Giving birth after previous 3rd degree tear

[zoobaby]

Can anyone offer any advice/info about their experiences of giving birth after previously having a 3rd degree tear?

Spoken to numerous staff at my hospital and they all have varying opinions (and levels of sympathy).

One obstetrician believed vaginal birth would be easier, another said they'd intervene earlier (episiotomy, which I had first time around with the tear), a midwife was non-commital, a consultant said consider CS.

It's 2 years later and I'm very emotional when talking about the entire experience. Obviously more traumatised than I thought. I think my greatest fear is urinary and faecal incontinence if I get another tear.

Please share your thoughts.

[Thelovecats]

I had complicated 2nd degree tear- was nearly 3rd degree because it was deep. Recovery took a while. Second time I had 2 stitches that was it. Pushing stage was 4 minutes instead of 1.5 hours ish so very straightforward. I think speed of delivery is the reason I had any stitches at all second time.

[Quitelikely]

I opted for a c-section as IMO the risk of it happening again just was not worth it.

I'm still traumatised by the whole experience and I doubt I will ever truly open up to anyone about what happened to me. My healing was awful, as was the pain when going to the loo.

Yes it was tinged with sadness that I wouldn't have a spontaneous labour but my health and sanity were worth so much more.

Yes opinions will vary greatly but remember it's YOU who will be stuck with any long term complications (if there are any).

Good luck.

[zoobaby]

Thanks for responding Lovecats and Quitelikely. Can I ask quitelikely why you say your CS had a tinge of sadness? Was it just setting a date and that being that? Or the procedure itself? How did you find recovery? Apologies if you'd prefer not to talk about it.

I had a lot of intervention last time round (induction with every single procedure being performed along the way, forceps, episiotomy, a week in hospital afterwards), so I don't think I'm adverse to CS intervention in principle. Just the thought of the "major surgery".

[mamaslatts]

Hi

I had a 3rd degree tear. I had a good repair job so left with no complications but decided for c-section for my second. I am a medical professional so knew right questions to ask when making my decision and what it boils down to is they just don't know. This is why you are having so many different opinions - each person is probably going on their own experience. You could be left with faecal incontinence if you were to have another 3rd degree tear but this may be many years down the line and there is basically no data/stats for anyone to give you a clear picture on this. From my pov I wasn't to take the risk. Others are. Its up to you really.
My experience of a planned c-section was very positive. Baby was out in 2 minutes then pictures and chatting whilst I was stitched up. Felt I was starting from a much better point than the sheer exhaustion of my first birth. First 2 days needed help lifting baby etc but after that I obv had to be careful and take it easy but it wasn't terrible and I don't regret it. Having my next baby by section too!

[CorporateRockWhore]

I had episiotomy 3rd degree tear with first pregnancy, then tore along the scar during second labour.

That one was just second degree and healed just fine.

[zoobaby]

Feeling pleased for zzzz and Corporate. I wonder - were these spontaneous labours?

Thanks for your info mama. For me it's the fear of the risk of it happening again. I'm a very conservative and non-risk type person in everyday life.

I was keen for a VB first time because I really wanted to experience it and, in some respect, test how "strong/tough" I was. I can say that pretty soon after starting the Syntocinon drip all my toughness resolve went flying out the window. Haha.

[seaoflove]

I've opted for ELCS. I'll reply in more detail later (busy with three year old!) but I read some guidelines and wasn't happy with risking a vaginal birth. Thankfully a consultant agreed despite dismissing my concerns and saying I would be unlikely to tear again. I know my body and wasn't so sure.

[FlossieTreadlight]

I had the same experience as manaslatts - ELCS following 3b tear. A really positive experience though not an easy option. Good luck

[Tournesol]

I had third degree tear with a good recovery for first baby.

Had second baby at home with no stitches required.

Third baby arrived very fast at home and had second degree tear. Also healed really well.

Three years on and no problems, am hoping it stays that way

After first birth the midwife really scared me saying no more natural births, but when I saw the consultant they were very supportive of my home birth and the midwife who attended really helped me to control the pushing stage hence no stitches.

[Quitelikely]

I just wanted to give birth naturally, I suppose I was afraid of more surgery and I was worried that something might go wrong afterwards but I need not have worried it was a doddle compared to my third degree tear.

I agreed with my dh that I would literally be doing nothing for two weeks afterwards except for looking after the baby and BF/ making bottles. He was aware so he dealt with everything else which meant my scar was given the best chance to heal.

As it was my baby was small so I could have easily (I think) coped with with a vaginal delivery but in the end at least I didn't put myself at risk.

I was like you and came to seek advice and found women who had managed to give birth fine after a bad tear but I was too afraid to take the risk and the consultant supported me too.

I mean if your tear healed nicely and you were ok afterwards then I think it could be ok. If it was a large baby that caused your tear they can keep an eye on the size etc in order to help you make the choice to go for a natural birth but it's always risky because the scans aren't always accurate.

Decisions. Decisions.

[CorporateRockWhore]

Induced both times, but first labour was long, ending in forceps and second was fast as hell, no time for anything!

[thomasstockmann]

Following on from mamaslatts'comment. I think there's a real issue around the care for serious obstetric injuries. As mentioned, because there is a lot of unknown (mainly hereditary factors) various healthcare professionals have vastly different views.

From my own experience (1st time mum, stuck baby, failed ventouse, epi, forceps that resulted in severe PPH, unrepaired 2d degree tear, faecal incontinent, urine retention, prolapse, horrendous coccyx pain - all gynae and colorectal surgeons I've seen since recommend ELCS next time), some healthcare professionals cannot dissociate their beliefs about birth from the attitude they have towards women with these types of injuries (my story include one GP, one woman's health physio and one urogyneacology midwife who were all talking to me as if my birth and injuries were "normal"). To me this is at least a denial of the seriousness of these injuries but looks more like a form of prejudice (leading to not being treated like a victim of an injury should). This is only my view of course.

Have you talked to colorectal surgeons instead of gynea? They're the ones dealing with faecal incontinence later on. If you find a good woman's health physio, without giving you definite answers, they should be able to give you an idea (again, because they are the first port of call for urinary and feacal incontinence later on).

My heavily biased view is: if this is your only or last child, you're over 35, had a dodgy birth before, then anything-to-protect-your-pelvic-floor and so would go for ELCS. I also think ELCS is the safest for babies.

All the best.

[Ragwort]

I had an EMCS (after being refused an ELCS - no problems whatsoever, recovery was really quick - maybe I was very lucky but in your position I would ask for an ELCS.

[MissYamabuki]

I had an ELCS after a 4th degree tear that apparently healed quite well but things will never be the same down there. I won't lie, the CS was difficult and scary, but better than incontinence. Also the recovery was so much better second time round.

With a second birth you are back to square one: nobody can guarantee that you won't tear, nobody can control how bad a tear would be. Not worth the risk for me.

All the best OP

[seaoflove]

Right, I'm back!

I had a 3B tear. The whole experience - having to go to theatre, missing out on those precious early hours with my baby, shoddy postnatal care, badly managed pain, - left me completely and utterly traumatised and depressed for a long time. Physically, although I had no issues with incontinence, it was a long recovery. It was seven months before I felt able to try having sex and two years before it didn't cause searing pain. I think it was a combination of being stitched a little tight, plus "lack of use" causing everything to become very tight. It was like being a born again virgin and I even put off having a smear because I knew the speculum wouldn't go in without pain.

I didn't want to go through that again, physically or mentally. And I just knew that my chances of tearing badly again were pretty significant - if I couldn't manage sex, how could I get a baby out of there? Now most consultants seem to think that once you've had a baby, subsequent babies pop out like shelling peas and everything will be hunky dory, but I didn't think that would be the case for me.

So I started looking at guidelines and found a document from the Royal College of Obstetricians and Gynaecologists. Not only did it suggest that women who have had 3rd or 4th degree tears are at increased risk of tearing severely again, it suggests that even an uncomplicated vaginal birth brings a risk of faecal incontinence in the future (interestingly, the consultant I saw said that it's pregnancy itself which stresses the pelvic floor, not the method of birth. I decided not to wave the printout under his nose to contradict him).

I'll just go away and find the link now.

[seaoflove]

www.rcog.org.uk/globalassets/documents/guidelines/gtg2911022011.pdf

Scroll down to section 12, "Future Deliveries".

All women who sustained an obstetric anal sphincter injury in a previous pregnancy should be counselled about the risk of developing anal incontinence or worsening symptoms with subsequent vaginal delivery

All women who have sustained an obstetric anal sphincter injury in a previous pregnancy and who are symptomatic or have abnormal endoanal ultrasonography and/or manometry should have the option of elective caesarean birth.

There's a wide definition of "symptomatic", from leakage of faeces to being unable to hold in wind.

So despite the consultant dismissing all my worries about tearing again (and suffering from incontinence even if I didn't) he still agreed to ELCS, just on mental health grounds. Fine by me. I was annoyed that he seemed ignorant of the evidence but ultimately I didn't care how the ELCS was justified, just as long as I got one. Baby no.2 is due in May.

[tippytappywriter]

Hi. I had a 3rd degree tear 10 years ago. I was taken to theatre, had a spinal and a good job done on the stitches I believe. Nearly 3 years later I had a vb . He was breech, it was quick and I only needed a few stitches. So nearly 8 years on no problems so far. I think there are so many different possible outcomes. Just wanted to give you my positive story.

[KittyCatKittyCat]

Gosh thank you for that paper, very useful to read. Also thinking that a ELCS might suit me after a 3b tear last time. With approx. 17m between births, I don't think I can risk facing the incontinence again!

[Iggly]

I had a 3c/b tear but was repaired in the labour room and my baby was with me the whole time.

I felt quite ruined by it but went on to have a second baby just after two years. I was offered an ELCS but said no. Was told I'd have to have baby in a consultant led unit which I didn't want as believed that interventions would make it worse for me. However in the end I got lucky, had baby in midwife led unit and only had a second degree tear as dd had her hand up and wriggled her elbow. Otherwise I'd have been fine said the midwife. Recovery second time was much quicker.

[Iggly]

it's pregnancy itself which stresses the pelvic floor

It does though?

[seaoflove]

Actually I dont dispute that at all Iggly. But the consultant said that pregnancy alone causes stress to the pelvic floor, and having a viginal birth after 3rd degree tear is of no consequence at all - which directly contradicts the guidelines.

The guidelines also say there's no evidence in favour of prophylactic episiotomy, and he said the option is always there to perform an episiotomy if it looks like tearing might happen.

I didn't point any of this out - didn't want to piss him off.

[toptomatoes]

I had a third degree tear with my first baby, repaired well in theatre. I saw a consultant midwife with my second and went through why there was so much intervention the first time so I felt better prepared the second time. DC2 was a textbook labour but I did have a second degree tear. With DC3 I had a couple of stitches.

[skitter]

I am currently due to deliver dc2 any day after 3c tear. What I've been told is that there are no guarantees, as with every birth, but that it does to some extent depend on the degree of the third degree tear and the results of any tests you've had on your sphincter control. At my hospital (not uk) they generally advise you try a natural birth if everything else is favourable if it was a 3a or 3b but they are much more cautious with 3c and 4th degree. I had ds at St Thomas's and they did various tests when he was 6 months old that showed an internal defect and minor pressure resistence, despite me having recovered well and having no symptoms. The Obs here have said that while I may have a natural birth without complications and it's fairly unlikely I'd have a third degree tear again, the real risk is later on life, around and after menopause and that having had a 3c tear and then another natural birth puts the risk of incontinence up somewhat - not hugely but enough that they need to let me know it's a risk, particularly as they can't be sure which muscles are compensating for the ones damaged during the first birth (and therefore if I have an episiotomy they may accidentally cut through those compensating muscles!). This is pretty much exactly what the specialist who did the testing at St Thomas's said to me when I had the testing done. Having been pregnant again does of course increase the strain on the pelvic floor and increase risk of postmenopausal incontinence but it's the actual baby passing through the birth canal that can also push up the risk in 3c/4th degree cases, so I've been told by multiple Obs. Many women don't find it a problem and have smooth second deliveries without ill effect (my sister is a midwife and has seen many success stories and is very pro natural birth after third degree tears if the woman is keen), but for me the combination of the increased risk, my postnatal test results and a desire for a much calmer, different birth this time mean I'm going for an elcs. My sister has told me that the psychological side is a big factor in the good births after bad tears that she's attended and I'm just not up for it mentally this time around!