Risk of infection with c-section Vs bad tear

[weebigmamma]

I am probably going push for a section with this pregnancy, having had a 3rd degree tear with the last one. Medical advice I have received is split over the issue but there is one thing I can't understand;

Those opposed to my having a section keep telling me about the risk of infection at the site of the wound (I am overweight and accept that this means the risk of infection for me is greater). But surely there must also be a risk of infection if you have a tear or episiotomy? I mean, your wound in that case is so close to.... well I don't need to say it really! But despite having a major tear the last time and being worried about it happening again nobody has mentioned this as a risk this time around. Can anyone shed light on this?

I had a third degree tear with my first child and hope to have a elcs if I have another. I know I wouldn't be able to labour in a good frame of mind if I was terrified of tearing again - and I know I would be.

You are at increased risk of tearing badly again if you have before. I can't remember the percentage. It's low but greater than someone who hasn't had one before.

I really don't know whether perineal tears are a greater infection risk due to their location. Mine didn't get infected, and I remember a MW saying she'd never known a third degree tear wound to get infected because they carried out such good repairs at the hospital I was at.

I'm not sure why they are suggesting a c-section wound infection is your biggest risk, as opposed to your risk of tearing again? I mean, surely having another bad tear would have much worse repercussions - you have to question whether the perineum would heal as well a second time, whether your pelvic floor would be permanently damaged (urinary or faecal incontinence issues, for example)?

For me personally, I would take the risks of a section over another third degree tear.

Yes that is how I feel about it too. They keep talking about 'a guaranteed wound Vs a possible one' but the possibility of another tear is just an unbearable thought really. I was stitched up really well and healed brilliantly the last time and I had no incontinence, but I feel like I was lucky. I had to have two anal scans to make sure everything was OK so I know it was a serious tear. Other risks they talk about include complications with subsequent births (I am 38, I don't want any more pregnancies after this one), and a longer recovery period (but last time I was in hospital about almost a week because of blood pressure problems and then on bed rest as soon as I got home for a further number of days. The wound healed fine but mentally I feel like the whole thing was pretty traumatic).

I had a vb with third degree tear, and when I fell pregnant with dc2 was automatically offered a section, which I declined. However breech dc2 had other ideas and I ended up with a section anyway. I have to say that the recovery from my (planned) section was far, far easier than the recovery from my vb we won't mention dc3. No-one really mentioned risk of infection apart from to keep the scar clean and dry. The section scar was certainly easier to keep a check on!

Saying all that only you can decide which way you want to give birth. I'm sure when I last looked prior to arrival of dc3 that having had a bad tear would give you a good case for asking for a section.

I had an infected episiotomy it was god-awful. I definitely wouldnt be put off a c- section by risk of infection. At least the infection would be in a manageable area!

Infection is a standard warning for any surgical procedure. I tend to warn for pain, swelling, bleeding, infection, numbness for everything. I don't know why they're pushing the infection part so much with you, I think your theory of more risk of infection with a tear makes a lot of sense but have no stats to back it up. Obstetrics isn't my area, with my only experience being my own EMCS but I was given intravenous antibiotics in theatre - I assume that's standard?
If you were to get an infection it wouldn't be great but should be fairly easily dealt with and if you have good wound care unlikely in the first place. some women get awful, dangerous infections but surely that's rare & if you're aware of what to look for & are vigilant any problems should be nipped in the bud. I hope you get the birth you want.

Just a simple tip, to help prevent infection after c section it's important to keep the wound dry so I used a hair dryer to completely dry the scar after shower, and a few times a day. I am not sure if it made an actual difference but I've had 3 csecs and no infection.

i had 3rd degree tear and episiostomy last time. i used tea tree oil on pad which im sure really helped to keep clean and infection free. i dont know huge amounts about it but im presuming because of increased blood flow to area its just better designed to heal vs a large c section scar which wasnt what nature planned (not saying anything wrong with it but our bodies have evolved to purpose!)

im having a second vb. i went into this with 100% certainty of a planned section. i have a wonderful consultant who has reassured me that all the factors that tend to result in fucked up bits (unfavourably positioned baby, instrumental delivery, pre term delivery) are unlikely this time around and its far more likely that it will be uncomplicated.

they give you antibiotics before a c now...

Thanks everyone. Much appreciated! I think part of the problem is that each time I've had a hospital appointment it has been with a different consultant- 4 in total! This means that every single time they've gone through the list of risks and it just makes it sound like the hospital itself doesn't want me to have a section. Whereas with the GP's I've discussed it with they're really surprised to find that I've had any hassle asking for one considering my background.

Risk of infection is much higher with c/s, and especially very serious infections. The abdominal cavity gets opened up which gives bacteria quite different access than any tear. Anyone I have ever known to end up in intensive care with a serious birth-related infection such as blood poisoning (sepsis) has had a caesarean delivery. Having a third degree tear can be pretty awful for a number of reasons but infection isn't usually a major concerns because it is all relatively superficial.

None of this means that having a planned caesarean would be a bad option for you in all ways, especially if this will be your last baby and there are no concerns about scarring etc. The other option is to meet up with a midwifery manager and make a plan for your vaginal birth to be attanded by someone hugely experienced and skilled who may be able prevent a third degree tear this time.

Having seen four different people it makes a bit more sense now. They'll each individually need to know that you know the risks have been properly discussed. So, each time they're presenting it as if no ones ever told you before to make sure everything's covered. And to be fair to them, some people just don't retain information/ only hear what they want to hear (& some Drs don't explain things well). If they've only met you once they don't know that you're brighter than that and on the ball so will repeat it to make sure you know. There was a study that showed if people were given the standard warnings for an op (think it was routine tonsillectomy), then asked a week later if they'd been told most couldn't remember/completely denied being told. Please don't see it as the hospital being against a ELCS, more just people double checking you understand your choice. It's unlikely you're seeing 4 different consultants unless your chopping & changing which days you can attend on, they'll have the same clinic each week. It's more likely to be what used to be called registrars and SHOs. If it's driving you insane, ask to see the consultant next time, then if anyone questions your choice you can just say 'thank you very much, I discussed it in full with Mr/Mrs Big Boss at my last appointment. They're quite happy with the plan & that I understand in full' Best of luck.

Oh yes, I had the ultrasound probe up the bum treatment as well. Thankfully, my dignity was long gone by then.

Speaking of third degree tear risk factors, I had none (I had a textbook labour and birth in water) and still got a third degree tear, so I just think my anatomy isn't suited to birthing average sized babies!

Isisisis, that is really interesting, thank you! I tend to think that everyone in a white coat is the boss lol. Ihaveseenmyhat, yes I had what they like to call a 'normal' birth too- just gas and air- and whammo- 3rd degree tear! I think the main thing that worries me about it happening again is that although the risk is small it is also completely impossible to predict, whereas a planned section is at least a lot more predictable.