5th Pregnancy After Uterine Incision: Understanding Risks & Planning for a C-Section

Question
I have 4 children and am newly pregnant with my 5th.  I had a c-section with my 1st and 4th.  The first was thought to be because he was breech...but after 2 tough and long vaginal births and another c-section due to the baby not fitting through the birth canal, the doctors finally believe that my pelvis just isn't big enough and was probably the cause of my first being breech.  So I am planning on a third c-section.  I am concerned about this, though, having just had my last 23 months before this one is due.  Also, we just recently transfered bases and in the process I hand carried my medical records.  I was looking through them and found a note on my hospital report for my last delivery that said "uterine incision tear".  I was never told of this.  What does this mean?  Did the incision they made tear while they were taking her out?  This last c-section was very difficult for me...I didn't feel a thing but pressure with my first, but this last one I felt EVERYTHING, I was screaming on the table despite trying desperately not to.  One side hurt more than the other too.  It also took them a LOT longer than the first did...  She was a big baby (10lbs)and there were other issues such as she relieved her self in me before she was born, and I ended up with an infection that was sucessfully treated.  I am just concerned about the supposed "tear" and what that means for this pregnancy.  I would think that if it was an issue they would have discussed this with me.  I haven't yet been to a doctor, military doctors are difficult to get an intial visit with, but should be seen within the next couple of weeks.  In the mean time I would just like my mind eased a bit...thanks so much!

Answer
If you had two cesarean sections in the past, you definitely should have a repeat  cesarean section again. The tear that they describe probably occurred prior to the making of the uterine incision due to the weakness of the previous uterine incision (this often can occur). This indicates that your uterine incision is weakened and you should schedule your next cesarean section prior to going into labor. I would suggest that you have the cesarean section at around 38 weeks gestation. This will avoid the problems that occur during labor. It is not a problem having another cesarean section so soon after your last one. I would also try to get an explanation for the operative report that you have so you can let your new doctors know what really happened during the last delivery. Good luck.