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Offered a c-section... (updated)

post #1 of 27
Thread Starter 

I had another thread about fighting with my OB over cervical exams and ended up trying a new OB.  Well...the new one wasn't any better.  I mentioned to her that I had a 3rd degree tear with baby #1 and she said that they offer c-sections to all women who have had a third or fourth degree tear.  I left the office thinking she was crazy, but the more I think about it, the more I am considering taking her up on that.

 

DS was born at 35 weeks and after pushing for 2.5 hours, they had to use the vacuum (heart rate dropping).  The tearing was horrible.  I literally did not drive anywhere for two full months because I couldn't sit flat on the seat to drive.  Didn't have sex for six full months... Ended up in physical therapy for months, and quite frankly, I have never been the same down there.  I guess if you have had one bad tear, another is more likely.  The other thing is that I don't have a lot of confidence that if I am lucky enough to have this baby go full term that I will be able to get an even bigger baby out without worse tearing.  Also, like DS, baby is measuring big (even bigger than DS) and I am very very small.

 

Just wondering what others thoughts are.  I do really want a natural childbirth but not if I end up with another third or fourth degree tear. 

post #2 of 27

It's hard because there's so many things to consider with something like this, and a lot of them only you will really know. I've never given birth, so I can't speak to recovery after a tear, but remember that recovery after a c-section, even a planned one, is not always easy either. I know you know this, but sometimes it gets so scary that the devil you don't know actually becomes the preferred option. 

 

Fear will have a lot to do with it, and that's something that only you know whether you can work through. Having a supportive birth team around you will help with all aspects of the labor and birth, including the pushing stage, and relaxing your perenium in combination with supporting it, so that you can decrease your chances of tearing. It's scary, but don't assume that because you tore last time, you will tear this time. It's a possibility, but only one possibility. 

 

What it comes down to is that you need to be happy and comfortable with your birth. Going into it full of fear and apprehension is sure to slow down labor and impede your pushing. If deep down you feel like a c-section will be more peaceful for you, then that's the right decision for you. Yes there are definately benefits to a vaginal birth over a c-section, but keep in mind that baby can also feel your fear and stress, so that's a benefit/risk to consider as well. Your own mental health and comfort can't be dismissed. 

 

If you do decide to go ahead with the vaginal birth, there seem to be tons of resources out there for mamas who have had bad tears, but I really want to drive home that a lot of it will do with you relaxing and being comfortable. I might try a birthing from within class or something similiar to work through those feelings. 

 

*hugs mama*

post #3 of 27

I think you have to do what you feel is right!

 

I had a c-section with my DS because we found out his umbilical cord was extremely small and he couldn't come out! My OBGYN also talked to me about the chances of an repeat C-Section!

I am making the decision I feel is best, based on what I know!

It may not seem like the right choice is someone elses eyes, but in the end, its what you feel is best that matters!

post #4 of 27

You can only do what you think is right for you.  In your situation, I would probably work on learning how to prevent tears and try for a vaginal delivery, but you know, that's kind of easy for me to say since even when/if I tear, it doesn't bug me much.

 

On the flip side, I'm aware that a c-section is a likely chance with this baby, and I've also made peace with that and I'm looking at the positives there as well. (In my case, I would have a quick and dirty diastasis repair- mine was 4 inches before this pregnancy- mostly because the adhesions wouldn't allow it to close- and a hysterectomy at the same time.  Yes, I'll need  while to recover, but at that point, I will not have to worry about those issues ever again.)  You know- while, for now, the goal is still a vaginal delivery, if it goes that way instead that is ok too.  

 

My ultimate goal is a safe delivery for baby, and having me functional within as reasonable an amount of time as possible.  I've had four vaginal deliveries, I don't have a special trophy, and that reality doesn't define me as a mother.  I don't see the point in carrying guilt about how you go through pregnancy, labor, and delivery. Yes, I am a huge proponent of natural birth for people who choose that path.  More importantly though, I am a proponent of supporting women in any choice they make as a parent.  

post #5 of 27
Thread Starter 

Thanks mamas!  The hard part is I guess I won't know if I'll tear or not so if I have a bad tear, I will wish I had a c-section and if c-section recovery is hell, I will wish I had tried for a vaginal delivery.  I've had quite a few friends who have done both c-section and vaginal births tell me they would pick a c-section over a 3rd degree tear. 

 

With DS, I was pretty darn relaxed during his birth, but they had me "purple pushing" and I am wondering if that contributed to my tear.  Got to 7cm before we went to the hospital and really I was having minimal to no pain, was making BBQ chicken, showering, and vacuuming my house immediately prior to going to the hospital.  The day after the birth I was really not in much pain even though I wasn't on any meds and hadn't been during the birth either.  It was like the pain built over the first week or so (and then my stitches popped open--pure hell).  I guess I am also scared because when you tear through the muscle of the anus you are also at risk of incontinence and I don't want to spend my life worrying about pooping on myself.  On the other hand, I react horribly to meds, etc. so the thought of having a c-section and having to have an epidural and then painkillers afterwards sounds awful too.  Part of me just hopes I'll go a little preterm so I can still have a vaginal birth.  It isn't really that I feel any guilt or anything like I'm not doing what is best for baby.  I think what will be best for baby will be to have a mom who isn't in a ridiculous amount of pain recovering from a c-section or from a 3rd or 4th degree tear.  Just not sure which one is a safer bet for making that happen!

 

Jeninejessica--can you suggest any resources on preventing tearing that you think are useful?  With DS I had started doing the massage of the perineum.  This is totally TMI, but I end up with tiny papercut like tears from DTD even a few times a year (and it isn't like we're being rough).  I've had the same thing happen from a transvaginal ultrasound in which OB couldn't find my cervix and was really aggressive with that stupid wand.  I am wondering if my skin and tissue is just more prone to tearing than most... Know of any supplements or anything to increase elasticity? 

post #6 of 27

I don't really know enough to have an opinion, but was just wondering if the tearing is the main reason she suggested a c-section or if there are other factors that weighed into it?  I know you said they offer it to everyone with a bad tear, but I would try to get her to go beyond just the routine/protocol offer and get her advice on your specific situation (cuz you have other complications too, right?).  I feel like risk of tearing alone wouldn't make me want a c-section, but I have never, ever been in your position so I have no basis for that gut feeling.

 

ETA: Ok, I'm reading as I'm typing.  Any increased risk of a 3rd degree tear might be enough for me to consider a section.  Holy crap!  I'm so sorry you had to endure that.  Looking at risk factors, it looks like being a 1st time mom is just as big a risk (4x) as having torn in the past (3.5x)?  So, 4% of 1st time moms have 3rd-4th degree tears and 3.6% (confidence interval of 1.8-6.4%) of women who have torn once go on to tear again.  Big babies increase the risk even more, as well as how they go about getting the baby out and whether your induced or get an epidural.  I don't quite get how the paper I'm looking at is reporting their stats, but I think that's right.  But let's make up some numbers.  It seems like you have maybe a 5-6% chance of tearing if you can stick with a natural birth. Of course, I would talk about it more with your OB and maybe get a 2nd opinion if there's someone available.

 

I don't know.  I think you're in a tough spot and that you can't really make a wrong decision given your situation.  There are too many unknowns.

post #7 of 27

APToddlerMama -  This is your decision and you should definitely go with your own intuition on this.

 

Because you asked about preventing tearing, here is what I have found in my own searches on this subject:  coached pushing is not recommended, hydration and good nutrition can be helpful ( http://wonderfullymadebelliesandbabies.blogspot.com/2011/02/would-you-rather.html  )  Birthing positions are also discussed.  (When I tore and needed stitches with my first, I was semi-reclined, holding my knees, and being coached.  After that, I birthed squatting and at home - no coached pushing and no holding my knees! I had a smaller tear the second time along the scar from the first tear, and the third birth I had such a small tear that it didn't need any stitching.  My babies weighed:  dd1-9lb3oz, dd2-10lb2oz, dd3-9lb14oz)

 

Perineal massage has been shown to reduce the likelihood of tearing, and should be started 4-6 weeks prior to the EDD. 

Here is detailed info from midwife.org:

http://www.midwife.org/siteFiles/news/sharewithwomen50_1.pdf 

post #8 of 27

With my first I had two fourth degree tears that were stitched up post birth. I never had much trouble other than the incessant itching while they were healing. I attribute my tearing to an extremely ROUGH hospital birth. Manual stretching of the perineum by someone other than the mom:: never a great idea!!! My second birth was a breech homebirth and I had ZERO tears! I felt amazing right after I gave birth and was ready to walk a 5K...even though I spend the following 3 weeks resting in my bed!

 

I guess there are a lot of unknowns to you case. I am more of a natural mind and even though I did tear and they weren't that bad to me, I would never EVER EVER want a c-section. My DH and I have an on-going agreement that unless I am in the hands of death, he cannot consent to a c-section. I just refuse! BUT, that is me! What caused you to have an early birth? Induction, over medication, etc...can cause stalled birth especially that early which can contribute to rougher methods of birth technique ie: vacuum or forceps. Was the stitching of your tears not done properly? That can cause a lot of trouble.


In the end, you have to do what you feel best about but for me, I would not preventative-ly consent to the possibility of something without knowing it's 100% necessary. Because you don't know if you will tear at all. Maybe you can change your birth plan to a hands off delivery. Hire a doula to advocate for you when you can't. Do the things you need to do to maintain a healthy, full-term pregnancy! I don't know because I don't know the circumstances. But with the women I work with, I try to persuade them against c-section at all costs. Maybe that is my transcended fear of it, but I have also seen some of the worst outcomes from c-sections that I would not want anyone I care about to go through.

post #9 of 27

My first two were c-sections and my last 4 have been VBA2Cs. With my first VBAC, I pushed gently while lying on my side and had 3 stitches, but with my 2nd I was on my back and being coached into "purple pushing" - and I had a 3rd degree tear! With the next two, I actually got epidurals just because of my fear of pushing after that birth. BUT, I told them that I did not want to push, but would gently "breathe the baby down" as I had read about. I asked that no one coach me and no one count, but just let me push as I felt the urge. In doing that, I had one stitch with baby #5 and none with baby #6 - and I was mostly on my back with both of them. 

 

I really feel that the forced pushing was the main cause of my 3rd degree tear. She did have a nuchal hand, but so did the one where I had the 3 stitches. My c-section recoveries were difficult and I ended up with uterine infections after both of them, so I am strongly motivated to avoid surgery! That said, I'm not in your shoes and completely respect any decision you make. It sounds like your recovery was long and painful! I wish you the best best birth for both you and your baby!

post #10 of 27
Thread Starter 
Quote:
Originally Posted by cwill View Post

ETA: Ok, I'm reading as I'm typing.  Any increased risk of a 3rd degree tear might be enough for me to consider a section.  Holy crap!  I'm so sorry you had to endure that.

Lol!  Thank you.  Yes, it was pretty bad.  I am not sure if most people realize how bad a 3rd degree tear actually is. 

 

Quote:
Originally Posted by BennyPai View Post

APToddlerMama -  This is your decision and you should definitely go with your own intuition on this.

 

Because you asked about preventing tearing, here is what I have found in my own searches on this subject:  coached pushing is not recommended, hydration and good nutrition can be helpful ( http://wonderfullymadebelliesandbabies.blogspot.com/2011/02/would-you-rather.html  )  Birthing positions are also discussed.  (When I tore and needed stitches with my first, I was semi-reclined, holding my knees, and being coached.  After that, I birthed squatting and at home - no coached pushing and no holding my knees! I had a smaller tear the second time along the scar from the first tear, and the third birth I had such a small tear that it didn't need any stitching.  My babies weighed:  dd1-9lb3oz, dd2-10lb2oz, dd3-9lb14oz)

 

Perineal massage has been shown to reduce the likelihood of tearing, and should be started 4-6 weeks prior to the EDD. 

Here is detailed info from midwife.org:

http://www.midwife.org/siteFiles/news/sharewithwomen50_1.pdf 


Thank you for the links BennyPai!  I do have a feeling the coached pushing did contribute, but I don't know.  I also didn't start the perineal massage early enough last time since I ended up going into labor 5 weeks early, so I might just go ahead and start it now and leave my options open depending on how long it is before I go into labor this time. 
 

Quote:
Originally Posted by sowega View Post

My first two were c-sections and my last 4 have been VBA2Cs. With my first VBAC, I pushed gently while lying on my side and had 3 stitches, but with my 2nd I was on my back and being coached into "purple pushing" - and I had a 3rd degree tear! With the next two, I actually got epidurals just because of my fear of pushing after that birth. BUT, I told them that I did not want to push, but would gently "breathe the baby down" as I had read about. I asked that no one coach me and no one count, but just let me push as I felt the urge. In doing that, I had one stitch with baby #5 and none with baby #6 - and I was mostly on my back with both of them. 

 

I really feel that the forced pushing was the main cause of my 3rd degree tear. She did have a nuchal hand, but so did the one where I had the 3 stitches. My c-section recoveries were difficult and I ended up with uterine infections after both of them, so I am strongly motivated to avoid surgery! That said, I'm not in your shoes and completely respect any decision you make. It sounds like your recovery was long and painful! I wish you the best best birth for both you and your baby!


Uterine infections sound awful :(.  That is really encouraging that you didn't have bad tearing when you pushed on your own.  Question for you though....by "pushing gently", what do you mean exactly?  Also breathing the baby down?  I hear these things but I guess I don't really understand and I'd love to know how to do it.  Thank you!
 

Thank you JKseawell too!  Breech without tears is pretty impressive. 

post #11 of 27

I think I first read about breathing the baby down in a hypnobirthing book. Basically, it mother-directed pushing while NOT holding your breath. When you hold your breath, you tend to tense up your upper body and jaw which leads to tension everywhere. The book encouraged practicing while having a bowel movement and bearing down while exhaling. To me, the pushing seemed slower because I was not bearing down with all I had, but a dear friend of mine (who happens to be a homebirth midwife) was at my last two hospital births and mentioned my short pushing phase. It was not coached at all. Both of them descended just fine, but neither one came so fast that my body didn't have time to adjust. 

 

I hope I explained that correctly and didn't just make things clear as mud..LOL. 

 

post #12 of 27
Thread Starter 
Quote:
Originally Posted by sowega View Post

I think I first read about breathing the baby down in a hypnobirthing book. Basically, it mother-directed pushing while NOT holding your breath. When you hold your breath, you tend to tense up your upper body and jaw which leads to tension everywhere. The book encouraged practicing while having a bowel movement and bearing down while exhaling. To me, the pushing seemed slower because I was not bearing down with all I had, but a dear friend of mine (who happens to be a homebirth midwife) was at my last two hospital births and mentioned my short pushing phase. It was not coached at all. Both of them descended just fine, but neither one came so fast that my body didn't have time to adjust. 

 

I hope I explained that correctly and didn't just make things clear as mud..LOL. 

 



Thank you sowega.... if I end up going preterm, I am definitely going to do that instead.  That does make sense, and was pretty much the opposite of what I was doing.

 

My care is being switched to a perinatologist for the rest of the pregnancy.  She won't deliver the baby, so I don't think she has any reason to push a c-section, but when I asked her what she thought about the tear, she claimed to be "crunchy", not like epidurals, and whatnot and said she wouldn't suggest it.  But then she took a look at my scar and changed her mind.  Said my perineum is really short and that my tearing was really jagged and not repaired well.  She said if I was to tear again there was a good chance it would be very difficult to repair well because of the damage that is already there, and that there was more of a risk of a serious tear because of the damage and short perineum.  On top on that, baby is measuring 2-3 weeks ahead on ultrasound as well as fundal height.  I know those aren't the most accurate, but I'm inclined to think this is a big baby.  So, I guess I am going to plan to do the c-section if I go past 36 weeks.  I feel sad about it, but don't want to risk a 3rd or 4th degree tear. 

 

post #13 of 27

DDCC - I randomly saw this thread as new and decided to read. I had a third degree tear with my first birth (purple pushing, on back, epidural). Sex was uncomfortable for a good six months PP. But I did heal relatively quickly and well. My second birth resulted in a first degree tear. I also ended up on my back while pushing (not planned), but with no epidural and even though I was being coached, I found I could not push as long as the OB wanted me to (no epidural that time). I had a complication in my healing because I spent too much time sitting up and dealing with hospital protocol (resulted in some rather scarey swelling). I didn't have the same difficulty with sex PP.

post #14 of 27
Quote:
Originally Posted by APToddlerMama View Post

I had another thread about fighting with my OB over cervical exams and ended up trying a new OB.  Well...the new one wasn't any better.  I mentioned to her that I had a 3rd degree tear with baby #1 and she said that they offer c-sections to all women who have had a third or fourth degree tear.  I left the office thinking she was crazy, but the more I think about it, the more I am considering taking her up on that.

 

DS was born at 35 weeks and after pushing for 2.5 hours, they had to use the vacuum (heart rate dropping).  The tearing was horrible.  I literally did not drive anywhere for two full months because I couldn't sit flat on the seat to drive.  Didn't have sex for six full months... Ended up in physical therapy for months, and quite frankly, I have never been the same down there.  I guess if you have had one bad tear, another is more likely.  The other thing is that I don't have a lot of confidence that if I am lucky enough to have this baby go full term that I will be able to get an even bigger baby out without worse tearing.  Also, like DS, baby is measuring big (even bigger than DS) and I am very very small.

 

Just wondering what others thoughts are.  I do really want a natural childbirth but not if I end up with another third or fourth degree tear. 



APToddlerMama, I saw your post in the thread I started (not realizing there was another already).

My goodness. I can't imagine what you've been through. I understand what you mean when over time you've thought about the C-section. I don't have a high pain threshold, so if it were me in your position and had weighed up all the information like you had, I probaby would go with a C-section.. Especially taking into account the experience of vaginal births in the past.  But since this is my first and my reasons are that I may be already experiencing different problems (fecal incontinence and I'm not yet 40), I'd inclined to want to opt for vaginal birth unless more serious medical issues necessitate.

 

I'm hoping my wish is granted and there is no reason for medical intervention. I'd rather try and birth without too much coaching and respond to what my body is telling me. I hear that can help minimize tearing and other pelvic floor damage.

 

I guess since I'm due a few weeks before you, I'll be able to let you know what happened.

 

post #15 of 27

Hey APToddlerMama,

 

Thanks for the advice about requesting physical therapist help after birth. I'll definitely be getting that.

 

 

post #16 of 27

I had my second appointment with the midwife today and she recommended I see the OB-GYN so they could examine me and discuss with me the pros and cons of vaginal versus c-section. This is only my second appointment with my midwife, but I have come to the conclusion she does prefer natural births. It's just that she is also concerned about the mother's quality of life afterwards and it pains me to say it, but I think my baby will most likely enter this world via major surgery instead of birth. It's not definite yet, but I kind of get an idea of where this is going for my particular case. It's hugely disappointing, but I haven't made the final decision yet. I'm still hoping that maybe I'll get a good prognosis for after birth.

post #17 of 27

Tearing like that is likely caused by the mechanical assist, and is in no way guaranteed to repeat.

 

My first, I was in a terrible position because the doc made me go from standing/squatting to semi-sitting on the bed, and I tore pretty badly... my butt was never the same, after that, still isn't 18 years later.

 

That baby was easy to push out, just tore at the last.

 

Her sister, born 6 years ago, had a 14 1/2 inch head that didn't mould, was a pound an a half larger, and I did not tear at all, despite it being brutally difficult to push her head out due to near cephalopelvic disproportion (she had a congenitally big head with craniosynstosis and the crown was by far the biggest dimension. It was a HUGE head, and did not change shape at all, and I still pushed it out without tearing.)

 

There is absolutely positively no guarantee that your baby will have decels this time, need a vacuum assist, or all the other contributing factors that caused you to tear the first time out. 

post #18 of 27
In Ina Mays book called Birth Matters, she talked about open mouth kissing (couples obviously) during the pushing/crowning phase because it causes blood to flow down to the vagina thus causing the tissues to swell & be able to stretch more. In her experiences 100% of the women that did this did not tear at all. She also says if you clench your jaw or keep your mouth tightly closed there is a higher risk of tearing but if you keep your jaw loose & open (kissing automatically does this) the risk of tearing is minimal.
post #19 of 27
Quote:
Originally Posted by FaithF View Post

In Ina Mays book called Birth Matters, she talked about open mouth kissing (couples obviously) during the pushing/crowning phase because it causes blood to flow down to the vagina thus causing the tissues to swell & be able to stretch more. In her experiences 100% of the women that did this did not tear at all. She also says if you clench your jaw or keep your mouth tightly closed there is a higher risk of tearing but if you keep your jaw loose & open (kissing automatically does this) the risk of tearing is minimal.

 

I have to laugh at this, because I keep telling my husband that and I swear to god he still kisses like a guppy.

 

Pelvic relaxation is so important, but kissing isn't mandatory. being in the birth tub was enough for me. 
 

 

post #20 of 27

ddcc (sorry) to say:

i never had a vaginal birth or a tear, so i can't compare, but i really want to avoid a c-birth this time.  not just because the recovery was difficult, that was actually the least difficult part for me (i never took any meds besides what was in the spinal and toredol).  i didn't get skin to skin time immediately with my dd, she was taken to weigh, etc. and they had to take her into the nursery (though dh went too) while i was sewn up.  we didn't get to breastfeed for at least 45 minutes (i have no idea how long really) and i think it severly impacted our breastfeeding.  it was so difficult after that point. 

 

though to be fair, you are an experienced mama and i wasn't then.. so it might not have such a big impact on you. 

if you do have a c-birth, you might want to make sure the lactation folks can come, even so, and you might want to let the anesthesia person know that it would be good to be aware of your desire to nurse- they might give you a lighter dose, etc.

 

personally i would choose a tear and my own recovery rather than have my baby be affected by the drugs and the c-birth in such a way.  i cry when i read stories of vaginal births where they talk about how calm and alert their babies were... my fil actually made me very sad the other day talking about how he watched dd screaming uncontrollably while they did stuff to her.  i know with a vaginal birth that doesn't have to happen.

 

and i have read lots of things about people preventing tears even with big babies.  would an episiotomy help, do you think? 

 

what an awful position you're in.  i am so sorry you're having to think about this!  so stressful. 

 

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