With my first child I had a perineal tear that was a third (almost fourth) degree laceration. I also had placenta accreta (my placenta had an abnormally deep attachment to my uterine wall). My OB had to manually extract my placenta, so I lost a significant amount of blood. This also created a postpartum infection, and recovery was very difficult.
I am currently pregnant with my second child, and due on June 29th. My OB is concerned about my baby being bigger than my first (he was almost 8 lbs) because it's my second child. If he is bigger, my risk for a fourth degree laceration is higher, which can cause a lot of complications with urinary and rectal incontinence. I could also have to have a surgery at a later date to repair the damage. Unfortunately, it's not something that can be predicted until I am already giving birth.
My doctor has recommended a c-section to avoid possible complications, but he has also said that he would never tell me I couldn't have a vaginal delivery because he can't say for sure if I would even have those problems. I prefer a vaginal birth, but given that this is my last pregnancy (hubby and I only want two children), I don't want this labor to be as traumatic as the first.
I would love to hear from women who have experienced similar complications, and how later childbirth experiences were. I have a medical reason and recommendation for c-section, but it's not required. Keep in mind, my only complication was not from vaginal tearing - I also had placenta accreta. I would love to hear what you ladies have to say. Thank you!
I had a major tear with my first child (I'll spare you the details, but it sounds like yours) and only a small, superficial tear with my second, along the first part of the scar tissue. In my case, the first tear was due to baby's positioning, and that didn't happen again with my second.
My situation was similar to Meredith's. The position of our son caused a horrendous tear. My new OB said it could have been avoided. Grrr! She feared that I would have some serious, long term issues if it happened again and recommended a C-section. We got pregnant with twins, they were huge 8.12 and 7.6, so I am glad we opted for a c section.
I had a 3rd degree episiotomy with my first. He was only 5lbs 13 oz. My second (7lbs 3oz) was a c-section because of placenta previa and a heart defect. I really wanted my third to be a VBAC, but I was concerned that he would be bigger and therefore not come out. My doctor was amazing and assured me that once "the trail's been blazed" it would be much easier the second time. I did it! The VBAC was a success and my son, who was 7lbs 3oz, slid right out. I only had 2 stitches. I would say your biggest concern is placenta accreta. Is there any way to know if that will be a problem before you go into labor?
Each birth experience is different. As someone who has had a c-section with a second baby, I will tell you that you are recovering from major abdominal surgery with all of the risks of infection and trying to take care of a newborn and your first child. Very difficult and very stressful. You should do a lot of research about what to expect as a result of a c-section. I couldn't drive for 2 weeks after mine (an issue since my older child was in kindergarten) and it took almost 12 weeks for me to get back to normal. Also, would the c-section be scheduled or would you wait for labor to start on its own? It is better for the baby to wait for labor to start on its own but most OBs prefer to schedule - this often results in babies that are born too early with those types of inherent problems (regardless of the "dates" given by ultrasound).
If you want to try to reduce tearing, then begin doing perineal massage daily - starting today! Also, ask for the use of hot compresses and oils during labor and delivery. If that is not possible ordinarily - ask if you can bring a doula or midwife to assist with this.
Do not be concerned about a bigger baby - your body will not grow a baby too big to birth unless you have GD. Your concern is positioning - so make sure that you are using a birthing ball and avoiding sitting with your legs crossed or leaning back (stay away from the recliners). You should have your legs apart and lean forward when sitting and stand as much as possible. You may want to see a chiropractor who specializes in pre-natal to try to get baby into the best position possible.
Also, keep in mind that altough your doctor said you need to decide by 36 weeks - that is totally arbitrary. If you decide c-section and then change your mind - you just say no. Also, if you go into labor and have planned to deliver vaginally and change your mind along the way then you can do that too....just tell the OB what you think you want at 36 weeks and then you can modify along the way. It is your right to make medical decisions (and change them) at any point that you want - even during labor!
Please let me know if you need info on perineal massage or anything else. I would be happy to get you some data if you would like - contact me directly.
You need to discuss with your OB about being able to move around freely - and possibly GIVING birth squatting, on your hands and knees or leaning over on the bed.
Being on your back is the worst possible position to give birth - even at the best of times. Gravity works against you, the baby is unable to move into position as it should - without interventions - and tearing is much more prominent. Also discuss with the OB about perineum support and using massage and oil to stretch and loosen the skin around the vagina and leading to the anus area.
Midwives do these things all the time, have babies up to 12lbs being born with little to NO tearing!!
Laying on your back is only convenient to the medical staff and OB, it's not helpful or really even logical for the woman in labor giving birth!
@ Sunshine
Your constant sniping and attempts to 'show me up' are getting beyond simply antagonistic and childish. Grow up please and simply state your opinion or experience without trying to drag mine into it.
If you are just sharing your experience and 'educating', then you state your experience WITHOUT MENTIONING 'contrary to a previous poster' - it's fine to say your experience worked and what you did - but you dragged in my post which was childish and unnecessary. PERIOD
I had a 4th degree tear with my 1st baby so with my 2nd, my dr didn't want me to go past my due date so the baby wouldn't be too big. She induced me on my due date and my daughter was born weighing 5 oz less than my 1st and I had a 2nd degree tear and NO problems at all! My recovery was wonderful and easy.
My sister also had the same thing happen. A 4th degree with her 1st (8lbs 5oz) and 2nd degree with her 2nd (8lbs)
I think usually you don't tear as bad after the 1st one but if you are way too scared and feel better having a c-section then do it! It needs to be what you feel comfortable with!
I delivered my first at 7lb 14 oz via vacuum suction and was given an episiotomy resulting in a third degree laceration. I delivered my second at 8 lb 12 oz and had a superficial tear that didn't require any stitiching, just to be extra careful about keeping things clean. With my second I definately believe the fact that I pushed and delivered on my hands and knees vs. on my back in the bed made a big difference in tearing, esp. since I was at a greater risk of tearing and tearing badly due the previous episiotomy. I hear you about not wanting another complicated vaginal delivery, the doc at my first delivery said something to my husband to the effect of he has seen many women struggle with first deliveries and go on to easily vaginally deliver their larger second children with no "help" and less physical trauma. I guess I am suggesting researching how you can push and position yourself in labor to minimize tearing vs. signing up for a c section to avoid it (there is the matter of recovering from a much larger wound and major surgery) but that doesn't speak to the potentional placenta issues, which I have no expereince so won't offer advice :)
i had a 4th degree tear with my 1st and he was 7lbs 10oz. i only had a 2nd degree with my next 3 kids and 9lbs, 9lbs9oz and 8lbs5oz. so there is hope for you:) i have had no complications with any of them. i think my bad tear was from pushing too hard too quickly ( i have fast labors). i also remember feeling very nervous about my 2nd birth and wish you the best with whatever decision you make:)
Hi Mommy of 2! I also had a 3rd degree tear. I labored for 72 hours, pushed for 5 hours, had several failed attempts at vaccum extraction, and an epsiotomy, resulting in the tear. I had months of recovery, including battling a staph infecting in my perineum.
I was absolutely terrified of giving birth again so I went into it with a lot of fear. I had itching hives for a month prior to the birth of my daughter just from the memory!
Thankfully, my second birth was AMAZING!!!! I gave birth 4 hours after arriving at the hospital, pushed for 20 minutes (while lying on my back, so contrary to a previous poster, there IS occasionally an ideal situation for it!) and we gave our daughter the middle name "Mercy" as a direct result of an easy labor.
I hope your labor and delivery are wonderful and stress free, and I hope you heal VERY quickly afterward! Congratulations!
@Pamela - I am not sniping or trying to show you up! I am sharing with this poster MY STORY. If it happens to be contrary to your "knowledge" you need to be able to accept that. You take every opportunity that you can on this board to push your views (and I don't disagree with your views, just your manner of bulldozing) so I can take equal opportunity to share my story and my views. I want this poster to have all the facts, and you just happened to leave out a fact that I experienced. Just doing my best to educate!
With my first I had a third degree (he came out with one hand above his head. With my second 20 months later I only needed 2 stitches and was fine. The thought of going through a C section never even crossed my mind to be honest. With my second part of the placenta got left behind and they had to manually scrap my uterus, but I do not think that would affect anything if I decided to try for number 3.
I would not consider a c-section. The risks of a c-section far outweight the risks of a vaginal birth even with your history. A c-section is major surgery. They have to cut through 7 layers of muscle. What if you get an infection in the incision? It happens all the time. Then they have to open up the incision and let it heal from the inside out. What if they nick a uterine artery and you bleed out? It happens. Not trying to scare you, just trying to give you a realistic view. Most likely you will not tear that bad again and maybe not at all. I tore with my first but not the second or third. It is also very important that you be allowed to deliver in any position you want. Squatting helps prevent tearing. It is also important that you give birth med free so you can control the pushing, this also helps prevent tearing. I would not worry about the babies size. Your body will not grow a baby too big for you to push out. Trust in your body and trust in your baby. You can do this. I have attended lots of homebirths and when I worked in the hospital I attended many c-sections. You don't want a c-section.
My second was 8 lbs 7 oz and I had an almost 4th degree tear as well (he was also four weeks early!). He had his arm up so I delivered his head with his elbow!
My third was even bigger, 8 lbs 11.5 oz, but his head and shoulders were smaller and there was no arm to contend with, so I only ripped a little (my midwife said I could have one stich or not, so I chose not) and I did just fine.
Since my midwife delivered my 2 and 3rd and knew after my second that I had such a horrible tear, I'm a little miffed that she didn't tell me my chances, or even the existance of, the complications you mentioned!!
I don't know if knowing that would have changed me having a vaginal birth or not, so I'm kind of glad I didn't know, but all the same, everything turned out better the last time around.
As for post partum infections, the chances are higher for C-sections, but I'm sure you know that already. Also, think about the mandatory down time with a C-section versus the possibility of down time if nature takes it's course. It's a little like roulette. With a vaginal birth, the amount of down time is a game of chance. With a C section, downtime is almost always a must (and you'll be trying to keep up with your first). I know lots of women who do it, though.
The placenta thing? I just don't know. That is one thing I never had to deal with.
This probably didn't help you a whole lot! I'm sorry!
All I can tell you with any certainty is that every pregnancy, labor and delivery experience is different! This next one could be completely opposite than before, even with your previous issues. Good Luck!!!
I'm not surprised your OB is recommending "major abdominal surgery". OB's are trained surgeons. He's recommending c-section to avoid possible complications?? Will he guarantee you won't experience complications with the c-section? Accreta occurs in 1 in 2,500 pregnancies and from what I've read it appears that re-occurance happens in 16% of pregnancies. Does your OB have strong suspicion of another accreta due to ultrasound findings? If I were in your shoes, I would educate myself on everything I could find related to placenta accreta, search for and consult with a midwife that will encourage you to change positions during labor/delivery based on what feels right for you and support your birth choices.
I have 4 children, all born vaginally. My oldest was my largest at 8lbs 11oz, my second was 8lbs 6oz, my third was 8lbs 10.5oz and my fourth was 8lbs. It's possible for your little one to be smaller than your first. Your OB is estimating based on ultrasounds(not accurate for weight), your measurements, your past history and the reality that most(but not all) women have larger babies than their first. I know of women that have had 10+lb babies and no tears because they had the freedom to move around and their perineum was supported during birth.
You may even consider checking out the International Cesarean Awareness Network (ICAN) to get feedback from women that have had c-sections (possibly some for suspected accreta) and to hear about their experience. http://ican-online.org/
Best of luck as you do your research and decide what option is best for you and congrats on your little one. Peace & Light,
Janet
I posted almost this same extact question when I was pregnant with my 2nd baby. I had a BAD 4th degree tear with the delivery of my daughter. One of my 5 OB's also suggested a c-section for my 2nd due to the same reasons yours is (incontinence, etc). I spoke in length with all of the other delivering OB's and a few OB nurses I know. They ALL said the 2nd delivery is always easier/better. The nurses all suggested that I "labor down" meaning that I wouldn't start pushing until I felt the need/urge (which didn't happen with the first since I really didn't know what was going on). The doctors couldn't say for sure that I wouldn't have the incontince and other problems but likelihood would be minimal.
The day I went into labor, I made sure EVERY doctor and nurse(I actually had the same nurse that was in my 1st delivery and she remembered my story) knew my history of the tear and my worry for it to happen again. The 2nd delivery was FANTASTIC!! Less then 30 mins of pushing and 1 stitch for a superficial tear. I believe that was in part of me educating the staff and telling them my concerns. I also heard from a few of my docs and nurses, that with the 2nd delivery that the "path has already been made" by the 1st, so it is usually a lot easier. I am so glad I did not choose to have a c-section!!
As for the placenta accreta, not familiar with that but agree with some of the other posts to research the liklihood of it happening again. And if you did have it again, would a c-section reduce the amount of bleeding and infection that much that is would make it worth having major surgery?
Good luck and which ever decion you make will be the best for you and your family!
DON'T GET A C-SECTION. Even if you tear you will have an easier recovery than major abdominal surgery. Remember that an OB/GYN is a surgeon they get paid to do surgery. Your doctor will make thousands of dollars more in less time by operating on you so of course he will recommend surgery. If you do your research you will find many ways to prevent vaginal tears. One of which is to choose a different position for pushing. If you are on your back you will be more likely to tear. I you are on your side with one leg in the air this can be helpful. I would recommend you watch the business of being born. This excellent documentary explains how doctors and hospitals are in business to make money. Your doctor is seeing you as a dollar sign and is feeding your fear. Birth does not have to be a damaging experience. You are able to control the outcome through proper education, nutrition, and exercise. If you are still worried about a tear I would look into perineal massage. This is something that you do for the final few weeks of your pregnancy. It helps to stretch the tissues in a natural manner. I would just like to say that I have had a few friends who had c-sections and all of them regretted it do not let this doctor cut you I would run the other way.
I have a friend who had a similar experience with her first and she chose a C Section with her second. She said she could never go through that again. I had two C Sections and would not change a thing, so glad my 'down there' was not torn or even stretched. C Sections are hard but in two weeks you are feeling almost normal again. Looking back I was just scared b/c I had never had any type of surgery. The second was much easier. congrats!
I had a 4th degree tear with my first and she was 7lbs even. The recovery was horrible for me. However with my second I barely tore only needing a few stitches and he was 7lbs 13oz its almost like my body knew what to do the second time so my sons size didnt matter. I also had a hysterectomy and they did an incision across my stomach in the same place where a c-sec would be and I would never willingly choose a c-section over a vaginal delivery. That was far more pain then my 4th degree tear ever was. I couldnt even use my stomach muscles to sit up for 2 weeks after my surgery. IDK why women think a c-sec would be better then a vaginal delivery.