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VB or elective c


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#1 MwahMum

Posted 06 January 2019 - 02:28 PM

Hello,

Can't see this same scenario in the forum, and keen to hear from others who may have experience to share...

Had a third degree tear after a fast, compound delivery. Drug free only due to arriving at hospital almost 10cm dilated.

Recovery was long (12 months). Swore I wouldn't have another.

Have divine 2yo. Now 20 weeks pregnant.

Given the tear and the recovery, and my family's experience (mum, sister) of a swift and easier second birth am thinking of trying for VB in first instance. But second guessing whether I'd be better with an elective c. Both mum and sister had stitches, but relatively minor tears.

Does anyone have any experience that might be helpful for me to consider?

Will have DP at home for 5 weeks after #2 arrives, and mum on call for extra help if/when we need it.

Edited by MwahMum, 06 January 2019 - 06:45 PM.


#2 Hands Up

Posted 06 January 2019 - 04:29 PM

Very personal decision.

I had a second degree tear with my first but still firmly wanted a VB as I was scared of the surgery. Second time around I got a first degree tear and it all worked out.

What does your caregiver say?

#3 Stylus

Posted 06 January 2019 - 06:02 PM

Do you have any long-term consequences from the tearing? Would those be worsened if you tore that badly again? Do you want to go through that recovery again, potentially? I don’t know anyone who’s had a 12 month recovery from a c sec.

#4 Reno-chic

Posted 06 January 2019 - 06:15 PM

Not me but my friend had a similar situation. Seems she wasn’t properly advised after her first, fast, early delivery that caused third degree tear requiring surgery to correct. She was all set to have a second VB and turned up at the hospital where the Ob on duty (public, so she didn’t have her ‘own’) said there was little choice and given the damage caused last time she needed (or was STRONGLY advised) to have a C.
She had no problem with that advice but was pretty annoyed nobody had said that earlier. It had been mentioned as a possibility during her appts but the head Ob showed up and was surprised she was asking about a VB, she thought it was that clear a decision.

#5 JomoMum

Posted 06 January 2019 - 06:19 PM

Personally, I would always opt for vaginal.

DS was born vaginal, but was posterior. I pushed for over an hour and nothing. Ended up with an episiotomy and vacuum assistance. I suffered a posterior prolapse which required surgery 2.5 years later. But the initial recovery was minimal and the prolapse caused me no issues or pain, (possible TMI) just a small bulge.

But having also had a full laparotomy since and going through that recovery, I would want a vaginal again.

Unfortanately, if we fall pregnant again, the chances are I would need to have a Caesar.

#6 MwahMum

Posted 06 January 2019 - 06:53 PM

Thanks. Appreciate the sharing.

I went public first time around, and will do so again this time. Although we've moved since DD1, so different hospital.

After DD1s birth, I had conflicting advice. At the 6 week follow up, the Doc I saw (only as the follow up) suggested a Caesar would be the best option if I went again. My GP, who I also saw at the hospital as part of my prenatal check ups, and who had more knowledge of me (if not the actual surgery) suggested that a subsequent vag birth should not be an issue...

The OB I've seen at the current hospital has indicated they'll support my preference unless there's medical reason not to.

#7 MwahMum

Posted 06 January 2019 - 06:55 PM

Hands Up, I'm hoping for a similar scenario.

Less of a physical impact with #2.

#8 MwahMum

Posted 06 January 2019 - 06:57 PM

Stylus, I thought I hadn't recovered fully, but had a physio appointment last week that said all a-okay.

And that made me aware how much of our recovery is in our minds as well...

#9 MwahMum

Posted 06 January 2019 - 06:58 PM

FomoJnr, that sounds intense! Our bodies take on so much...

#10 MwahMum

Posted 06 January 2019 - 07:01 PM

Reno-chic, thanks for sharing your friend's story. It has made me think I need to get clarity on the hospital's stance on this.

The advice I had was one doctor's perspective (albeit, the view I wanted to hear!), and I really should be armed with what the hospital / head Obs take on it is.

#11 afterlaughter

Posted 06 January 2019 - 07:07 PM

I had a small 3rd degree tear and episiotomy with my first after two hours of pushing with vacuum and forceps to deliver. Recover was at least 4 months. This time is had 15 mins of pushing at a stretch no assistance and I did tear they said was second degree but recover was maybe 4 or 5 weeks and a lot less painful, was declining pain meds very early on. Private OB did offer me a elective Caesar but declined having watch a friend recover with a toddler from a ceaser with a toddler. I am happy with my choice.

#12 Islander

Posted 06 January 2019 - 07:14 PM

I had third degree tear and 12 month+ recovery (with two rounds of subsequent cutting and stitching) with my first (after a 16hour labour though) and my second was a VB with no tearing, quick recovery. I’d also changed regions between and asked for my notes to be transferred because I wanted advice re CS or VB taking that into account. Good luck with an individual and personal decision though!

#13 vanilla_bear

Posted 06 January 2019 - 07:17 PM

Not me, but a friend in the exact same situation.

She opted for a c section and loved it, and the recovery for her was a million times better than her VB.

#14 MwahMum

Posted 06 January 2019 - 07:18 PM

Afterlaughter, glad it went so well for you second time around 👍

The toddler situation coupled with a c section recovery is a strong consideration for me too.

#15 MwahMum

Posted 06 January 2019 - 07:21 PM

View PostIslander, on 06 January 2019 - 07:14 PM, said:

I had third degree tear and 12 month+ recovery (with two rounds of subsequent cutting and stitching) with my first (after a 16hour labour though) and my second was a VB with no tearing, quick recovery. I’d also changed regions between and asked for my notes to be transferred because I wanted advice re CS or VB taking that into account. Good luck with an individual and personal decision though!

Islander, your recovery from #1 sounds intense.

With #2 how was the care team? And do you feel like their advice helped you decide what to do?

#16 Islander

Posted 06 January 2019 - 07:31 PM

Yep my first was a super difficult time- but it turned out there’d been some medical mismanagement in terms of the stitching. I think that enabled my ob and midwife to really look at my body (and my history) prior to the birth of number two and provide their advice to try for VB again. Getting my notes transferred and being very upfront with my fears well before the birth of number two really helped I think.

#17 Soontobegran

Posted 06 January 2019 - 07:42 PM

I had 1st and 2nd degree tears with all of mine but had I had a 3rd degree I would have opted for a C/S for subsequent pregnancies as minor tears are not in the same ball park when it comes to possible post natal complications and lengthy healing processes.

It sounds like you had a very rapid delivery for a first mum complicated by a compound presentation, it is likely your second will also be precipitate which in itself increases your risk of tearing.

I would pay more attention to the opinion of the obstetric staff than your GP....they saw your tear, they are better equipped to give an opinion.

Going Public does not mean you can not have an elective C/S, in fact they may actively encourage one dependent on your history.

Lots of luck, it is a personal decision......mine would be for a C/S.

#18 cabbage88

Posted 06 January 2019 - 08:54 PM

You really should seek assessment and recommendation from a women's health physio. They can look at location scar tissue etc and give you evidence based advice.
And on a side note... One VB and one c sect here and I'm so never doing a c sect again. 18 months before I felt normal  again.

#19 HolierThanCow

Posted 06 January 2019 - 09:32 PM

Obviously everyone heals differently, but almost everyone I know personally who has had an elective c section (myself included) was feeling pretty good by 4 weeks post op. Good as in having to remind yourself not to lift anything too heavy because you feel that you can do everything as normal (well you probably can, but it could still strain something).

The one friend I have who had a tear (3rd degree) during a VBAC elected to have another C Section for her third instead of another VBAC. She had an unusually difficult recovery from her first C Section, but said the 3rd degree tear recovery from the VBAC was worse.

You will probably know what you want as you get closer to the date. As other have said, it's very personal (and I have heard of much longer C Section recoveries of course and am not saying they are always easier).

Edited by HolierThanCow, 06 January 2019 - 09:36 PM.


#20 Reno-chic

Posted 06 January 2019 - 09:43 PM

No problem. It was only a few months ago so pretty fresh. She has no regrets about the C and recovered well, but it was similar to above where her GP did shared care and believed there was no medical reason not to attempt vaginal birth but the obs at the hospital were surprised it hadn’t been explained to her earlier (why they believed a C was by far the best course of action)

#21 munchmum

Posted 06 January 2019 - 09:44 PM

I had a similar situation except my first birth was long.  I was advised by multiple caregivers (ob and physio) to have a c section which was a much quicker recovery.  

For me the risk of incontinence from a second tear that large was too high and I had other risk factors which made it likely (look up the literature) such as the large babies.

#22 munchmum

Posted 06 January 2019 - 09:47 PM

https://www1.racgp.o...-tears-a-review

#23 ERipley

Posted 06 January 2019 - 10:04 PM

So I also had no drugs, forceps, and lucky me, fistula. 3 operations, months of recovery including a colostomy bag, and my baby was 6 months old by the time I was whole again. Not to mention the trauma. I was told by everyone, only a c-section for future births.

The two experiences were like day and night. So much pain and stress and uncertainty for the VB, such a relaxed and happy and comfortable experience for the C-Section. I obviously recovered from my C-Section much faster as the VB was abnormal, but I was up breastfeeding twins all night by myself within a few days. Carrying them, changing them, getting on with life within a few weeks.

Medical staff have told me a few interesting things since a VB wasn’t even an option for me. These include the fact that women are pushed to have VBs because it’s cheaper and easier for hospitals (unless something goes wrong) but a C-section is safer for both mums and babies and obstetricians generally opt to have c-sections themselves because they know this. I don’t know if that’s true, it’s just what was passed on to me.

Just given my personal experiences, I loved my c-section and my VB was appalling. I’m absolutely not having more children but if I did it would be a c-section in a heartbeat!

#24 ERipley

Posted 06 January 2019 - 10:06 PM

Oh and it’s SO much easier to take care of your new baby when you’re not already exhausted from spending the last day (or two) in agonising labour.

#25 Stylus

Posted 06 January 2019 - 10:47 PM

View PostMwahMum, on 06 January 2019 - 06:57 PM, said:

Stylus, I thought I hadn't recovered fully, but had a physio appointment last week that said all a-okay.

And that made me aware how much of our recovery is in our minds as well...

It's good to hear that you've (largely) recovered well. I had the same tear during my first delivery and multiple doctors strongly recommended a C-sec for subsequent deliveries, including the doctor that delivered my baby. I think I've recovered quite well but it's been a lot of work and required lots of follow-up, with more to come. I had a very difficult delivery requiring lots of intervention in addition to the tearing, so I'll be following the medical advice that I received and having a c-sec next time.

It's also a really tough way to start with a new baby - being separated for hours after delivery while you get repaired in theatre, managing all the medication, the pain, the inability to do very much and needing lots of help, plus dealing with the unknowns of what your recovery will be like. I suppose some of those things would also apply to c-sec recoveries, but everyone I know that had c-sections or uncomplicated vaginal deliveries seemed to bounce back much more quickly than I did.

I feel lucky to have recovered as well as I have and wouldn't risk it again.




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