Birth after 3rd Degree Tear

[SunshineSnowflakesDaydreams]

Hi everyone!

I was hoping to hear some of your experiences of giving birth after a third or fourth degree tear.

After my first baby 19 months ago, the consultant advised I would be offered an elective c-section as an option for further deliveries due to suffering a 3b tear. I am now pregnant again and am going backwards and forwards in my head about the best way to deliver this baby. With my son, I didn't get the urge to push and now have these thoughts that I wasn't pushing hard enough and it was me that caused the need for the episiotomy and forceps delivery because I wasn't pushing effectively. Which is probably another issue entirely!

I have no long lasting symptoms from the tear, besides a little urgency but it's certainly manageable, though I am worried that another tear will result in it becoming worse or unmanageable. I definitely don't want to be 35 and incontinent! But I also don't take the c-section lightly either. Both have their risks, plenty of pros and cons for both and I just can't make a decision.

For those of you who were faced with this decision, what did you choose and how did it turn out?

[SharkSave]

I had a 3b tear first time and was very lucky (I think) to have suffered no ill effects at all. However second time round I opted for a c sec. I didn't consider a vaginal birth at all. I had it 12 weeks ago and am still really happy with my decision. The first week of recovery was tough but I was ok after that.
The biggest things for me were not ending up incontinent or repeating the experience I had first time (which I found really traumatic)

[tmc14]

Hi!
I had a third degree tear with my first but only have one baby so can’t really help. But! I was told I would be offered an elcs if I have a second. There is a greater risk of having a 3rd/4th degree tear if you’ve had one before, but it’s still only a 5-7% chance of one (www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-third--or-fourth-degree-tear-during-birth.pdf). So, if I do have a second I think I’ll try for a vaginal birth still as obviously with an elcs you’ll definitely have a wound, as opposed to a 5-7% chance of injuries with a vaginal birth. If that makes sense.
Can you talk with the hospital team about your last labour? I tore as my second stage was really slow, ending in ventouse & I pushed too hard, plus my baby had a massive head! Ha. Perhaps if you can get more info on what happened last time you can make a clearer decision.

Not sure any of that helped but good luck!

[tmc14]

I should also add I too had no ill effects after, & fantastic aftercare from my hospital. Which I think influences my mindset about it.

[Lindtnotlint]

Elective c-section here after two difficult vaginal deliveries with healing problems. Was WONDERFUL. in your shoes I really wouldn’t hesitate.

[brokenharbour]

Does everyone get offered a section after third degree tear? Anyone not been?

Have consultant appointment two weeks today and want to know if I need to go into battle or not. Couldn't find anything on nice guidelines that said it had to be offered...

[OoohAyyye]

I also had an episiotomy and forceps delivery. Does that count as 3rd degree?

If so, I was never offered a cs for my second. I had a wonderful home birth. Although annoyingly I still had to go to hospital for stitches!

[AllChangeNat]

I had a third degree tear first time round and wasn't offered a ELCS for DC2. Second time round I didn't even need stitches. But perhaps it's more to do with tear position and amount of scar tissue rather than the degree of tear IYSWIM?

[Jazzmin]

I had 3rd degree tear followed by a 2nd degree with child number 2. I was never offered a C section. Was given lots of advice the 2 nd time and they tried to manage it better. I preferred the firsttime as had to go into theatre for stitches so didn’t feel a thing! Good luck x

[ifiwasabutterfly]

I had a 3rd degree tear with shoulder dystochia followed by an elective c sec with my second.

The c section was AMAZING in comparison, the recovery time was so much quicker.

[Tumon]

A 3b tear here with my first and I’m due second baby in Feb. Have decided already on a section as I just am so terrified of the aftermath from first birth. I feel it’s just too risky and I would absolutely beat myself up for life if I got another 3rd degree tear (someone’s going to be in that 4-7% bracket and the midwives or consultants couldn’t give any more info on how to avoid that) my first birth was no epidural or forceps /epi so was unusual to tear so badly apparently !

[Heatherbaby]

Hi all

I'm sort of in the same boat. I had a 3a tear 12 months ago with my first. Annoyingly I'd had a really nice birth experience with just gas and air in a birthing pool. I thought the water would reduce the chance of any tears so no idea what happened there. Then i had the glorious spinal tap in surgery for stitches and was sad i wasn't numbed out for the birth part after all!

Fast forward 12 months and I'm due baby 2 in 5 weeks. I wasn't offered a c sec. The consultant asked if i had any incontinence problems and luckily i don't. It healed pretty well although not totally as good as new.

However the chances of it happening again are less than the chances of it happening in the first place or so I'm told. I know women have very different experiences of c sec recovery but if you are otherwise healthy, a c sec is major abdominal surgery and more trauma to your body than a vag birth so definitely worth weighing up the options.

I think some ladies have a tougher recovery from tears than others and consultants should be able to advise if you fall in to that category i.e. bad healing/ scarring and loss of control in your muscles down there.

If it helps, my logic is this - second time around I know more about what to expect with pushing. I plan to advise my midwives to help me go slower at the final push and help hold the area together as baby comes out. I have just ordered some oils to help with perineal massage to start prepping the area and stretch it a little.

Who knows if any of the above will work, but I'd much rather chance a smaller degree tear or no tear at all than guarantee myself physically traumatic surgery because I also have a 1 year old to look after and don't want to have too much down time.

Can't predict how it will go though so here's hoping. Good luck OP, you will be fine which ever method you choose to give birth to your precious bundle of joy x

[Spudina]

Hi. I had a third degree tear and was offered a c section for DD2 by the Registrar. Which I was really happy about. The Consultant tried to talk me out of it, saying that I didn't need one as in not fecally incontinent! But I held fast and got my section. I blooming loved it!! The whole experience was amazing. Loved not having to go through Labour and take the risk again. I would never ever have another vaginal delivery.

[snop]

I had a 3rd degree tear with my first and an elective section with my 2nd, the c section was wonderful in comparison with my vaginal delivery. If I was you I defiantly have the section it's just not worth the risk of tearing again

[Spudina]

Forgot to say that I had healing problems and pelvic floor weakness after DD1. Think tear was just short of a 4.

[SorryAuntLydia]

Problem is if you tear again in the same place, it can be very hard for to repair. Is it worth the risk? I found elective c section really easy to recover from - just so much easier to enjoy my baby in the aftermath of planned surgery rather than a frightening unplanned repair.

[SorryAuntLydia]

Oh and don’t blame yourself please. For a long time I thought I’d pushed too much but in truth it was a horrible combination of distressed baby, inexperienced midwife and just bad luck. But no need to risk your health, you have nothing to prove.

[teacherspets]

I had a 3a tear followed by a wonderful elcs.

[Tumon]

It’s a hard decision as everyone is so different and definitely my lingering symptoms have pushed me towards a c section. I read a blog (sorry can’t remember where!) and it said something along the lines of “if no one else had to know what type of birth would you chose” and I really liked that. I think many women (me for first birth for sure) would have felt judged for choosing a section with the whole “too posh to push” attitude. In hindsight a c section would have been best for both myself and the baby but we didn’t know what we didn’t know like everyone else on here. If any part of the decision that is worrying what others would think then just do what you personally feel would be right for you.
So happy to hear of all you wonderful women going on to have better experiences second time- regardless of the method of birth. women really and truly are the unsung hero’s of the world ! Best of Luck with your decision xx

[balalalala]

I had a 3c tear 2 years ago and my second is due in December. I too have suffered no ill effects so I'm currently planning a nature birth again this time round. I keep getting nervous but my gut says it's what I would rather. I was offered an elec though.

[Saymaname]

I had a 3rd degree tear with my first. Wasn’t offered and didn’t think about cs. Had my second baby with a little tear.

[Whereisthegin1978]

Hi, I had a 3rd dégrée with my first 11 years ago, have gone on to have 3 normal deliveries -with my third I had a 2nd dégrée but 2nd & 4th all was fine.
C section was never mentioned but they wouldn’t let me deliver again in our local midwifery led unit, had to go to a consultant led unit.
It must be a really hard decision because there is no right or wrong - I think you just need to go with what you feel is best.

[SunshineSnowflakesDaydreams]

Thanks ladies for sharing your experiences. I really appreciate it.
I've been in contact with Birth Afterthoughts to arrange a debrief, which I hope will shed some light on what happened the first time around and ease my mind.
I also had a really good chat with my OB yesterday who was quite happy to book a c-section but outlined what the plan of attack would be if I did try for a vaginal birth (regular growth scans to look for trends, induction if estimated birth weight was going to be over 3.6kg and absolutely no forceps).
I'll wait until after the debrief to make any decision but it feels like a huge weight has been lifted, even though I've not made my mind up!
Also reading what other women have experienced after severe tears has also really made me think I can have, or it's a least possible, to have a positive outcome regardless of the choice.
So thanks ladies! You've helped a girl out!