I am currently 21 weeks and am contemplating a c-section do to the pain and discomfort following a button-hole repair during my first delivery (3 years ago - 8 lbs 1oz). I do not have any fecal incontinence, but do feel "uncomfortable" in my perineal area maybe with a little flatuos? incontinence. My OB said that I do not have to have a c-section but that it is my choice. I thought the rectal tear was sustained due to the baby's head scraping my rectum against my pelvic bone. My OB said that usually a button-hole occurs from the episiotomy. If it was from the baby's head, I feel that the chances of it occuring again a great enough to warrant a c-section. If from the epsiotomy, then maybe less likely, but I am still concerned about further anal trauma.