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Q. I had a 5 hour labour (1 1/2 of those hours were to push his head out). My baby's shoulder also got stuck and extended my episiotomy to a third degree tear posteriorly. It took me 8 months to recover from the pain of having that many stitches etc. My obstetrician told me I should have an elective caeserean next time because I might tear like that again and "I may lose contol of my bowels." Is he being an alarmist or should I heed his advice.

I coped really well in my first labour and used only the gas and a small shot of pethidine prior to pushing. I am scared of having a caeserean but am just as scared of tearing so extensively again - it was hell. Can you offer any help or perhaps other women have had similar experiences.

A. Although your first experience was difficult there is no reason to assume those things will happen again. It's understandable that you would be concerned - I've had a couple of extended episiotomies myself and they definately can complicate your recovery. Making sure you have a good understanding of useful positions for labor and pushing could make this birth more comfortable. It sounds as if the contractions themselves were something you managed easily and your second birth is likely to progress more quickly than your first. I would sugggest taking a class in childbirth education such as Lamaze, Bradley or ICEA. If you prefer a review series one can usually be found. You would want to find an instructor who clearly expresses faith in a woman's ability to work with her body to give birth. Of course it is also important to have good communication with your practitioner so that s/he understands your commitment to giving birth as free of intervention (such as episiotomy) as possible. Massage of the delicate perineal tissue prior to and during labor can be helpful in decreasing the need for episiotomy as well. I hope things go well for you!

Cyndi Klausing, RN, ACCE, has been a childbirth educator and breastfeeding counselor for over 18 years. She currently works as a newborn nursery nurse and is the mother of four sons.

Cyndi will answer your questions on fertility, pregnancy, birth, breastfeeding and babies. Her advice does not take the place of your practitioner. Personal answers will not always be possible.