Any advice for C sections after a 4th degree tear? My MD is giving me the option and I'm not sure what to do.....

Jenny - posted on 01/11/2009 ( 42 moms have responded )

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My MD said that there is a possibility that if I decide to deliver vaginally I could experience anal incontinence!!! Not a pleasant thought!! She did say there was only a small chance I would tear badly again and would probably choose to deliver vaginally. I'm not sure if I could handle the whole anal incontinence deal. Any advice?

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User - posted on 01/19/2009

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i have discussed this with my sister as i have put in my previous comment, she will be facing the same thing when she has more children - personally it would of put me off seeing what she went through but she is more determined to have another vaginal delivery, also reading some of the comments again people saying that vaginal allways heals better than c- sections i certainly dont agree with this i healed fantastic only had paracetamol yes it was sore but no excrutiating pain i was out shoppin within 4 days of having my son! yes it was probably a bit risky but i did take it easy and i healed perfectly with no complications where as i said b4 my sister who is still in pain from her tear and her daughter is now 5 months! The choice is yours and whatever choice you make it will be the right one for you were all different you know your body better than anybody x (if u do have a section i do advise that you have someone to help you for the first two weeks at least do what you can but get them to help if it gets too much for you)

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Lauren - posted on 11/24/2010

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I had a 4th degree tear with my first child followed by a cesarian with my second. The C section was planned and I can honestly say I recovered quicker after the Csection ! no lie. I had to have over 200 stitches with the tear , surgery and physio and many follow up appointments. I still dont have great bladder controll because of it :( I even had to pee in a bath of water for a week after ( TMI) as it hurt soooo much. C section was alot calmer ultimatly it is your choice but for me ( pregnant with my 3rd) The very real posibility of really truly damaging myself beyond repair this time is enough to put me off !

Megan - posted on 01/19/2009

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my first child was a c section after 25 hours of labour, so i know nothing about tearing. when we got pregnant with our second, i was told by my doctor that i should have another c section due to the reasons i could not deliver my first, chances were it would probably happen again. i dont want to scare you with this info so if thats whats happens i apoligize in advance. my daughter was a scheduled csection and because there was no labouring process for her she was not ready to come out and when she did she inhaled the amniotic fluid, they call it wet lung and they say that it a common problem with c section deliveries. and it usally does not need any sort of treatment, just some low level oxygen, but they put her on a machine called a cpap to help her breath, unfortunaltey it did more harm than good, she ended up with what they call a numothorax, which is air forced out of the lung ( as a result of the machine) we were in sick kids hosptial for ten days, it was the worst days of my life. if i had to go back and do it all again i would have taken the chance with my own well being rather than hers. if someone had of told me that this was possible i would have never done it in the first place. my advice to you is weigh all your options with your doctor talk to them about the risk and if you do decide to have a csection have the doctor schedule it as close to your due date as possible, the london docs had told me that if my doctor had of waited just a few more days there was a large chance that any of what happened to her may not have happened. best of luck.

[deleted account]

As with anything in life, no one can really tell you what to do, they can only tell of their experience or give their opinion, but you are the one who knows your body, knows what you would prefer, and knows which way you are leaning. Take all of the information you gather here and make a decision that is right for you and your baby. Ultimately, that is all anyone can do.

Courtney - posted on 01/19/2009

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C-Sections arent as painful as people make them sound my first and only child was a c-section and the only time it realyl hurts is the first time you stand and walk. Personally the more risk of tearing severly is the more I would prefer a c-section its quick and easy and no real lasting pain. The scars arent even that big I had my daughter in 2007 and my scar is almost completely gone. Due to bleeding when tearing I would definantly go with the c-section. That way they can at least control the bleeding rather then risk anything to painful and long lasting. My personal opinion thought!

Jessica - posted on 01/19/2009

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This is such a personal decision.  My first child was C section.  For my second I tore pretty heavily and bruised my tailbone in the process.   By the time I had my third child, I didn't tear much at all!   I had already been stretched out enough, even with all the scar tissue.  But it all depends on what you are comfortable with.  I had pretty intense reasons for not wanting another C section, but I think a C section is a very viable option.  there is nothing to be lost by having a C section.    I actually recovered better after the c section than I did with my second child!

Zahra - posted on 01/19/2009

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I have had 7 c-sections.  They have all gone well.  I am not able to dialate to 10.  So if the doors dont open you have to go through the window.  Remember you could.  It doesnt mean you will experience Anal Incontinence.  If you do end up getting it, you could get rid of it by strenghtening you core area.  My sister who has torn before and had one c-section before says that if she had a choice she would take the section.  If you decide on the section.  You will have to have help afterwards and all that.  You need to think of the whole picture.

Pauline - posted on 01/19/2009

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hey im in the same boat i had a third degree tear when had my son and now im pregnant again the md says i should think about a c section but im not sure what to do x

[deleted account]

ohh another thing..If you have a good doctor delivering your baby,you will have no problems
In emergencys like my first 2 c sections,I would recomend a c section..
Good Luck

[deleted account]

Hi Jenny,
I tore bad with my first born,and went on and had 3 more natural deliverys with no problems,followed by 2 emergency c sections(hand presentation and footling breech) and then had no choice of natural delivery after those 2 c sections and then had 4 more c sections...Yes 10 children!!...GO NATURAL..
after 6 c sections I know what I am talking about,..they suck!!
and No I am not having anymore children..10 is enough!

User - posted on 01/19/2009

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hey i had an elective c-section after my son was breech and i was absolutley petrified, waiting to go down for it i was a bag of nerves and had a panic attack as id read of some horror stories, i couldnt of been looked after better, my partner was in with me and i can remember it all very clearly we were having some great conversations to take my mind off it they told me what they were doing and i got so emotional when they told me that they had his feet!!! they gave him straight to my partner and took a photo of the first moments! i was wheeled out into recovery where my mum was waiting for me - she later said it was funny because she saw all the women who had just given birth naturally coming through looking absolutley shatterd and pale from exhaustion and i got wheeled through holding my son with a massive smile waving and full of colour! my sister who had a natural birth 7 weeks before me had over 60 stitches from a tear (only 5 were external) and is still having problems now (her daughter is now 5 months) i was fully healed and back to normal within 6 weeks so i am 100% positive that i made the right choice to have a section and would definatley choose the same way again!! good luck with whatever you choose x

Coleen - posted on 01/17/2009

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It is very unlikly that this would happen again.  You could have weekly ultrasounds to measure the baby.  If the baby is on the larger end see if you could be induced at 38 weeks.  Overall your recovery is faster vaginal than csection.

Coleen - posted on 01/17/2009

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It is very unlikly that this would happen again.  You could have weekly ultrasounds to measure the baby.  If the baby is on the larger end see if you could be induced at 38 weeks.  Overall your recovery is faster vaginal than csection.

[deleted account]

i had a c section with my last one never again i could not hold my baby for 5 days it was agony i could not stand up straight where with a natuural once baby arrives all the pain went if i had the choice id go for natural anyday xx hope i was some help

Angela - posted on 01/17/2009

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I had a 4th degree episiotomy with my 1st. She was 9 lb 2oz. But with my second, I insisted on a perineal massage & only had a 2nd degree epi. So, that was definitely better.....left the "back end" in place & she was 8 lb 7 oz..... SO.... it can be done... the massage made the diff. for me.

Melissa - posted on 01/16/2009

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I had a midwife with both my children. With my first, I had a very hard delivery with MD assistance in the end.  I was 8 minutes from a C section after pushing for 5 hours.  I  tore first because of the suction cup and the doctor gave me a4th degre episiotomy. My daughter was 7lb 14oz and finally delivered via forcepts. There was quite a bit of damage and it was much deeper than a normal epesiotomy should be, involving some muscle of the pelvic girdle. Personally, I think this MD should have retired years ago, and I had to have the incision repaired a 6 weeks later due to complications and rupture of the sutures inside.  I had my second child, weighing 5oz more than my first, without a single tear and I only pushed for 14 minutes. I have no complications from the tear or episiotomy and my situation was quite extreme.  My midwife uses mineral oil to massage the perineum which helps to strech the area making it easier to accomodate the baby through. Your prebirth condition will also help determine your outcome. If you exercise moderately, walking etc, your muscles will work better than those those that are not as often used. Kaegals are good too. You can use mineral oil at home on the perineum before delivery to help prepare. If it's a vaginal delivery you really want, you can try these ideas. If a c-section is more comfortable for you than chose that. Ultimately, it's your body and what you're comfortable with. I love my midwife, her wholistic approach/suggestions/interventions and her honesty. She mentioned the fecal incontinence but also recomended the ideas I listed above and said that if my second delivery seemed to head in the direction of my first she would send me to the OR to avoid that complication. I loved having the option either way.



 



Good Luck,



Melissa

User - posted on 01/16/2009

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For what is worth I had 4th degree tears with my 1st child ,sounds like pretty much the same situation Big practice went into labor got OB on call she was awful and unattentive and I tore every which way possible a year later I was still not healed I went on to have 3 corrective surgeries after the 3rd I said this is it however it heals it helas I'm done when it came time to deliver my second child i GOT A NEW OB HE SAID THE same as yours I listened, and am soooo glad I did.  You know how bad the recovery is from a tear and being your first you don't know you just assume this is how it is...Well let me tell you yes there is pain asssociated with a CS but compared to what we have already been thru it is a walk in the park, If anything you wont wince every trip to the potty:)  My advise don't even hessitate scheduled C section  is the way to go.  You will have your OB and hopefully no major surprises well not the bad kind anyways.  Good Luck!

Kimberly - posted on 01/16/2009

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I agree with Christa Heitter. I had two C-sections. Both Emergency... I must have a high tolerance for pain, because I just took over the counter meds. The experience was not hard at all....



I think you take your docs advice and do what you feel is best for you and your baby... 

User - posted on 01/16/2009

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I would listen to your doctor and do the C-section. I've had two c-sections (one emergency and one scheduled) and neither one were horrible. It's best to take the docs advice...

Abby - posted on 01/16/2009

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I would go with a C-section. I had the choice and went with a C-section. I didn't want the chance of me ripping down there that just sounds too PAINFUL!!!!! Plus how many times can it rip apart and actually shrink back to a decent size. Talking about your vigina. I Was to scarried that I would be loose as a goose! I know theres kelod exercises. But how long you really think it takes to get it almost back to normal?



I have alot of guy friends and they tell me terrible stories about the having sex with girls after they have a kid vaginaly and it being so loose, it felt like sticking your finger in a bowl of spagetti. I couldn't take the thought of worring if thats what my man was thinking about me.



I know this doesn't matter to some people but I want to make sure we're both happy!!!



I really didn't have much discomfort took some advil for the discomfort. But I was back to my old ways in no time. Just make sure you wear a gerdal. I didn't and ended up a 1wk and 1/2 after the delivery i got water on one of my abs and that was more pain full than any thing. I didn't wear a gerdal till this happened. The doctor said I was lifting to much. I was carring my son in the car seat up and down 3 flights of stairs and doing all the stuff around the house. I only wore the gerdal for maybe a wk at most and only wore it when I was in pain.

Jenny - posted on 01/16/2009

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Thanks everyone for all your advice!!! I really appreciate hearing your experiences. There is still a lot I need to discuss with my MD but I have about 5 months to still decide.

Jenny - posted on 01/16/2009

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I have the same MD as last time unfortunately my MD was on vacation when I delivered last time. So it was a different MD. No guarantees that I will get my current MD this time either. So it's hard to say. They said they didn't think I would tear at all until the last push it all happened. They didn't see it coming.

Zarah - posted on 01/12/2009

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I'm sure, by now, you've done plenty of research. At the end of the day you need to go with what makes you feel safest and most secure about the birth, your health and your child.



I had four babies delivered vaginally over 6yrs and all was fine. Many years later I got pregnant again (remind me that whiskey is evil!) and had to have an emergency C-section as my uterus was in danger of rupturing. I was lucky, we had enough time for me to decide that I wanted to be awake so I could see and hold my son right away. My husband was allowed to be with me (bless, he looked funny in his scrubs!) and both the surgeon and the anaesthetist were wonderful. I must admit, it's an odd feeling being awake for something like that, but it was the way I wanted it.



I was up and walking around a little only a few hours later (using a wheelchair as a walking aid!), allbeit attached to the dreaded drip and bent double, lol. I was never apart from my son as I had him roomed in with me. I breastfed, changed him, cuddled him, all the 'normal' things. I was home 2 days later and recovered there.The kids 'helped' and my hubby was wonderful.



I won't lie, it was painful when the drugs wore off, but it's the kind of thing you just get on with, you know?



You hear all kinds of horror stories, about vaginal deliveries and C-sections alike. Everyone has a different experience. I would advise, however, that if you DO have the C-section, you don't go rushing around too soon. I did, and it set my recovery back several weeks. I kept saying, "but I've only had a baby!"  We all know it's not that simple.



If you trust your doctor and you've done your research, then go with what you feel is best, don't let yourself be pushed into anything you're not sure about.



Wishing you all the best for a safe delivery and beautiful baby.



 

Amanda - posted on 01/12/2009

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My advice to you is to talk with your MD about a slightly early delivery.  PossibIy to do an induction and turn to a C-Sec if it looks like you're going to have difficulties.  Did you have a large first baby.  I had a nasty tear with my first child as he was 9# 11 oz., his head was 15 1/4" and chest 15 3/4".  It was suggested that I be delivered 2 weeks early with my next pregnancy to avoid it again. It actually ended up not being a problem though as I had to be induced at 37 weeks and she was a smaller baby by almost 2 pounds.  Good Luck!

Hanan - posted on 01/12/2009

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I had a 4th degree tear with my first child and I was terrified when i got pregnant with me second!! I decided to do vaginally again and my doctor induced me 2 weeks early and it was the best experience...Fast delivery..and couple stitches!  The reason you had a 4th degree is because your baby was too big for you or if you had the epidural you couldn't feel yourself pushing properly  my first was 8lbs and 5oz and my second was 7 so i can only imagine if i would have waited full term how big he would have been...good luck to you

Cheryl - posted on 01/12/2009

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hey there !
i had a 56 hr labour and a 3rd degree tear with my daughter, no one would advise regarding c section with my second baby . The stats were inconclusive but generally agreed that second births are far easier as the "path has been laid" i was allowed to choose a c but in the end decided against it as i felt that anal incontinence was a better outcome than some of the probs with c's and the fact is u will definitely have pain and scar with a c and just a chance u might with vag birth.i did perineal massage to ensure i was in best shape poss and ate lots of oily fish and fresh stuff so all skin was in best shape possible. i also had t talk to myself and say that everything down there is strong and able to cope with birth.as i was worried sick id go on to have a fourth this time . praise god i only had a second degree tear this time an labour was 4 hrs start to finish ! i think its very much up to you but if u have no side effects from the tear then you have a good chance of doing good this time. Also look into perineal management as this helps (my birth was too fast, i only pushed twice) and use upright positions, do a little research on what gives u the least chance of tearing x hope this helps xxx
also... i wanted an epidural this time as u dont have such an urge to push and my ob agreed it may help me not to push when baby crowns which is when most tears happen... again i didnt have time for one but it was the plan !
if it was babys elbow that caught and tore u then there is little chance of it happening again.
i do fully understand how scary it is tho, god luck xxx

Michelle - posted on 01/12/2009

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go c-section.iv had 2 hard natural labours and my 3rd child was c-section which was so much better.the only down fall was the 6wk recovery.the pain was nothing compared with natural birth.gd luck

Carol - posted on 01/12/2009

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i had a c section with my first and a natural with my second they gave me a choice said cause i had one c section i could have it again but decided to have a natural has it would be hard to look after a 2 year old with havin a c section and you do heal a lot quicker havin a natural i had 3 degree tears was painfull but not for as long as c section

Sarah - posted on 01/12/2009

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Hi I'm not sure about the tearing, but I had both of my little girls by C section (they were both breech) and my first one was great no complications however with my second my recovery time was a lot longer because I got an infection and blood clots in the wall of my uterus. If I were you I would get a second opinion but I would probably go for a C section anal incontinence sounds pretty awful. Good Luck

Melissa - posted on 01/12/2009

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I never did experience a V birth, i ended up having an emerg c-section. It wasn't all that bad, there are the pros and cons. Pro's being I didn't have to go through the pain of a vaginal birth and hours of labour, cons would be I didn't really like the fact that I couldn't really tend to my baby for the first little while and had to watch my husband do it all it was hard to deal with because this is my first baby. Mind you it might have been a little bit of a diffrent story if I didn't have a cathider and wasn't hooked up to I.V's. It's hard to get out of bed and stand up right and walk for that matter, but as my mother stated " at least when you go to the bathroom it wont feel like you are peeing out razor blades" EEK!
So I think maybe the c-section is the way to go. It's really your choice.

Kristy - posted on 01/12/2009

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hi jenny, i would definately recommend having a c section a friend of mine went through a similar thing, there is also a chance of bleeding out if the tear becomes worse by having the baby naturally. good luck with your decision

Kim - posted on 01/11/2009

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Again, this is JUST my opinion. I would opt for a vaginal in a heartbeat!!! My 1st was a c-section, awful recovery!!! My 2nd was vaginal and I tore BADLY, healed really well. My 3rd was a c-section and the recovery was so bad that at 6 weeks postpartum I still wasn't able to walk the flight of stairs in my house with out pain. Recovery from a section, for me, is slow even though I did everything I was supposed too. The recovery from tearing was painful but not nearly as bad and didn't last as long!



I wish you well in the rest of your pregnancy and I hope you make a decision that you will be happy with once you are holding your new llittle one!

Jessica - posted on 01/11/2009

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I have had two c-sections. The first done after being in labor for several hours, and the second scheduled. I didn't think that recovery was very bad. In fact, I was at the zoo with my husband and kids two weeks later. I can't compare the healing process to a vaginal delivery, but, if you opt c-section, I suggest that you get up and moving about carefully just as quickly as possible post-op. I have heard from many friends that the longer you wait to walk, the more difficult it is.

Katie - posted on 01/11/2009

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I had an emergency c-section with my first, 3rd degree tears (100+ stitches) with my second, and 2nd degree tears with the 3rd. I would say the recovery was comparable in all....just different types of pain. I've heard a c-section without labor is better than the emergency ones because you haven't started the labor pains yet. The biggest difference between the two I've experienced is the feeling of being out of it from the pain killers after the c-section. I liked being more alert. Ultimately you'll be fine after both so just think through what you feel like doing! Good luck.

Michelle - posted on 01/11/2009

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hi there, i actually have experince 2 c sections, it does hurt the next day when u have to get up and walk around, its been 2 years since my last c section and i still het some sort of pain, down near my scar, and it also get sore and ichey, depending on what type of underwear i were, and i also regret having this done but my second son was breech, so i had no choice the second time round,and my first son was 6weeks early.........but now i feel like something is missing because i never got to experince a natural birth. but if u need to have one then do it,,you don't want to go through have a tear that badlolxx

Jennifer - posted on 01/11/2009

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I don't know what anal incontinence is, but as far as tearing, I went with a midwife for both of my deliveries and tore pretty bad the 1st time.  I don't even know how many stitches she used, she either didn't want to tell me, or she lost count. It was pretty bad, I tore left, right, front and back, and front was the worse, that's where it really hurts.  My MW said my skin looked like it had been shredded.



With my 2nd, at about 34 weeks I incerted 6 Evening Primrose Oil gelcaps vaginally before bed, then in the morning, I massaged my perineal using the same oil. I didn't even know about massaging with my 1st.  Also, my midwife used perineal massage to help me stretch while my boy was crowning. My 2nd was only 2 oz and 1 inch bigger then my 1st and I didn't tear at all. I don't think you need a midwife to have a successful vaginal birth, but I think it would help if you have someone versed in natural  delivery methods, even if you use medicated pain relief.



If I were in your shoes, I'd choose to deliver naturally- I have a dislike of being cut open and of being stuck with needles; that's just me. In the end, you need to do what's right for you. My best advice is gather as much info as you can, weigh the risks and benefits, then decide what you are willing to deal with.  If you decide on a vaginal birth, just be prepared for a c-sect incase it does become necessary.



OH! And if you can, I'd recommend a doula for labor support!!!! I had the same 1 with both my deliveries and she was amazing both times!  She's the 1 who taught us what labor pain really was, how to deal with it naturally, and about the perineal massage. The doula organization is called DONNA (sorry, don't know what it stands for), I believe you can look up a doula in you area from their website.



Sorry this is so long, butI hope it helps, and I wish you the best, whatever you decide to do:)

Amy - posted on 01/11/2009

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csection. I'm a L&D nurse. I would recommend a csection if you tore that bad before. now you have scar tissue there and it will be harder to stretch. definitely csection.

[deleted account]

My sister in law suffered a 4th degree tear with her first child and went on to deliver her second child vaginally with no problem. Drs. these days need to tell you all the gory possibilities so that they're covered if something happens. Just as your vagina can be repaired with sutures, so can an anal tear. Not comfortable or pretty, but easier than recovering from C-section with one child and one newborn. Vaginal delivery is always easier to recover from than C-section, and with the proper support of your perineum during pushing you should be okay. Have you considered perineal massage prior to labor? You gently massage and stretch your perineum with vegetable or olive oil in the last few weeks before delivery and it helps to avoid tearing.

Lynn - posted on 01/11/2009

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I do not know anything about the tearing. But I have to say if you do decide to do a C Section, I didnt find it to be that bad at all. I planned on having it the natural way. And after being in labor 14 hours they said ok lets do C Section. they found the cord was wrapped around his neck twice, and thats why he couldnt come out. But if ever in my life we decide to have another child. i will probably choose C Section..

Christa - posted on 01/11/2009

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Do you have a different MD than you had last time?   Did they give you a reason for the tearing?  If this Dr. is more "hands-on" and helpful than your last one, I would go ahead and deliver vaginally.  With proper perineal support and coaching, not tearing at all is very possible. I'd talk to her more in depth and see what her thought process is on perineal support during the pushing stage.  I'd also research online about ways to avoid tearing. GL!

Lisa - posted on 01/11/2009

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wow that is a hard decision! I really dont know what i would do! My friend had a c section and said it was not horrible. I probably wouldnt take the chance. some people never have a chance to deliver vaginally so at least you got to once ya know? not easy though I really dont know what i would do. best of luck though!

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