Based on the results of my survey, I have decided to avoid an ELCS at all costs. There. I’ve said it. Just typing this thought makes me nervous. Will I be too scared to push? Will the hospital be short staff again? Am I even capable of delivering a baby without syntocinon? There are no answers to these questions. However, I’m confident that the risks can be minimised so have compiled a few lists of actions that I will take to avoid a severe tear in the future. The first source of information I’ve relied on is the lovely 50 women who completed my survey….
Based on my survey results, I’m certain that I will take the following actions to avoid severe tears in future labour:
(1) Say no to forceps
(2) Say no to induction with hormone drip
(3) I will not push strongly during delivery of the head
Obviously, there may be extreme cases where 1 and 2 can not be avoided but these decisions must certainly not be taken lightly. A well informed birth partner and comprehensive birth plan will be essential.
Based on scientific literature, I will take the following actions:
(1) I will not give consent for an episiotomy
(2) I will choose an ELCS if still experiencing severe symptoms from first tear at time of delivery
(3) Prior to labour, I will have a recto-anal scan to determine strength of muscles, extent of scaring and any weak areas that could cause problems
(4) Request the midwife be ‘hands on’ during delivery if circumstances seem right
(5) Listen to my body instead of push when instructed
Based on my gut instincts, I will do the following:
(1) Deliver baby with an experienced midwife I can trust who is up to date on the latest research regarding severe tears
(2) Not worry about the size of baby unless excessively large
(3) Ignore any advice given to me about my skin type
I’m still undecided on the following points:
(1) Should I have local anaesthetic in perineum again? (pro – would stop me worrying about tearing, con – would stop me worrying about tearing!)
(2) Is the length of my perineum important? (is it worth learning whether mine is normal?)
So there you have it. I may come back and add to this post in the future.
3rd & 4th Degree Tears 
Very interesting blog. This has become an area of interest of mine in maternity care. Have you asked question of whether women prefer midwife to have “hands on” to support perineum and baby’s head or “hands off”. I think it depends on individual aspects of that particular birth. Some midwives are adamant “hands off” or “hands on” but actually should be what is needed at time. Know I have prevented severe trauma by hands on at certain births, but quite happy to be hands off at pool births. Would love women’s views.
Thank you. Glad you found it interesting. I did ask the hands on/off question. The exact wording I used was:
‘How was your baby’s head delivered?’ and the answers to choose from were:
(1) Nobody was touching the head:
(2) Medical staff were controlling delivery of head;
(3) I was controlling the head as it emerged.
In both first and second labours approximately 60% of women had medical staff controlling delivery and within this group there were both severe tears and no tears at all so no real pattern there I’m afraid. However, it would be interesting to know if 60% is close to or less than the norm. I would be interested to hear your thoughts…
Also interesting is that in second labours (but not first) a small proportion of women (6%) were controlling delivery of the head themselves and these women only experienced either a second degree or no tear at all.
I didn’t ask the question about choice for hands on or off directly though – only if it did or didn’t happen. In your experience, do midwives ask permission before being hands on? I wonder if this would make a difference. Interesting point though.