Caesar after 3rd degree tear?

[KMond]

had a failed ventouse and then a forceps delivery with the birth of my son (2.5 years ago) and sufferenced a 3B or a 3C perineal tear as a result. In the first couple of weeks after his birth I had a couple of incidences of faecal incontinence. I have had no problems since but still experience some faecal urgency at times.

I had physio follow up etc and my OB at the time wrote me a letter recommending that I seriously consider a C/S for any subsequent births in order to avoid further ano-rectal symptoms (TMI! sorry!) but that I should discuss it with my OB at the time.

So am due to have my 2nd child in Jan (there will be 3 years between the births) and am having real trouble finding any information on this particular issue. It does not come up in any of the articles on caesareans as being one of the common reasons for having a C/S rather than VB.

My current OB is also recommending a C/S saying it is not worth risking permanent incontinence by having a VB.

But then you do hear stories of lots of ladies who have had bad tears go on to have normal deliveries and no subsequent problems.

I would like to have a VB but am quite happy to have a C/S if it means I'll avoid having faecal incontinence for the rest of my life, however, I just want to read up and get informed but can't seem to find any information on this subject.

Anyone else experienced this or know where I can get more info?

Thanks! (sorry for the long post)

[Trevo]

I am not sure where you could get more info on VB after a 3rd degree tear except for your Obstetrician or Physoptherapist. Your going to find info that supports both VB and C/S in that also.
There is no reason why you would have repeat trauma to the same degree with no2 especially when its unlikely you would need forceps again which was probably the biggest contributor to the 3rd degree tear. With forceps you also have an episiotomy most of the time which also contributes due to an extension of the cut.
I would go with what you want. If you don't want to risk further trauma then the C/S would probably be the answer. Unfortunately even with great care at preventing reopening of prior trauma there is no guarantee. In saying this of the third degree tears I have seen go on to have VB I think one was intact peri and the others were 2nd degree tears.
Also with C/S they do cut straight through the pelvic floor muscles which weakens the bladder so having a C/S does not safe proof you from incontinence although that is of urine.
Its a tough one but I am sure you will get the support in which ever birth you choose to have. Also if you go for a VB I would make sure you have an experienced Midwife or Obstetrician assisting with the delivery as it does make a difference when guiding the head and shoulders out in preventing trauma (over a student for example)

[LSK]

you poor thing, i had the same and had to be restiched. i can Pm you cause you dont have 50 post yet but if you give me your email address i can definaly listen to you and provide my exp with my second child.

[Janie]

What a time you've been through! Just on what you're saying, I would guess that your faecal incontinence and urgency resulted from a weak/damaged pelvic floor. I'm assuming you had a difficult or long second stage of labour, given that you had an assisted delivery. I'm not sure where you are, but I would suggest that seeing a women's health physio would be very benficial to you.

I had a very difficult and long second stage (4 hours), failed ventouse and then forceps delivery, although I had an episiotomy so no tearing. My pelvic floor was very weak post-delivery, and I saw a physio in hospital who suggest I continue with some physio to help regain some strength in that area. I only saw her another couple of times, but she was excellent, and really whipped me into shape! I think I might see her again at some point during this pg to make sure I'm in good shape for the next birth.

A physio may also help you to understand whether it's your pelvic floor or something else that is concerning, with regard to having another VD. I personally would also be looking further into it, and not just taking your Obs word for it. Do you think you might have a women's health physio nearby? Or could you see another Ob for a second opinion?

[Hollo]

not really sure about your particular situation but just wanted to add that scar tissue from my 2nd degree tear was a problem with my second birth. the scar tissue was a hard ridge blocking her head and i needed an episiotomy to help her out. might be somethig else to consider when making your decision.

[misty]

Maybe there is something about your situation which the drs are right to be concerned about - I don't know I don't have a medical degree.

All I can do is tell you about my experiences.

I had bad 3rd degree tearing after my first was born nearly to my rectum (along with some of those other embarrasing symptoms you mentioned). No-one ever suggested to me with my second that a c-section might be a consideration because of this. (maybe because I went through the midwife program rather then seeing a dr or ob?) I was very concerned about tearing again, However with my second child, I had no tearing AT ALL. It surprised the hell out of me. I also had no other complications. With my third, I also manage to give birth once again without any tearing (just some minor grazing). All my babies successively got bigger too (3.5kg - 51cm, 3.6kg - 53cm, 4.32kg - 53cm).

So don't think that just because you tore badly the first time, you will neccessarily tear the next time too. Having said that maybe there is something different with your situation then with mine? But if you are not happy / are concerned about the c-section, then definitely seek out a second opinion.

[bon]

Studies have shown that caesarians do not provide any more protection from incontinence than vaginal births. It is not actually the birth at all that causes the most weakness to the pelvic floor muscles, it is the pregnancy - having a baby stretch and then press on them, especially in the third trimester.

Having a bad tear in your first birth is no guarantee it will happen again. It seems odd to me that in order to protect you from tearing your perineum again, your OB is happy to cut through your abdominal wall and scar you that way instead - not to mention the risks that are involved with having major abdominal surgery.

Definitely get a second opinion hun

[KMond]

Thanks so much everyone for your responses and feedback. I really appreciate it.

We are living in the Middle East at the moment and this baby will be born here. There's nothing available in the way of home birthing etc here or independent midwives etc. Are doulas the same thing? I have also had an opinion from an OB in Australia who also recommended a C/S so I have already had a 2nd opinion.

It wasn't actually the physio that recommended a C/S it was the OB who delivered my first baby which was born in the UK. After that birth I was referred to a 3rd degree tear clinic which was made up of my OB, some specialist anal-recto nurses and specialist pelvic floor physios. Prior to making the recommendation I had both (warning TMI coming up!) an endo-anal ultrasound and ano-rectal manometry which showed significantly reduced squeeze and resting pressure of the sphincter muscle ie reduced function. Following these tests the OB made the recommendation re the C/S.

So I do feel that there is some basis to what they are saying they are not just saying oh well you've had a 3rd degree tear you'd better have a C/S.

I do understand that with a better birthing experience things could very well be different. Things went downhill from the beginning the first time around. I was induced due to polyhydramnios, then constant monitoring so on my back the entire time, an epidural and then of course the ventouse and forceps delivery. So far from ideal and nothing like what my birth plan looked like.

So I realise that there is lots I could change to hopefully get a better outcome this time around...but there's always still the risk of another bad tear and the possibility of permanent faecal incontinence. Are the risks associated with a C/S worse than the risk of faecal incontinence (I can't think of much worse at the moment)?

[Trevo]

Can't say I have heard of a C/S causing faecal incontinence so I think it would safe guard you against further anal/sphincter damage. GL I hope you have a beautifuk birth experience meeting your baby this time around.