Maybe there is something about your situation which the drs are right to be concerned about - I don't know I don't have a medical degree.
All I can do is tell you about my experiences.
I had bad 3rd degree tearing after my first was born nearly to my rectum (along with some of those other embarrasing symptoms you mentioned). No-one ever suggested to me with my second that a c-section might be a consideration because of this. (maybe because I went through the midwife program rather then seeing a dr or ob?) I was very concerned about tearing again, However with my second child, I had no tearing AT ALL. It surprised the hell out of me. I also had no other complications. With my third, I also manage to give birth once again without any tearing (just some minor grazing). All my babies successively got bigger too (3.5kg - 51cm, 3.6kg - 53cm, 4.32kg - 53cm).
So don't think that just because you tore badly the first time, you will neccessarily tear the next time too. Having said that maybe there is something different with your situation then with mine? But if you are not happy / are concerned about the c-section, then definitely seek out a second opinion.
Studies have shown that caesarians do not provide any more protection from incontinence than vaginal births. It is not actually the birth at all that causes the most weakness to the pelvic floor muscles, it is the pregnancy - having a baby stretch and then press on them, especially in the third trimester.
Having a bad tear in your first birth is no guarantee it will happen again. It seems odd to me that in order to protect you from tearing your perineum again, your OB is happy to cut through your abdominal wall and scar you that way instead - not to mention the risks that are involved with having major abdominal surgery.
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)?
Can't say I have heard of a C/S causing faecal incontinence so I think it would safe guard you against further anal/sphincter damage. GL I hope you have a beauti*** birth experience meeting your baby this time around.
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