I have read through posts about repeat 3rd or 4th degree tears over the past couple of years - and while I have read many encouraging stories I am wondering what it is that is best for my particular situation. Each time I read research pubs, it seems that I have many of the risk factors for increased chance of a repeat tear, but then there are such positive stories out there that I'm having trouble making a rational decision. I am currently pregnant with my 3rd baby, and I will wait to make a decision until labor begins and I do have an extremely supportive birth team assembled. I am just waiting on information such as what the scar tissue looks like during labor, what my PT thinks down the road, how large this baby is looking, etc. (BTW, hopefully my marginal placenta previa will have moved enough by then as well...but that's a different story).
Here are my circumstances, please give me your opinion or any information you can share.
1st baby - cesarean, 9lbs, cascade of interventions
2nd baby - unmedicated VBAC, 9 lbs 4 oz, no interventions at all, MW, doula, pushed in all of the optimal positions, pushing lasted 3 hrs, 4th degree spontaneous tear
I am afraid of the following: that I will be almost 38 yrs at delivery, that this baby will also be over 4000g, that my "short" perineum will contribute to another spontaneous tear (it is 2.5 cm long), that my original tear was spontaneous and there were no factors other than perhaps pushing too hard that I can change for the coming birth - and my biggest concern is that I currently experience urinary, gas and fecal incontinence and that a second tear/repair will worsen the anal sphincter.
It seems like I have many strikes against me. I worked HARD for my VBAC, and believe in birth whole heartedly. But until I experienced fecal incontinence (and it's only minor right now - but still, can you imagine?), I couldn't imagine my quality of personal/family life with this condition worsened. However, this is my big chance to walk away from my 2nd vag birth unscarred and feeling victorious. What a choice to have to make.
Thanks for reading!