Advice from STM+ w/ tears

JannieJ · July 2016

I've searched our board and couldn't find anything on this, so please lead me to the right direction if I've overlooked it.

With my first delivery, I sustained a fourth degree tear. Fast forward to this pregnancy and I went in for my first appt. to a new OB. He informed me that he recommends a C-section for those who have previously had a fourth degree tear. When I said that was surprising to me and that I would rather deliver vaginally again, he said that makes him uncomfortable, but that if I chose to, he would for sure do an episiotomy to counter the possibility of me tearing again. The episiotomy would cause any tearing to be away from the tissues that could cause incontinence issues should there be a tear.

I absolutely value my doctor's opinion. It simply makes me hesitate when I asked what the chances of tearing again are, he said he really didn't know, because most women just choose C-section. I would love to be able to make an educated decision, but when my doctor has nothing "scientific to offer" I worry. (He's fairly young compared to the previous doctor I had. He's been practicing for 5 years)

My question to you ladies is, would you seek out a second opinion or does this seem like sound advice? Has anyone experienced this before? With his plan, I would have an incision either way, so I am leaning towards the C-section, because at least that is controlled, and I really don't want to have incontinence problems. I've healed well from the first time and have no problems. TIA

Starfish113 · July 2016

I had a 3rd degree tear with DD and it was HELL to recover from. But I can't imagine going for a c-section to avoid the tearing. Ugh this gives me anxiety!! I'm curious about responses too. Not that mine was 4th degree, but I'd hope to not necessarily tear again...

birdiejo · July 2016

I personally would go for a second opinion. Sometimes doctors aren't comfortable doing certain things ... For example: a family friend was having twins and was told there was no other option than c-section.

Shawlls · July 2016

I can tell you that a very good friend of mine is in your exact situation and she has received 3 doctor's opinions (including her own father) and they have also said c-section. With her first, she had months of physio therapy (but is fine now) and all of the opinions she has received this time are that she could face life-long incontinence and nerve damage if she tried it again (1st will be 2 when baby is born so trauma is recent). The specific reasoning they gave her is if you tear again, you may not tear the same way, thus causing even more damage (i.e. the tearing from the first time is still there, and then you would be adding to it). To clarify, this is NOT MY OPINION, just sharing what a friend is going through since it may be helpful for you to know that your doctor does not seem to be unique in his opinion.

1017Shannon · July 2016

Along with a 4th degree tear and having to have forceps to pull my first out, they highly recommended a c section and I happily decided to get one...I never wanted to go through a vaginal delivery again. It was not a bad experience at all! If you do end up having to get a c section don't worry it can be a great experience

just some positivity for you in case you have to get one

birdiejo · July 2016

Seeing what @Shawlls said , there's some compelling info there to make me see why your doctor would not want to do vaginal. Sorry you have to make this decision , but hopefully the extra info and suggestions help ! Good luck.

JannieJ · July 2016

@Shawlls Thank you for sharing your friend's experience. I feel better knowing that even her own father recommends a c-section!

@1017Shannon That had to be so scary!! Thank you for sharing. I plan to talk to my Dr this week more about how a c-section goes down. It probably sounds silly, but I get most anxious about not being able to hold my baby right after he or she is born....I had such a great experience with my first in that aspect of delivery. I'm glad to hear you had such a great experience with your second!

JannieJ · July 2016

@Starfish113 Tears down there are never fun....so much anxiety when it comes to decisions like this!!!

@homemake I agree! Her evidence is very compelling! I definitely would rather recover from a c-section than have life long medical problems.

kswiger06 · July 2016

I think its a good idea to get a second opinion. The Dr. might tell you what you have already heard, but at least you would have heard it from more than one source and might be able to accept it better instead of always wondering the big what if. My situation is slightly different because the tearing with my firstbwent upwards. It stretched almost clear to my clitoris. The stitches actually got sewn up and one came out from under the hood area. Super gross and TMI I know. It healed up after what seemed like forever and everything is fine, looks fine, acts fine and such. Then came baby 2, I switched doctors and was in a group that never really seemed to know what was going on. I ended up having #2 vaginally (med free too yikes) and the baby was 1 lb heavier, but I had no tearing at all. I'm not saying you should risk it because that sounds scary, and awful, but wanted to put it out there that just because you tear once doesn't necessarily mean you will tear the next time.

hispenguin · July 2016

I would go for a second opinion. I had a couple friends who had this happen, one did a vaginal delivery the second time (with minimal tearing). The other had horrible bladder control issues post delivery #2 and opted for a c-section, she sought out medical advice before going this route.

fourPsinapod · July 2016

If anyone is cutting any of my lady parts open, I'm gonna get a second opinion. Not to say that your doc doesn't know what he is doing, thats just my personal philosophy.

MrsDrKirkpatrick · July 2016

I can see the point on both sides. While I don't have any experience to offer, if it were me I would maybe try to get the opinion of a midwife. Maybe one who works at a free standing birth center, and see what she thinks. Sometimes doctors recommend c sections when they aren't necessary due to convince (though they certainly have their place on medicine). Maybe a midwife would be a little less biased and give you some good tools if you did want to proceed with a vaginal delivery. And honestly if the midwife recommended a c section I would just go with that.

poofwok · July 2016

I had a 4th degree tear with my DS. It was a difficult recovery and I ended up with very minor but permanent consequences.

This is a talk I'm having with my OB as well. She says it's really up to me. She thinks a vaginal delivery would be a much better experience this time around and doesn't think I would tear in the 4th degree again. Especially because it's a second delivery.

on the other hand, she says in the event I do tear with a 4th degree again, I could end up with fetal incontinence amongst other issues. There's just no guarantees! Whether you get a second opinion or not, you'll never know what your body will end up doing so... My OB offered the c section and while I know it can also be a difficult recovery, there's less chance of permanent damage there. I'm taking it.

laurenmichael725 · July 2016

@kswiger06 lots of respect to you for what you went through. That sounds like a nightmare! I don't have experience with tearing to this degree so I don't have any knowledgeable advice to give to OP, but i think if it were me I would go with the c-section to minimize risk.

LaurenAshley04 · July 2016

I tore badly with my first but no idea what degree but I had around 30 something stitches. My guess is that it was only a 2nd degree or so as I didn't find recovery that bad.

I would definitly go get a second and maybe 3rd opinion (high risk OB/Midwife). If it were me I would really want to make sure that the CSection was the best route.

Best wishes on whatever route you go!

peachesnbean · July 2016

I would get a second opinion for sure! The doula in me is trained that there are almost NO good reasons to perform an episiotomy, I don't know if your case is one of the rare exceptions, but for the most part they are unnecessary. You could try a VBAC friendly OB or a MW for a second opinion.

JannieJ · July 2016

Thank you for your thoughts and for sharing your experiences. I'm for sure going to get a second opinion so I can make a better educated decision.

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