Caesar after 3rd degree tear??

[KMond]

I 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)

[Midwife Melissa]

I'd be getting a second opinion from a midwife. Most women who have had a third degree tear do not tear again, third degree. I do not agree with the advice of your physio, nor do I believe a physio is qualified to give such advice.

An OB will generally recommend surgery when there's the slightest indication for surgery as this is their specialty. So I'd recommend consulting with a midwife for a second opinion, to get some balance to the info that you're getting.

[Alan]

I agree with Midwife Melissa. I also suspect that the failed ventouse and the forceps delivery greatly contributed to the degree of tearing that you suffered. I would also suggest that you do some reading on birth positions. Birthing on your back is known to increase your chance of tearing

[sas85]

My mum had 2 forceps deliveries on her back with both my brothers 11lb and 10lb, posterior, foetal distress and stuck so she had to have a full episiotomy through to her anus and Dad thought bubs head was gonna pop off the Doc was pulling so hard to get him out urgently with his foot on the end of the bed etc- she said for the first few weeks no control over bowel motions/urgency - so same problem. But she never had any ongoing problems with that recovered fine after the first few weeks, had the same thing after my next brother, but again wasn't ongoing didn't need physio though to get continence back - that might make a difference. My birth was natural as I was healthy and not stuck- she DID tear with me but not all the way through so didn't have the problem with foecal incontinence at all. Hope that helps.

I understand the fear of tearing though - I only tore 2nd degree (didn't push when crowning and was on my knees but just bad luck) tore in 3 directions, they had to call the OB to come stitch as was very awkward, but the stitching up memory is the biggest scare factor for me going back again as I can't believe how excruciating that 40min was (plus the 5 months it took for no pain upon 'activity'). So don't mind if I have to CS next time for any other reason.

Also, my gf tore 3rd degree (took them 3 hours in OR to stitch her up blood loss etc) OB recommended Caesar for her next one too - but if she did want to VB to be in a position the midwife could see when bub crowning in case was due to over-pushing as she was waterbirthing and midwife didn't have clear view. So they do admit that there can be reasons - forceps deliveries are terrible so you might be fine next time. All the best with your decision.

[~breeze~]

I didn't have a forceps etc delivery but I did have a 3rd degree tear from birthing my DD. Just like you I had Dr's "strongly" suggesting I have a c/s for the birth of my DS 3.5yrs after the birth of DD. They said because DD was considered to be on the larger side when born & subsequent babies tend to get larger & being a boy they are generally bigger then I apparently had a big chance of tearing again.It made me so scared thinking that if a Dr thought I needed a c/s to avoid having the incontinence etc as a result of another tear then maybe it would be best that I go ahead with the unwanted c/s.
I decided to go ahead with another vaginal birth & only had a tiny tear, hardly even noticable.
I suggest you get a second opinion.
One thing that I made sure I asked my midwife to help me with before the strong labour started was to help me breath through the pushing part as I just pushed DD out without letting "down there" stretch so to speak which is why I tore. She helped me breath & it was so hard to breath through contractions when your body is telling you to push but I'm so glad I did, I'm sure that is why I hardly tore at all.
Thats just my experience but I think its worth asking your midwife to help you in that stage of giving birth.

Wishing you luck with which ever birth you choose

[JellyBean]

Gosh you poor thing.... How horrible that you now have this fear. I agree with the others that a second opinion is a good idea - OB's are ultimately surgeons - it is their job definition, so to speak - so they absolutely would favour this option. Whereas midwives specialise in normal birth, so would have seen and assisted many woman experience normal and subsequent labours which do not result in this outcome, despite the baby being large.
I had an episiotomy which turned into a 2nd degree tear with my firstborn, and sustained a large haematoma on my perenium which hurt like buggery. However, I was pushing hard (which I have now learnt actually tightens the rectal and vaginal spincters making it harder for bub to come down - and makes vaccum/forceps/episiotomy more likely) and I was on my back (partially reclined), which closes the pelvis and birth canal. I also did no preparation for the perenium.

This time I am doing perenium massage/stretching with essential oils, and intend to have my DH/midwife apply these prior to the crowning phase. More importantly, instead of pushing I will be adopting the calmbirthing/hypnobirthing method of 'breathing the baby down' gently, using gravity to assist - either kneeling on my hands and knees or standing/leaning over the bed or birthing pool. This gives the skin time to gradually stretch without force. Birthing in water also significantly reduces your chances of tearing as the water softens the skin.
I would suggest exploring these options and maybe consider a midwife-led birth (ie- a birth centre) if it is truly a natural, low-intervention birth that you desire. Remember that you are free to change your care provider at any time - its your body, your baby - so don't settle for less.
I also suggest looking into the calmbirthing/hypnobirthing methods to help you address any fears you may be carrying from your first birth. I am yet to birth my second - but so far the methods and practices have already done wonders for me - both mentally and physically.

Best of luck whatever you decide.

XX

PS - you may wish to check out this link - http://forums.bellybelly.com.au/foru...reat-vids.html

[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)?

[Alan]

Here are a couple of articles that you may find interesting.

https://www.bellybelly.com.au/birth/...-vaginal-birth
https://www.bellybelly.com.au/birth/...tually-happens

[Tascha]

Hi,

My son was born under similar circumstances. I had a episiotomy and still tore 3rd degree down into the muscle around the "back". My DS was born via suction cap due to his heart rate failing during contractions.

Since then ive been recommended to have a C/S for my next baby, for similar reasons as yourself.

Ive been worring and stressing over the birth of this baby before he/she was concieved. I found my last labour and birth very traumatic (Not too mention the risks of faecal incontinence.)and therefor have booked myself in for a C/S. (with the option to change my mind) I did however find as much info on the subject from both sides. Mostly talking to mothers who have gone through similar situations. It helped me find my own choice.. what felt right for me.

I have found not a great deal of support for this choice. I actually don't tell many people due to the snide looks or remarks.

Good luck with your decision. One way or the other.. enjoy the birth!

[KMond]

Thanks for telling me your story Tascha - it really is so helpful to hear from other people who have been through the same thing.

Was starting to feel like a bit of a freak as no-one else I know has had a similar experience and faecal incontinenence is certainly never one of the main reasons they list for having a caesarean when you read all the books on caesareans.

I think you're absolutely right that at the end of the day you have to decide what's right for you as you are the one who has to live with the outcome of whatever route you choose. I think I am in the same boat as you at this stage and am definitely leaning towards a C/S as attempting a VB just seems like in my situation it's not worth the risk.

Thank you so much for responding and all the very best with your decision.

Thank you for the links Alan to those articles - some very interesting reading.

[sas85]

Tascha - Boo to the snide remarks and looks. You're not a celebrity opting for a CS for convenience - you have valid medical concerns and you've made the right choice for you. in many ways I think birth and child rearing can bring out the worst in people as far as enforcing personal opinions . All the best with the birth.

[Tascha]

KMond,
You are most welcome. I know how you are feeling so thought to share. I like to be able to talk to people who understand. So I might be back to see how you are going with this journey. Compare notes if you will! Untill then

sas85,
BIG thank you! And you are totally right .. my body, my child, my choice.

[rascal]

I'd be getting a second opinion from a midwife. Most women who have had a third degree tear do not tear again, third degree. I do not agree with the advice of your physio, nor do I believe a physio is qualified to give such advice.

An OB will generally recommend surgery when there's the slightest indication for surgery as this is their specialty. So I'd recommend consulting with a midwife for a second opinion, to get some balance to the info that you're getting.

I know this is an old thread, but I couldn't go past this. How is a physio not qualified to give advice about the pelvic floor? And why is a midwife the most appropriate person to give advice to a woman with a 3rd degree tear who has had fecal incontinence and urgency. These in themselves complicate the issue and increase the chances of further nerve damage occurring. This is not in the scope of practice of a midwife. Yes if the woman chose to birth vaginally, then we could provide advice about ways to minimise tearing. But management and advice of an anal sphincter defect that is symptomatic is the remit of an obstetrician/general surgeon and a physio (prererably ones who have specialist training or interest in the area.)