I had an episiotomy and then third degree tear with ds1, he was big with a big head and had his hand up by his face as well. With ds2 my ob was happy with vaginal birth but said i would need to have an episiotomy. Then he went on holidays and at 37 weeks i saw his partner, not-so-affectionately known as 'dr knife' who scared the bejesus out of me about fecal incontinence and strongly recommended a c-section, which I was very upset about. I sought other opinions and the consensus was that i could very well tear again and a c-section was not an unreasonable option. I booked the c-section as I knew that if i tore badly again I would always regret it. Luckily for me, I went into labour in the middle of the night and as I was being prepped for my 'emergency' c-section, my baby came so quickly that all the ob could do was to give me an episiotomy. DS2 was born in the room next to the operating theatre. I didn't tear at all, so was very, very happy that i escaped the c-section. Still very angry with dr knife about the whole thing. When my own ob came back from his holiday he said that there are two schools of thought about whether a c-section is needed after a third degree tear. He thinks no, his partner clearly thinks yes. I guess no one really knows if a woman will tear badly again, so it's a gamble. I hope your friend can get some useful advice and make a decision that she is happy with.