Suddenly freaking out about getting another tear!

[Zephram]

Long story short, my first was an emcs, my second was a VBAC forceps birth that resulted in a bad third degree tear (3b) and episiotomy. Despite the severity of the tear (it all took 90 minutes in the OR to stitch it back together) I was back on my feet sooner than after the emcs. Obviously the first few weeks I was sore and tender and pooping was hell, but I didn't feel as slammed as I did after the emcs. So I have thus far been keen to have another VBAC with my third. Until now!

A couple of weeks ago I had a VBAC clinic appointment at the hospital with an obstetrician (this is standard for NZ at around 34 weeks if you have had a cs before) and we discussed the situation - she was more cautious than my midwife and really went into how we have to avoid anymore damage to my anal sphincter (haha, sorry). This is what started me thinking about maybe doing an elcs instead. And then last night I got curious and thought I would have a look at my vulva with a mirror (more TMI, sorry!) to see what kind of state it is actually in as after the birth of my second I have really avoided looking at it at all - kind of like a don't think about it and everything will be fine attitude!

Anyway, it is a bit of a mess down there. I can see the scar from the episiotomy which is a neat straight line and then the scar from the tear which is a bit of a mess. So I am seriously starting to think I don't want to go down that path again!!

The obstetrician said I am not allowed another forceps birth, so if it gets to that stage again it'll be off for c section instead, but even if I manage to push him out without being assisted, I'm terrified this scar tissue will just give and I'll either end up with permanent damage or with even more of a mess down there.

What would you do if you were me? Would you book an elective c section or would you go with the flow and see how labour seems to be going? This is the first time I've really been nervous about labour in 3 pregnancies, the other two times I very much had no expectations, but this time I am scared of further damage.

 

[x-ginge-x]

Hmm this really seems a case of pros and cons weighing up, though through fear alone I think I would go ELCS. An elective is massively different to an emergency, I recovered better after my second CS even though I had laboured for three days! If you are really unsure the scarring would hold up then I wouldnt risk it personally!

 

[Kirstiedenman]

An obstetrician is always going to lean more towards an elcs. I am an advocate for homebirth and obstetricians are more along the line of advocates for csections as it is more time efficient and cost effective for them. Yes there is a risk that you could tear again and have damage but did he sit there and tell you all of the risks and the damage that could happen with another csection?? it is major surgery and although they are great to have for an emergency it is still that major surgery and also comes with major risk factors.
I would start looking into things like hypnobirthing and having a look at why you tore last time. Where you able to move around freely did you have an epidural, what was the reason for the forcups. Really scrutinise your last birth and see if you can find a way as to why all of that happened and what could have been done to prevent such a large tear and epesiotomy. How big was the baby? Maybe using a birth pool this time as that reduced the risk of tearing.
Obviously at the end of the day if going for an elcs feels right and what’s best for you then it is the right decision to make but don’t do it without really informing yourself you obviously want a vbac and it is great that got one already make sure you do all you can for yourself to make sure it’s the birth you want by an informed choice and not scare tactics. Unfortunately not all obs are supportive of vbacs which is sad as just because you needed a csection with one does not mean you do for all.
I hope this doesn’t come across as rude or judgemental that is not my intention I just want women to be able to make informed choices for birth and it saddens me when obs and drs try to fear monger when birth is a perfectly natural part of our genetic make up and we should always be supported to treat it that way.

 

[Natsku]

I was really scared of tearing again and had an appointment with an OB at the hospital to discuss this and she told me that the risk of tearing is greater with the first vaginal birth - subsequent births are less likely to tear because they've already been stretched before so it's easier for them to stretch again.

 

[Kirstiedenman]

Also have a look into getting some oil and getting your partner to massage your Perinium in the weeks leading up to bubs arrival or do it yourself if HD isn’t comfortable.

 

[Bonnie11]

It's really a pros and cons thing for you lovely. My sister had very similar to you, ended up with a 3degree tear last time and they offered her a section this time around. I think it was the thought of the continence being affected that pushed her to it. To be honest I would have made the same decision as her but it's really up to you. Personally I'm taking a planned section this time over a poss emcs as I don't want that again and I know they will be more cautious with me this time around not to let me hang in labour too long so I've opted for the planned section x

 

[Zephram]

An obstetrician is always going to lean more towards an elcs. I am an advocate for homebirth and obstetricians are more along the line of advocates for csections as it is more time efficient and cost effective for them. Yes there is a risk that you could tear again and have damage but did he sit there and tell you all of the risks and the damage that could happen with another csection?? it is major surgery and although they are great to have for an emergency it is still that major surgery and also comes with major risk factors.
I would start looking into things like hypnobirthing and having a look at why you tore last time. Where you able to move around freely did you have an epidural, what was the reason for the forcups. Really scrutinise your last birth and see if you can find a way as to why all of that happened and what could have been done to prevent such a large tear and epesiotomy. How big was the baby? Maybe using a birth pool this time as that reduced the risk of tearing.
Obviously at the end of the day if going for an elcs feels right and what’s best for you then it is the right decision to make but don’t do it without really informing yourself you obviously want a vbac and it is great that got one already make sure you do all you can for yourself to make sure it’s the birth you want by an informed choice and not scare tactics. Unfortunately not all obs are supportive of vbacs which is sad as just because you needed a csection with one does not mean you do for all.
I hope this doesn’t come across as rude or judgemental that is not my intention I just want women to be able to make informed choices for birth and it saddens me when obs and drs try to fear monger when birth is a perfectly natural part of our genetic make up and we should always be supported to treat it that way.

The obstetrician did actually tell me I am a candidate to have another vaginal birth, she didn't try to tell me to have a c section instead, but she was definitely more cautious than the midwife. I definitely agree that obstetricians are more risk averse than midwives, but on the other hand I feel my midwife has either glossed over or not really considered the effect that more perineal damage might have on my future continence!

She told me that I should try to avoid an epidural (I got one last time as I was more than 24 hours in labour and I was exhausted and needed to rest) as it obviously increases the risk of having an intervention. The obstetrician basically told me the opposite, which was that they would want me to have an epidural as it 'helps to relax the pelvic floor', her words, and also so I wouldn't feel a tear/episiotomy. The doc is also recommending I get an episiotomy prior to pushing so it deflects away from the tear scar. And also I suppose so if I need to have another cs they've already got the port in my back.

My midwife also suggested a water birth tio help soften my perineum but I'm really tossing up whether I want to try as I'm more inclined to want the epidural for the fact that if I'm going to tear again I really don't want to feel it. Because I was a forceps birth last time they stuck me with a local anaesthetic as well as the epidural (it had actually largely worn off as I pushed for 2 hours prior to forceps being suggested), so I didn't feel it, but the thought of not having an epidural and then feeling the tear as it happens is making me wig out.

I think I'm resolved to seeing how labour goes before seeing where we're at intervention wise. I think if it doesn't go on for so long that I'm exhausted I'll see if I can do it without the epidural, but if I have another long labour I can't see not having one. I'm not going to go as far as plan an elective CS, thought I have been booked for elcs/induction if I go 10 days over, but I'll cross that bridge when I come to it.

I really understand why lots of ladies are saying to have the cs - part of me wants to but I think I'm resolved to test the waters through labour first. I'm just scared!

 

[Kirstiedenman]

An obstetrician is always going to lean more towards an elcs. I am an advocate for homebirth and obstetricians are more along the line of advocates for csections as it is more time efficient and cost effective for them. Yes there is a risk that you could tear again and have damage but did he sit there and tell you all of the risks and the damage that could happen with another csection?? it is major surgery and although they are great to have for an emergency it is still that major surgery and also comes with major risk factors.
I would start looking into things like hypnobirthing and having a look at why you tore last time. Where you able to move around freely did you have an epidural, what was the reason for the forcups. Really scrutinise your last birth and see if you can find a way as to why all of that happened and what could have been done to prevent such a large tear and epesiotomy. How big was the baby? Maybe using a birth pool this time as that reduced the risk of tearing.
Obviously at the end of the day if going for an elcs feels right and what’s best for you then it is the right decision to make but don’t do it without really informing yourself you obviously want a vbac and it is great that got one already make sure you do all you can for yourself to make sure it’s the birth you want by an informed choice and not scare tactics. Unfortunately not all obs are supportive of vbacs which is sad as just because you needed a csection with one does not mean you do for all.
I hope this doesn’t come across as rude or judgemental that is not my intention I just want women to be able to make informed choices for birth and it saddens me when obs and drs try to fear monger when birth is a perfectly natural part of our genetic make up and we should always be supported to treat it that way.

The obstetrician did actually tell me I am a candidate to have another vaginal birth, she didn't try to tell me to have a c section instead, but she was definitely more cautious than the midwife. I definitely agree that obstetricians are more risk averse than midwives, but on the other hand I feel my midwife has either glossed over or not really considered the effect that more perineal damage might have on my future continence!

She told me that I should try to avoid an epidural (I got one last time as I was more than 24 hours in labour and I was exhausted and needed to rest) as it obviously increases the risk of having an intervention. The obstetrician basically told me the opposite, which was that they would want me to have an epidural as it 'helps to relax the pelvic floor', her words, and also so I wouldn't feel a tear/episiotomy. The doc is also recommending I get an episiotomy prior to pushing so it deflects away from the tear scar. And also I suppose so if I need to have another cs they've already got the port in my back.

My midwife also suggested a water birth tio help soften my perineum but I'm really tossing up whether I want to try as I'm more inclined to want the epidural for the fact that if I'm going to tear again I really don't want to feel it. Because I was a forceps birth last time they stuck me with a local anaesthetic as well as the epidural (it had actually largely worn off as I pushed for 2 hours prior to forceps being suggested), so I didn't feel it, but the thought of not having an epidural and then feeling the tear as it happens is making me wig out.

I think I'm resolved to seeing how labour goes before seeing where we're at intervention wise. I think if it doesn't go on for so long that I'm exhausted I'll see if I can do it without the epidural, but if I have another long labour I can't see not having one. I'm not going to go as far as plan an elective CS, thought I have been booked for elcs/induction if I go 10 days over, but I'll cross that bridge when I come to it.

I really understand why lots of ladies are saying to have the cs - part of me wants to but I think I'm resolved to test the waters through labour first. I'm just scared!

I have torn with every single one of mine and never felt the tearing happen once. It’s actually pretty amazing the human body the perinium stretches that thin that there is no nerves there at the time so essentially you have no feeling other than the normal burning you feel when the baby is crowning. I had no idea with any of them I had torn until the midwives told me.
To my understanding a tear actually heals better internally is the muscle tears with the grain where as an epesiotomy cuts through the grain.
I think massaging in the last 6 weeks would be really beneficial for you and lots of meditation over the fear to release it and accept it (if your into that sort of thing)

At the end of the day you have to do what you feel is the best and what you feel most comfortable with.

It would be nice to see into the future hey as you could have a glimpse of the labor is going to go great and the tear will either be non existent or minimal or the opposite.
I hope that your labor goes smoothly and you get the intervention free birth you want with minimal or no damage!
If you are into reading read ina may gaskins spiritual midwifery and guide to childbirth such amazing books!!

 

[jessmke]

With my first I had a very complicated 2nd degree tear, the OB had to call in two other doctors to get their opinion on how severe the tear was, I had people's fingers all up in me in varying places, it was horribly uncomfortable and went on for well over an hour before I was stitched up and they decided it was only a 2nd degree tear. I was really worried about having a worse tear with my second, and I did end up with a 2nd degree tear but it was much less severe and only took maybe 10 min at most for the midwife to stitch up. He was almost 9 lbs, but the only reason I tore with him was because his shoulder got a little stuck so the midwife had to put her hand up there to help him out. So in my experience the tear with my second was much less severe, even though he was over 2 lbs heavier than my first. My scar tissue is also not bad at all. I saw a pelvic floor physiotherapist after the birth of my second and she did an internal exam and even commented on how great I looked down there considering the two tears.

With my first I had been in labour for 30 hrs and had only dilated to 5 cm, so I got an epidural and had a nap, woke up 4 hrs later dilated to 10 cm and ready to push, so in my experience an epidural can definitely help you relax and dilate! With my second I didn't have any pain medication at all and I had no idea that I had torn, with all the pain and stretching going on down there I didn't feel the tear at all.

 

[lilmisscaviar]

I had a bad tear with my first birth and was extremely scared of tearing with my next pregnancy remembering the nightmare of trying to use the bathroom for the first 2 weeks after birth. However once you've already stretched down there once, it usually stays pretty elastic. I didn't tear at all in my last three pregnancies and bounced back pretty quick. If you're really worried about tearing, could you ask to get a late trimester ultrasound to measure the size of the baby and, if the baby measures larger than average, possibly be induced a couple weeks early to ensure that the baby comes a little easier? The larger the baby, the more prone you are to tears.

 

[Zephram]

It's certainly a relief that no one has commented saying they tore worse the next time! I'm honestly just worried about 1) feeling it during childbirth if I haven't had an epidural and 2) it effecting my future continence. Eek! I think I just need to stop thinking about it so much, I obviously can't know what will happen until I get there!

 

[Kirstiedenman]

I hope your able to release that fear hun and enjoy the rest f your pregnancy and labor and I hope your medical team are supportive of what ever decision you make. Have faith in yourself and trust your body research birthing positions that minimise the risk ignorance tearing. Reasearch breaking baby out rather than pushing on your back all these things will help.
I am also hoping to not tear this time as this will be the fourth time my first needed stitching my second came so fast literally one push/breathing him out and head was out then his body just shot out like a rocket so no time for stretching and my third no stitches but still tore because he wouldn’t turn and he came out at the widest part of his shoulders at the narrowest part of my hoohah. I will be reasearching how to minimise this time as well. It would be so nice to not have a fear of the toilet for the week or so after birth!

 

[Bonnie11]

Zephram could you book a section (40 weeks maybe?) and then if you don’t want to go through with it then just cancel? That’s what they advised me to do initially when I was hoping for a VBaC (not going to end up happening now) but they advised me to book one at 39/40 weeks and if I didn’t want it then just cancel, that way you have both options and you can decide nearer the time x

 

[plutosblue]

Its a personal decision and only one you can make x I've had 2 extensive second degree tears, didn't feel either of them, my son (2nd time) was worse but I think that was due to his and my positions (he came out facing sky and I was on a squatty stool thing). A senior midwife had to sort me out and declared it was one of the most difficult she'd done That said, I healed sooo much faster, had minimal discomfort and have had no issues since even through this pregnancy. I am nervous about tearing again, but only in case there's permanent damage, but I'm doing as much as I can myself (perineal massage, breathing exercises) and have requested hands on help when crowning and hope to be on my side/all fours. That said I think I'm just unlucky and have dry/non stretchy skin! I have a few friends who had 3rd degree tears who got away with just grazes second time x