Thought I was having a section now been told I could have VB. Confused - Help!

[AttillaTheHan]

I had a long labour and a severe 3rd degree tear with DS (now nearly 4).Also lots of back and pelvic floor problems afterwards.

Am 25 wks pg with dc2 and had consultation last week. I had been previously advised that a section was best way to go due to tear last time and the possibilities of becoming doubly incontinent if I tear again. They told me last week that they may advise I have a vb this time too.

I am not at all adverse to a V birth IF the risk of tearing again is minimal and this could be guaranteed but I understand no one would be able to guarantee that. In an ideal world I would have a V delivery as I am in no rush to have major surgery but i am now panicking that they will advise a VB and I will end up in a much worse situation than last time...

Any advice please...

It's entirely your decision - but planned cs is much easier than em-cs. But it's still major surgery and if the risk of tearing is minimal, it's the same risk any mum would have.

The midwife at this point said they can't guarantee the risk of tearing will be minimal. I am concerned that they 'sell' a VB to me on the basis that the midwife should be able to prevent me tearing to such a degree again. But realistically they cannot give me that guarantee can they? Especially as it happened last time and the midwives didnt seem to be able to prevent it last time?

you can absolutely request an elective c.s

or go for a trial of labour

it is your choice.

i think you need to see your consultant and ask for some more info re the risk of tearing as badly again. it might be that your tear was due to something that could be prevented or might not happen again

e.g baby born with hand by his face

very fast delivery

perineum not getting enough time to stretch

position you delivered in

position of baby

no-one can guarantee you won;t tear again, so best to get more info really and make a decision that is right for you

If I were you I would insist on whatever you feel comfortable with. Like you said they cannot guarantee that you will not tear to that degree again, and considering your previous history that area may be weaker and more prone to tearing and complications than someone else. If you decide on a vb then I wish you the best of luck, but if you are not at all sure, don't be persuaded into doing what they are trying to 'sell' you because it would make their cs statistics look better.

Just a random thought, and I may be completely off the mark, but could you ask about whether an episiotomy might reduce the chance of you tearing badly again?

Obviously an episiotomy isn't an ideal situation either, but might be the lesser of 3 evils (episiotomy, c-section or bad tearing).

Hi

Spotted this earlier while at work but couldn't reply then.

I had a vbac with ds2 4 1/2 years ago. Had third degree tear (after episiotomy) and was subsequently advised to have elective section with ds3. My consultant was very clear that it was my decision but he recommended the c/s. I was a bit gutted because I wanted to try another vbac. At the time, the advice was that there were no studies about the incidence of bad tear after previous bad tear. What evidence there was suggested greater risk of tear with consequences if you'd suffered any extended continence problems or there was any evidence of (significant?) nerve damage. I had some very interesting tests done on my bum which did demonstrate significant nerve damage. I think you need to find out if there's been any change to guidance/advice (NICE, or Obs/Gyns governing body) over the last few years. Also, did you have any tests to establish the extent of damage your original tear caused.

Good luck with your decision, I know it's not easy.