Caesar after 3rd degree tear??

[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

[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.)