Please or to access all these features

Add post

Watch this thread

Save thread

Start a new thread

Flip thread

Hide thread

My feed

Active Unanswered threads

Getting started FAQ's

Unanswered threads Acronyms Talk guidelines

Hide shortcut buttons

Talk

Pregnancy

Talk about every stage of pregnancy, from early symptoms to preparing for birth.

Flip

Original poster

Poll: vb or elcs after 3rd/4th degree tear

12 replies

Tea1Sugar · 01/01/2014 17:47

Just want to see what everyone's decision is/has been. Which is the most popular "route" after a 3rd/4th degree tear? I know the risks and benefits of both.

I had a 3a "the best of a bad tear", dd2 due in April, I'm 95% set on an elcs, already approved happily by my consultant.

OP posts:

Are your children’s vaccines up to date?

Set a reminder

weebigmamma · 01/01/2014 19:30

Glad you've started this. I am in same position as you- due in April and had a 3rd degree tear last time which healed very well. Except my consultant is very keen for me to go for a vaginal birth again. I don't know what to do. Keep swinging back and forth. I also know the risks of both. Very scared of having another rough birth and feel like I'd like more a controlled birth this time but also thinking of the recovery... they keep telling me it's 'major abdominal surgery' and there's no reason to think I will tear again....

Sleepthief · 01/01/2014 19:37

For me in those circumstances it would be ElCS, no question. I just wouldn't want to risk it. And I speak as someone who's had two very successful VBaCs. Good luck with whatever you decide.

BTW, my recovery from my EmCS wasn't 'bad' at all

Flisspaps · 01/01/2014 19:38

I had a 3a tear with DD.

Elected for Homebirth 2nd time round (DS had other ideas so had forceps in theatre with episiotomy)

If you've had a tear you're no more likely to tear than someone who hasn't - but if you do it's probably going to be worse.

For me, the idea of definite surgery now to prevent possible surgery later seemed pointless. If I need surgery later, I'll seek it then (I read lots including the ragged bits threads in General Health before making a decision)

cravingcake · 01/01/2014 19:59

ELCS for me with DC2 in 3 weeks (or sooner)

I had 4th degree tear 2 years ago, shoulder dystocia, episiotomy, pph, pnd, ptsd. For me i'd rather have a scar which is easy to keep clean so less risk of infection and planned normal surgery than the unknown. And i dont want to be left faecally incontenent which i run a high risk of if i was to give birth naturally.

DanGleebals · 01/01/2014 20:14

I had a vb after a 4th degree tear. It was absolutely fine and I only needed a few stiches. However, my repair job first time round was very good with no lasting damage and my consultant felt a vb would be fine (but did give me the option to change my mind right up till the last minute). It's up to you really but if you're consultant's approved a c section then that would maybe suggest that's the route you should take? I hope the birth goes well - whatever decision you make.

Original poster

Tea1Sugar · 01/01/2014 20:49

What's swaying me to the elcs amongst other reasons is that a vb could be totally fine or potentially leave me incontinent. That risk, however small is what I can't justify. That answers my decision doesn't it?!

OP posts:

cravingcake · 01/01/2014 21:42

It sort of does.

I look at it as 6 weeks (approx) of recovery with elcs, which yes will be hard with newborn & toddler but you have time to get friends, family or other help organised. Plus its a common operation so chances of things going wrong are limited.

Or the potential of life long incontenance, pain from scar tissue if you were to tear again, more surgery to fix any problems another vb could cause. These chances are small but they are very real and not something i'm prepared to risk after the long recovery i had last time.

Original poster

Tea1Sugar · 01/01/2014 21:48

I couldn't sit anywhere at all, couldn't sleep, walk or anything for 3months after my tear as my stitches were stabbing me. I resorted to paying privately for a full restitch when as was was 3months and as a result I've gratefully suffered no continence issues . But I don't want that work undone!

OP posts:

kernowmissvyghen · 01/01/2014 21:49

3a tear first time, elcs booked for Februay for my second.

What really swung it for me was the advice leaflet from the RCOG given to me by my registrar - if you've had any continence problems following a previous tear, there is a 17-25% chance of worse continence problems after a subsequent birth. So, imagining an average 4-6 bed postnatal bay, if they all contained women with previous tears and any continence issues at all, one woman (on average) per bay would be left with worse incontinence. That is too high a risk for me.

Also, I am a bit unsure about the thing about "no greater likelihood of tearing". Surely it must depend on why you tore in the first place? I tore badly without any apparent reason at the end of a well managed intervention free birth, with a v small baby. Later found out that other women in my family have also torn badly after straightforward births. It seems to me that there's going to be a greater risk of me tearing again due to not having been born stretchy enough in that department than, say, someone who tore because of an awkwardly presented baby and subsequently has a perfect second birth. But there doesn't seem to be any disaggregation of the statistics like that.

For me, the risk of worsened continence problems is far more awful to contemplate than the risks of routine (although major) abdominal surgery.

BlanketSky · 01/01/2014 22:57

I had a 3rd degree tear after forceps, despite episiotomy; DS was 9lb8oz at 39 weeks (history of big babies in my direct female line). I'm booked for ELCS at the end of April. I am symptomatic as have some urgency issues. No question for me (and no argument from the hospital), regardless of the PTSD/PND that also resulted from the delivery as well.

Flisspaps · 02/01/2014 08:56

I did forget to mention I had no continence issues following my tear, if I had then that would have changed my decision.

My SoM told me the no-more-likely-to-tear info, and I found nothing to suggest otherwise - but a further tear would be likely to be worse.

There is no wrong or right choice here, as with so many birth choices. Just right or wrong for that particular woman - OP if you want the CS and think it's right for you, take it

Beegey · 02/01/2014 16:03

I am expecting DC3 in April. After two Vb's, I have been wheeled off for surgery after each time (retained placenta first time and 3a degree tear second time ).

After the birth of DC2,and the tear, I was certain that it would be a section for me for any subsequent children. But my mind has since been changed for a few reasons; I was very fortunate not to have any continence issues and feel completely healed. When I had a recent consult with the surgeon, he said that the area which tore is likely to be even stronger than before because of the surgery (though nothing to prevent a new year elsewhere,I guess). Also, my first two DC's were back to back and the consultant seemed certain that this baby would rotate during the labour if it found itself in the same, awkward position.

I bloody hate having surgery and would do anything to avoid that vomming and shaking after birth when I should be having a cup of tea and cuddling my new baby...so I will give it a shot. I will also be trying hypnobirthing this time to learn some coping techniques as I am pretty terrified of labour after DC2.

I completely agree that the worst case would be incontinence in mid life or indeed sooner but I guess like most difficult decisions it's about weighing up the benefits and risks.

Good luck, OP

Flip