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)?