C-section or natural after 3rd degree tear?

[Anonymous]

It won't necessarily be like the first time! I would consider doing a vaginal delivery if I were you...UNLESS the Dr really feels strongly based on your circumstances that you need the C-section. IE, for example if you have specific prolapse issues you're having or could have that they can see. Just the fact of having a significant tear does not mean you will necessarily have one again. A normal vaginal delivery without tearing is generally going to be an easier recovery than a c-section.

For my first, I was induced at 40 + 4, and then his head was tilted/he was stuck and they had to use suction. He was born at 8 lbs 11, and due to 3 hours plus of pushing plus the force of suction, I ended up with a tear between 2nd and 3rd degree which was extremely painful. No permanent issues, but the first 3 weeks of recovery were really rough and it was months before I felt completely back to normal.

My second, three years later, was a breeze! Went into labor 1 week early (after having membranes stripped), had an epidural, labor was 5 hours total, and I think I pushed 3 times. No significant tearing to speak of- it was a whole different and better experience. Daughter was 7 pounds 8 ounces. So thankful I didn't opt for a c-section out of caution, as I might have had it been suggested (it wasn't).

If I were you I would specifically ask the doctor, if they can tell from examining whether that there are still ongoing issues from the first tearing. If you have healed completely (as I did) I'm not sure why you couldn't have an easier second delivery.

[Anonymous]

Anonymous wrote:I've only had c-sections so I have no idea how painful the recovery after a tear is, so please take that into account in my response.

Just remember that a c-section is major abdominal surgery where your muscles, uterus, and nerves are cut through. Here are a few things that you should seriously consider about having a c-section vs. risking a second tear:

- You won't be able to carry/lift your older child for at least two weeks, possibly even longer after you give birth.
- You will have a really hard time going up and down stairs for at least a few days, possibly even longer after you give birth. I live in a three story townhouse and just assumed my recovery would be as easy as last time. I forgot that the first time, we lived in a ranch, so of course it was easy.
- You may have nerves cut that don't repair themselves. Read up on abdominal numbness after c-section. I didn't have this the first time, but it's 15 months after my second, and there is a chunk of my lower abdomen that I can't feel because the nerves didn't grow back. My OB says that at this point, it's probably permanent.
- The C-section shelf is real.

There is so much more...

This isn't universal, though. With my scheduled C, I didn't have a problem going up and down stairs. I left the hospital early and was going for long walks within a day.

I agree about the shelf, though. That does seem to be universal.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I remembered this thread from a few months ago because I am now in exactly the same situation. Third degree tear, incredibly long labor, blood transfusion... and so (new) OB says that I am "eligible" for an elective C. She's certainly not pushing it on me, but did talk about how new research is highlighting the risks of tearing and how they can lead to fecal incontinence. I would like to avoid this. Like OP from this thread, I would like 2 kids -- maybe 3 if I accidentally got pregnant, but really 2 is my number. I'm curious what decision OP made -- if any -- and if anyone else has feedback about either a second vaginal birth after bad tearing or an elective c after bad tearing.

Were you induced or did you require augmentation? Those are the biggest risk factors for severe tearing.
If so, then what are the chances of you will need induction/augm. this time? Are you AMA? Other pregnancy complications?
Why did you hemorrage? C-section surgery is a risk factor for severe hemmorage and there are other risks with it so there is a lot to consider.

I was induced and it took forever -- a week. Forceps (probably related to the hemorrhage, but they attributed that to a long third stage -- 3.5 hours). It's unlikely this would happen again, since it's a second kid.. but, hard to say! I'm still in my first trimester, and I'm not AMA. My blood pressure tends to be pretty high.

You are not very likely to have another severe tear (around 1% do per research). If you can avoid an induction and avoid or delay an epidural, that will be your best bet for minimizing tears. Can you hire a doula? I would strongly consider that, or else do some self-study on measures you can take to avoid tearing. There are evidence-based things you can do that help - certain pushing positions, warm compresses/warm bath, etc.

Your provider's flexibility is big, too - how late are they comfortable with you going before inducing? If a medical indication arises later on, could you still schedule a C at that time? Do they support a low-intervention labor?

I had a doula and delayed my epidural a long time with my first birth. Also, it seems here that over 7% of women who have a third or fourth degree tear have one again their second vaginal birth, so not 1%. Where are you finding the 1% number?
https://www.rcog.org.uk/en/news/bjog-release-new-study-examines-mode-of-delivery-following-a-perineal-tear-and-recurrence-rate-in-subsequent-pregnancies/

This is where I got the figure: http://www.tandfonline.com/doi/abs/10.3109/14767058.2013.806902 (there is a full text link somewhere, I can't find it now)

This study distinguished between 3rd degree tear recurrence risk (1%) and 4th degree (22%). Each study is using different methods so who knows what the true number is. The bigger issue is what are the risk factors and if OP has any of those factors at play with her pregnancy that would tip the scales in favor of surgery.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I've only had c-sections so I have no idea how painful the recovery after a tear is, so please take that into account in my response.

Just remember that a c-section is major abdominal surgery where your muscles, uterus, and nerves are cut through. Here are a few things that you should seriously consider about having a c-section vs. risking a second tear:

- You won't be able to carry/lift your older child for at least two weeks, possibly even longer after you give birth.
- You will have a really hard time going up and down stairs for at least a few days, possibly even longer after you give birth. I live in a three story townhouse and just assumed my recovery would be as easy as last time. I forgot that the first time, we lived in a ranch, so of course it was easy.
- You may have nerves cut that don't repair themselves. Read up on abdominal numbness after c-section. I didn't have this the first time, but it's 15 months after my second, and there is a chunk of my lower abdomen that I can't feel because the nerves didn't grow back. My OB says that at this point, it's probably permanent.
- The C-section shelf is real.

There is so much more...

This isn't universal, though. With my scheduled C, I didn't have a problem going up and down stairs. I left the hospital early and was going for long walks within a day.

I agree about the shelf, though. That does seem to be universal.

I don't have a shelf! And I really want to know what my OB did so that I can, like, monetize it or something.

I do, however, have the numbness PP mentioned. But I would c/s again and would choose c/s in OP's position.

[Anonymous]

Anecdotal story...my dear friend had a 3rd degree tear with her first baby in Germany, but she didn’t know/understand the medical implication at the time. She was an American newly wed in her husband’s country. For her second birth, the hospital here, received her records AFTER she already delivered with no tears, a healthy full term baby...and her doctor came in and told her on day 2pp if he had seen her chart he would have recommended a c-section, but clearly she didn’t need it. She went on to have four kids total, and the last one was a c-section. Better for her body and her family planning overall to have had those three vaginal births and 1 c-birth than to have attempted 3+ surgeries.

[Anonymous]

Anonymous wrote:Anecdotal story...my dear friend had a 3rd degree tear with her first baby in Germany, but she didn’t know/understand the medical implication at the time. She was an American newly wed in her husband’s country. For her second birth, the hospital here, received her records AFTER she already delivered with no tears, a healthy full term baby...and her doctor came in and told her on day 2pp if he had seen her chart he would have recommended a c-section, but clearly she didn’t need it. She went on to have four kids total, and the last one was a c-section. Better for her body and her family planning overall to have had those three vaginal births and 1 c-birth than to have attempted 3+ surgeries.

OMG There is so much judgement in this post. "Better for her body and family planning." Well guess what, would you still be saying that if her vaginal delivery did not go well and she ended up with 4th degree tear, fistula, levator avulsion, prolapse, incontinence, pelvic pain, etc. Does she leak when she coughs or runs? How is her sex life? Does she suffer from laxity or dyspareunia? Does she have to wear a pessary due to prolapse? Can she still control gas? The reality is that you just don't know.

I am so sick of the women on these boards pushing the "vaginal is best" ideology. . There are risks and benefits to everything and that includes emergency Caesarean, scheduled Caesarean, instrumental delivery, unmedicated delivery, medicated delivery. There is no perfect way to have a baby and all delivery modes have risks and benefits. But atom demonizing Caesarean sections and holding up vaginal birth like the holy freaking grail. Let OP decide based on science and reason, not dogma and ideology. There's a reason 30 percent of OBs have scheduled Caesarean sections so let's stop pretending like vaginal is not without its own risks and complications.

[Anonymous]

Anonymous wrote:I remembered this thread from a few months ago because I am now in exactly the same situation. Third degree tear, incredibly long labor, blood transfusion... and so (new) OB says that I am "eligible" for an elective C. She's certainly not pushing it on me, but did talk about how new research is highlighting the risks of tearing and how they can lead to fecal incontinence. I would like to avoid this. Like OP from this thread, I would like 2 kids -- maybe 3 if I accidentally got pregnant, but really 2 is my number. I'm curious what decision OP made -- if any -- and if anyone else has feedback about either a second vaginal birth after bad tearing or an elective c after bad tearing.

Original OP here. I'm still pregnant, so no final decision yet! I am leaning toward a vaginal birth though. My first birth was uncomplicated other than the tear, and the tear itself healed quickly and without complication or lasting issues. The odds seem to be in my favor in terms of hoping for a better outcome this time (the risk of a bad tear is still overall quite low, though higher for me than for someone who didn't have a bad tear the first time, and my doctor seems to think subsequent births are often easier though this seems anecdotal). Also, my first child will be 22 months when the baby is born, and the prospect of caring for a toddler while recovering from a c-section is daunting. Of course if this baby ends up being really big or there are other complications I will revisit the options.

[Anonymous]

OP just keep in mind that recovering from a scheduled Caesarean is very different than recovering from a difficult vaginal birth, or a vaginal attempt and an emergency Caesarean. My friends who had scheduled C's had far easier recoveries than my instrumental delivery. Best of luck with your decision.

[Anonymous]

Whenever I see these posts about how easy the recovery is from a scheduled Csection, I feel the need to chime in and just say that you can't count on that. My csection was planned well in advance (breach baby), I had an otherwise healthy and uneventful pregnancy. I was not AMA, I was fit, with really strong core, did the yoga, etc. The surgery went well, and my baby was healthy, and I even got a lot of compliments on my scar (as if I had anything to do with it, but I still liked hearing them). I left the hospital a day early even.

BUT, you will be unable move properly for weeks. You will not be able to pace the floor with your new born like you need/want to. It will be months later, and you will still feel weak in your abs, and will not be able to get up off the floor. This is a very serious surgery, and it will take months to recover. And last time, I didn't even have a toddler. Look, I haven't ever recovered from a 3rd degree tear, but I don't know any mom who did a vaginal birth who was physically recovering as long as I was. I just don't want this thread to give anyone an overly rosy view of csection recovery!

[Anonymous]

Anonymous wrote:Whenever I see these posts about how easy the recovery is from a scheduled Csection, I feel the need to chime in and just say that you can't count on that. My csection was planned well in advance (breach baby), I had an otherwise healthy and uneventful pregnancy. I was not AMA, I was fit, with really strong core, did the yoga, etc. The surgery went well, and my baby was healthy, and I even got a lot of compliments on my scar (as if I had anything to do with it, but I still liked hearing them). I left the hospital a day early even.

BUT, you will be unable move properly for weeks. You will not be able to pace the floor with your new born like you need/want to. It will be months later, and you will still feel weak in your abs, and will not be able to get up off the floor. This is a very serious surgery, and it will take months to recover. And last time, I didn't even have a toddler. Look, I haven't ever recovered from a 3rd degree tear, but I don't know any mom who did a vaginal birth who was physically recovering as long as I was. I just don't want this thread to give anyone an overly rosy view of csection recovery!

Hi, I am a mom who is still physically recovering from a traumatic vaginal delivery-- so know you know someone. I could not sit down comfortably for months and brought my hospital donut everywhere. I could hardly walk for weeks. I Couldn't have sex without pain for over a year and I spent 6 months in pelvic floor PT because of nerve damage and pain. Nothing is rosy about childbirth, but my 3 friends who had uncomplicated scheduled Caesareans all were back to exercising well before I could even walk without discomfort. I know people will say that my experience is an outlier but the more I talk to women the more I realize how common these issues are in the post partum period. They just are not talked about. All recoveries suck, and some are harder than others.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Whenever I see these posts about how easy the recovery is from a scheduled Csection, I feel the need to chime in and just say that you can't count on that. My csection was planned well in advance (breach baby), I had an otherwise healthy and uneventful pregnancy. I was not AMA, I was fit, with really strong core, did the yoga, etc. The surgery went well, and my baby was healthy, and I even got a lot of compliments on my scar (as if I had anything to do with it, but I still liked hearing them). I left the hospital a day early even.

BUT, you will be unable move properly for weeks. You will not be able to pace the floor with your new born like you need/want to. It will be months later, and you will still feel weak in your abs, and will not be able to get up off the floor. This is a very serious surgery, and it will take months to recover. And last time, I didn't even have a toddler. Look, I haven't ever recovered from a 3rd degree tear, but I don't know any mom who did a vaginal birth who was physically recovering as long as I was. I just don't want this thread to give anyone an overly rosy view of csection recovery!

Hi, I am a mom who is still physically recovering from a traumatic vaginal delivery-- so know you know someone. I could not sit down comfortably for months and brought my hospital donut everywhere. I could hardly walk for weeks. I Couldn't have sex without pain for over a year and I spent 6 months in pelvic floor PT because of nerve damage and pain. Nothing is rosy about childbirth, but my 3 friends who had uncomplicated scheduled Caesareans all were back to exercising well before I could even walk without discomfort. I know people will say that my experience is an outlier but the more I talk to women the more I realize how common these issues are in the post partum period. They just are not talked about. All recoveries suck, and some are harder than others.

Sorry--I shouldn't have compared the two--and I don't mean to imply that recovering vaginal child birth is anything rosy at all! Just the vibe I got from some PPs (maybe this was their experience--if so I'm jealous--or maybe the details just faded into the memory hole that is the postpartum months) was that the recovery from a cs is no big deal. I just wanted to clarify that this is not the case. And my experience is not an outlier--this is what it is to recover from having your abs cut open and a baby yanked through them.

[Anonymous]

the PP at 11:05 nails it. OP, go with your instinct and your heart. Know that there are risks to both. I have terrible and permanent damage from a vaginal birth and I dearly wish I had a c-section. Understand the c-section risks, and learn about the risks that tears bring (chiefly prolapse which is no walk in the park - impacts your sexual enjoyment, continence, confidence, what you can eat, etc.) We focus so much on the risks to the baby - my biggest wish is that women know the risks to themselves with both approaches and make an informed decision.

[Anonymous]

23:05, I mean. that person is 100% right.

[Anonymous]

Anonymous wrote:You guys realize CS have serious risks to them? Not just now but in the future? Recovering from a bad tear isn't easy but how do you think they get the baby out in a CS? They cut open your abdomen and uterus. That's a much bigger and more serious wound.

I'm a midwife and I see women who've had serious tears not even need repairing the second time. I'd choose a vaginal birth and ask that my provider do good perineal support and let me lead pushing rather than direct it themselves.

Just about everyone recovers from a C-section, especially a scheduled C-section after a routine pregnancy, without incident. I've had a third-degree tear, and I've had a C-section, and I'd choose the latter again in a heartbeat.

There's no gold medal for vaginal birth, OP. Despite what midwives might claim.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I've only had c-sections so I have no idea how painful the recovery after a tear is, so please take that into account in my response.

Just remember that a c-section is major abdominal surgery where your muscles, uterus, and nerves are cut through. Here are a few things that you should seriously consider about having a c-section vs. risking a second tear:

- You won't be able to carry/lift your older child for at least two weeks, possibly even longer after you give birth.
- You will have a really hard time going up and down stairs for at least a few days, possibly even longer after you give birth. I live in a three story townhouse and just assumed my recovery would be as easy as last time. I forgot that the first time, we lived in a ranch, so of course it was easy.
- You may have nerves cut that don't repair themselves. Read up on abdominal numbness after c-section. I didn't have this the first time, but it's 15 months after my second, and there is a chunk of my lower abdomen that I can't feel because the nerves didn't grow back. My OB says that at this point, it's probably permanent.
- The C-section shelf is real.

There is so much more...

This isn't universal, though. With my scheduled C, I didn't have a problem going up and down stairs. I left the hospital early and was going for long walks within a day.

I agree about the shelf, though. That does seem to be universal.

I don't have a shelf! And I really want to know what my OB did so that I can, like, monetize it or something.

I do, however, have the numbness PP mentioned. But I would c/s again and would choose c/s in OP's position.

I don't have a shelf or numbness post-C. I can't even really see a scar.