Birthing After 4th Degree Tear

After sustaining a severe 4th degree tear during the birthing of my daughter 3 years ago, I have been advised by my consultant to not attempt further vaginal births with any future pregnancies. Having come to terms with the idea of elective caesarian, I understand the respiratory risks of such a procedure to the baby and also am conscious of the natural role of hormones in labour and am keen to not completely disrupt and lose their huge benefit in terms of bonding, breast feeding etc. Would you recommend an in-labour c-section in this case? Am worried if things move swiftly along I may find myself risking a further trauma due to scar tissue not stretching.. Suzy K

Your double fear is justified. After a 4th degree tear when your daughter was born, we understand that you, and your consultant, prefer to avoid a birth by the vaginal route next time. We understand also your reluctance to have a caesarean before the baby has given a signal that his (her) lungs are ready to breathe, since it is in particular through such signals that the baby participates in the initiation of labour. Furthermore, as soon as the labour starts, the baby is exposed to hormones that can give a last touch to the maturation of the lungs. For all these reasons you might negotiate with your consultant the principle of an ‘in-labour non-emergency caesarean’ (i.e. an ‘elective caesarean during labour’). This simply means that as soon as the labour seems to be established, you call the medical team asking them to prepare for the operation while you are on the way.