3rd degree birth with DC1 - do I go for a vb or cs?

(37 Posts)
Chilli81 Wed 16-Oct-13 18:51:32

I posted this in my antenatal group but didn't get replies. Basically I'm 32 weeks and had a doctors appointment today to discuss options for labour and was told that there's no way I'll be allowed to go to the birth centre as I had a third degree tear last time. I guess I understand the reasons and its better to be safe than sorry but I did have my heart set on the birth centre. I didn't get the chance last time because it was full on the day. However I can deal with that.
What I'm most concerned about is whether to go for a vb or cs. The doctor said that if you've had a 3rd degree and have another the risk of long term incontinence is higher. The doctor also said that I can ask for a cs at any point leading up to my due date because of the tear and that some women would rather choose that option than take the risk. Did any of you have a 3rd or 4th degree tear with your first? What did you do/what are you planning on doing this time? Any experiences appreciated. I'm very confused confused

schmee Wed 16-Oct-13 18:59:30

I had two cs and have ongoing continence issues (I think bladder damage during the op but I'm not sure) so it's important to understand that neither option will prevent issues, although of course it is more likely with a vb.

I think it boils down to how you feel about giving birth again. Do you want to have a vb or are you equally happy to have a cs?

There are risks to you from both options. I think NICE has a paper available which lays them out with percentages. What is the worst case scenario for each option? Which would you rather live with? Which is the risk which worries you the most - and which option gives the least likelihood of this occurring?

If it was me I would probably go for a cs, but I have issues with vb. You will have different views.

Chilli81 Wed 16-Oct-13 22:40:37

thanks schmee. that's really helpful advice.

Chilli I've just had a c section due to pervious fourth degree tear

I do not regret the choice at all

I am in pain but I know I will heal
And I won't have the long term problems from a fourth degree tear

Whistleforit Thu 17-Oct-13 21:48:39

Hello. I had third degree for first. Vb and second degree the second time - in pool in birthing centre. No ongoing problems. The key for us - and I wanted a vb - was to escape the consultants who were pushing for cs and find a hugely senior and experienced midwife who said a) she was happy to have us in birthing centre b) it was absolutely possible to have a good vb. Which it was. So, from our experience, recommend finding someone you trust who will take care of you either way, in our case we had to practically barge down the door of the the right person but it was possible once we had her name... Good luck. Is not an easy decision I know.

schmee Sat 19-Oct-13 18:36:52

Glad the advice was helpful. Huge congratulations on your pregnancy btw!

Chilli81 Sun 20-Oct-13 09:01:58

thanks for the responses. it's a tough one but I think I'm going to try for a vb and then if it looks like it's going on for ages, ask for a cs.

best of luck chilli

Chilli81 Mon 21-Oct-13 14:42:20

thanks White x

maxbear Tue 22-Oct-13 16:13:31

Where I work women who have had a previous third degree tear that has healed well usually have a vaginal birth. I am a birth centre midwife and we regularly have women who have had previous third degree tears. I can't see why going to a consultant led unit would be an advantage. The risk of having another one is small, if it were to happen in a birth centre you could be transferred afterwards. This is a different matter for women who have had a fourth degree tear though, they would usually be advised to have a Caesarean.

maxbear Tue 22-Oct-13 16:17:55

Sorry posted before I'd finished. I've delivered quite a few women with previous third degree tears over the years. I remember doing an episiotomy once as the woman had a very short perineum but I don't routinely. I've never had anyone who has had more than one third degree tear (thankfully, although I don't think it is the midwifes fault, it would still feel horrible if it happened)

Chilli81 Tue 22-Oct-13 18:32:24

thanks maxbear I think I will ask for their reasoning at my next midwife appointment for not letting me go to the birth centre. I don't know if the fact that I had a 3c tear makes a difference.

Tea1Sugar Tue 22-Oct-13 18:42:37

I had a 3a tear three years ago. I'm 14 weeks with dc2 and will request an elcs. I was told at my debrief I'd be entitled to one if I wanted one. I don't want to take the risk of continence issues.

hazeyjane Tue 22-Oct-13 18:47:25

I had a 3rd degree tear with dd1 and was allowed to use the birth centre to have dd2,after discussing options thoroughly with the mw.

I had an elective cs with ds (3rd birth) and it was the most difficult of the 3 births to recover from, but it is all so individual to each birth!

Have you had any continence issues so far?

thursdaysgirls Tue 22-Oct-13 20:56:08

I had a VB with my DD1 and DD2 after 3rd degree tear and keibler forceps with my DS1.

Both subsequent births went very well, I had a minimal tear with DD1 as she came out so fast, and DD2 there was no tear or graze and it didnt sting when I peed a few hours later which was just the most joyous thing ever grin

Mondayschild78 Tue 22-Oct-13 21:46:21

I am 36 weeks pregnant and had 3rd degree tear two years ago with DS. I have made the decision to have a VB and have been told I will have a Senior Midwife at the delivery. I have told consultants and midwife that if I go overdue then I would like an ELCS and do not want to be induced (which from research will be more likely to lead to possible epidural/ intervention which could increase risk of another tear or an EMCS).

I am very nervous about whether I've made the right decision and it was difficult to make so in the end I've gone with my gut feeling and what feels right to me. Fingers crossed it goes well.

Good luck in making what is such a tough decision.

I had 4th degree tear with DD1 and two years later had VB and 2nd degree tear with DD2. No continence probs. I was offered cs but said I wanted vb. I had to be in a particular position so they could keep an eye on any tears but all OK. I went with my gut feeling. Good luck everyone x

tired what position did you need to be in/ just curious as when i had my dd
i was on all fours in a birth pool and i was told that was optimal position

Chilli81 Wed 23-Oct-13 20:19:31

thanks so much to everyone for sharing their experiences.
hazeyjane I didn't have any incontinence issues which is probably one of the reasons I am thinking of going for a vb again. sex hurt for a good few months afterwards but not an issue any more (sorry if tmi)
Mondayschild yours sounds like a good plan. I have also been told that I'd have a senior midwife if I go for vb. I think the fall back option of an elcs if you are overdue is a good one.

Mondayschild78 Wed 23-Oct-13 22:32:02

Fingers crossed all works out for you Chilli (and everyone else). Not an easy choice to make! My friend had similar situation and said the senior midwife helping her second time round was invaluable. Her youngest is now 2 and she said she's had no incontinence issues (although they could of course arise in future). It was good to hear her positive experience though.

GobbolinoCat Thu 24-Oct-13 00:09:09

I would not risk incontinence do you have people that can help you with the recovery from the section?

If so its a great way to have a baby, I have very fond memories of mine.

GobbolinoCat Thu 24-Oct-13 00:11:25

I guess one way to look at it might be, if you do end up with nasty issues, and you were offered a sort of get out card, and you are struggling, can you cope with your decision to have VB?

I know that I was very sensitive to the issues I had below after 1st labour and didn't want a repeat, it made me feel run down and hard to relax with baby as was in pain.

whiteandyellow for DD1 I was on all fours in a bed (induced at 42 wks, 5 hour labour, 10.5lbs, retained placenta, 4th degree tear) I do remember crying every time I went to the loo for a couple of months.
For DD2, I had to be lying on my side on the bed so they could watch my scar as I delivered. 9lb baby 3 hour labour and just a small tear that the midwife stitched. Both births were positive experiences, and no long term health side effects.

TwoTearsInABucket Thu 24-Oct-13 04:51:32

I had 3b tear 4 years ago with dd. it was vbac. Now nearly 37 weeks with dc3. Was told that because I had good labour apart from tear that Cs wasn't reccommended.
I have opted to try for vb but straight to Cs if overdue. No induction.
I didn't have any continence issues.
I saw consultant mw who wrote in my notes about my concerns re tearing again. So going to try to be on my side at least and push slowly with warm compress on perinium at pushing stage. Fingers crossed!

sleepywombat Thu 24-Oct-13 05:06:54

I had 3rd degree tear with ds1.
20 months later had ds2, no tear, no stitches, just a little graze. It was amazing, next to no pain straight after birth (I had thought the weeks-months of agony after ds1 was the norm & just part of childbirth).

I had been told that I was likely to tear along the same line in subsequent births, but I think my babies' positions made all the difference (ds1 came out back to back with his head sideways, ds2 was in perfect position).

Never had continence issues (yet - am pg with ds3, so don't know what the future holds)!

sleepywombat Thu 24-Oct-13 05:07:27

Also, I never even considered C section, didn't even know it was an option for me really. Nobody mentioned it.

TwoTearsInABucket Thu 24-Oct-13 05:22:49

Dd was back to back as well. I was also lying on my back. Going to try to keep active this time.

Mondayschild78 Thu 24-Oct-13 12:30:34

TwoTears we are in a similar position, I'm nearly 37 weeks and also trying for VB but if overdue straight to section no induction. I wondered if you already have the section date booked? Mine hasn't been yet but I am thinking about following up with the consultant to ask for a date now.

TwoTearsInABucket Thu 24-Oct-13 20:31:45

Monday, I''ve been booked in to see the consultant at 40 weeks if the baby hasn't arrived and she will do a stretch and sweep. I suspect on that day she will book the cesarean just in case. She said I would have to wait till 42 weeks. That's what happened with DD who was vbac. She arrived at 41 weeks the day I was meant to go in for pre-op appt.

According to the consultant her sweeps are famous, I did ask if that was in a good way. Not looking forward to that!

Mondayschild78 Thu 24-Oct-13 21:52:55

Ah thanks for the info. Same here actually I have an appointment and sweep booked for 40 weeks and told my situation will be 'reviewed'. I have today sent a letter to the lead consultant requesting a C Section date for between 40-41 weeks as would prefer something that I know is booked (although I'm probably being a bit over-zealous!)

Good luck with the delivery and 'famous' sweep wink

TwoTearsInABucket Thu 24-Oct-13 22:00:54

I hope you get what you ask for. I understand your thoughts on it. I had initially asked for elcs but was told it wasn't recommended. It really sent me into a tailspin. I am now comfortable (just) wIth vbac but am still waking up very early every morning thinking about birth. Gah. Nothing is straightforward. Best of luck!

Mondayschild78 Fri 25-Oct-13 15:58:48

TwoTears I am surprised they didn't agree to an elcs given that you have previously had a section?

Following my letter to the lead consultant yesterday which outlined my wishes very clearly and reasons behind it ie. VB up to 40 weeks and then I would like a C Section booked for between 40-41 weeks (w/c 18th Nov) I have today received an email from him saying he is happy with my plan, is booking me in for an appointment with him on 6th Nov when he will book the elcs for w/c 18th Nov.

I feel so much happier knowing that I will get this rather than wait until my 40 week appointment and then be told yes you can have a section but you have to wait until 42 weeks as it's too short notice to book it.

If it is stressing you out TwoTears would it be worth putting something similar in writing to your consultant and pushing for an elcs for slightly earlier? I do wish you the very best of luck and sounds like we will be having them around the same time!

Chilli so sorry to derail the thread a little but I hope that sharing my experiences on this thread after having a third degree tear is useful to you and perhaps others in a similar situation. Best wishes for what you decide to do smile

Chilli81 Sat 26-Oct-13 08:15:50

Hi Monday not at all. it's really helpful reading about other people's experiences and their considerations. I have a midwife appt this week. I've requested a 38 week appt with the doctor as I'd like a bit more info now that I know my previous year was a 3c. I didn't have that info at my last appt. I also went to have a chat with the birth centre who said that they wouldn't consider me high risk and that they've dealt with loads of women who've had third degree tears in the past. they were a bit critical of the doctors for saying I was high risk. I got the sense there's a real clash of cultures at my hospital. anyway I've also booked in to go on a tour and info evening with my dp too the birth centre next week so I'll hopefully be as informed as possible when I finally do make my choice. good luck Monday and twotears (can't help chuckling at the irony of the abbreviated version of your name) wink

Mondayschild78 Sat 26-Oct-13 19:42:27

Good luck to you too chilli and IMO the healthcare professionals all have their own differing opinions and agendas so best thing you can do is research as much as possible and decide what you want then make it very clear (in writing if you have any doubts like I did).

smile

TwoTearsInABucket Sun 27-Oct-13 16:39:09

Ha ha, yes, how ironic about my user name grin I hope there are no more tears or tears!
Because I had a successful vbac, albeit with a tear, they advocate another vb. especially as I have absolutely no continence problems.
I think after reading about your success with the letter monday that I might request am earlier c-section than 42 weeks because I am six days ahead of my dates but because wasn't 7 days ahead they didn't change my due date.
I was still so much happier after the vbac than the c-section, but the c-section was after failed induction and 2 weeks in hospital with preeclampsia.

ktbeegirl Thu 06-Mar-14 17:19:50

Message deleted by MNHQ. Here's a link to our Talk Guidelines.

macaroonlady Fri 06-Jun-14 22:57:11

You might find this blog useful:

3rd4thdegreetear.wordpress.com

Best wishes.

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