, I also have an update!

Really glad your CS went well though and congratulations

So I spoke to a mw at the hospital who spoke to my consultant and they basically just put a note in my labour notes saying I might request a CS when I turned up in labour. But they did make it clear that if I was already half way dilated or anything they wouldn't be able to do it as they wouldn't do an EMCS just for the tear thing.

I had an appt planned for this Monday coming with my consultant and was going to ask her to book in an ELCS date.

However, my waters went last night. By the time we got to the hospital (after the in-laws had arrived for DS) and I'd got checked I'd probably been contracting for about 2 hours and was 4cm dilated so I think I would have been a bit late for a CS in any event.

The end of the story was, 50 min second stage, 4 hour total labour, but I did get a second degree tear. Oddly not from the head which they got out really carefully, it was the shoulders apparently.

In any event I feel a different woman compared to last time! So am hoping it will all heal up again. I can at least walk with a vague degree of normality, and my tummy aches more than my undercarriage. The doc that checked the tear did say she was very impressed with the work that had been done on my bottom last time

Ah, congrats gd and biscuits! Glad both your respective births went so well - enjoy your new little bundles!