4th Degree Vaginal Tear & Cesarean Section: Understanding the Risks & Recovery

Question
Hi
I am 15 weeks pregnant with my 2nd child.  My first child (who is 2 1/2 now) was born weighing 11 lbs.  I am very tall (5',10"), did not have GD or Preclampsia but big babies do run on my husband's side of the family (he weighed almost 12 lbs at birth).  I only had 1 ultrasound at 20 weeks with my daughter.  My labor was about 10 hours, I had an epidural and pushed for about 2 hours.  I pushed her whole head out in one push, that, coupled with the fact I had several hemorrhoids ended up with me getting a 4th degree vaginal tear.  A surgeon took about 40 minutes to stitch me up.  My recovery was hard but I am fine now, no incontinence issues yet.  I did have to go to physical therapy for my knees and lower back during the year after the birth.  My ob/gyn has given me the option to have a c-section with this 2nd pregnancy however I'm not sure if that is the right thing to do.  I keep reading all this conflicting information about tears the 2nd time around (sometimes it's worse, sometimes it isn't).  There are a lot of women out there who are in my predicament and are unsure of what to do.  I want to make the best decision that will not only ensure a safe delivery for my baby but also the best recovery for me. I feel like I have to weigh the risk of another bad tear resulting in anal incontinence or I am risking having major abdominal surgery of which might have complications as well.  I guess I would rather have a vaginal delivery but am not sure I am ok with the risks involved.  I appreciate any insight you may have for me.  I know there are no guarantees but I am just searching some kind of answer here or maybe you can point me in the direction of some good research on this.  

Answer
Hi,
  I apologize for the delay!  I had unexpected surgery.

I know exactly what your talking about.  I had what my doctor said he would call a 5th degree if there was such a thing with my first baby.

I had 2 others without issues.  There is no clearly defined reseach though.

I would ask your doctor on your next visit.  It may depend on how your laceration healed, how the tissue is now.

Many times, they won't be able to determine anything until the baby is crowning.  The risks of another tear can be much less than the risk of major abdominal surgery.