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What to expect - Consultant appointment to discuss birth after third degree tear last time

(20 Posts)
flippyfloppy Tue 04-Jan-11 12:59:53

HI there, I'm 20 weeks pregnant with 2nd child, had my DD1 3 years ago which resulted in a third degree tear. I have an appointment with the Constultant next Thursday to discuss my birth options and I wondered if anyone has been in this position before - what they were advised, what they did and what was the outcome? I am confused at the moment and seem to be getting lots of conflicting advice, hopefully it will be clearer after next week. TIA

emoo777 Tue 04-Jan-11 13:56:21

I am very interested to know the answer to this as have just become pregnant with my second, and had a 3B tear myself first time around. Do you know which third degree tear you had, a,b or c? I gather there is quite a difference between these.
Sorry I can't help.

snowmummy Tue 04-Jan-11 14:11:31

I had a fourth degree tear with my first child, and had a c-section for my second. I am currently pg with third and will be having another c-section.

As far as I know, you should be given the option of a c-section. They will not advise you either way, but will give you the facts about the risks of a c-section and another vaginal delivery and then leave you to make your own mind up.

For me, the decision was made even before I became pg with my second. I would not have had another baby if I had to have another vaginal delivery.

Hope this helps, but please fire away if you have any other questions.

caramellokoalalover Tue 04-Jan-11 14:40:32

I'm pregnant with my second and had an appointment with a consultant at 16wks to discuss the options, similar to you.

Same as snowmummy, I was offered the choice to elect to have a C-section and the risks were outlined. I asked if I was at higher risk of needing an episiotomy or tearing again and needing stitches and he said no, whilst it could happen again I am not more likely to, the scarring won't affect things and I could have no problems at all.

I've decided not to have a C-section. Whilst it wasn't fun first time round, I healed well and fairly quickly and I had great care from a physio for about 9mths after the birth getting everything back to normal. I'm just going to take my chances that this bubba doesn't try to exit sideways or change his/her mind halfway and get wedged!

Good luck with the decision and I hope the appt with the consultant goes well and helps you to make the right decision for you.

yummytummy Tue 04-Jan-11 14:58:44

hiya. i was the same as you had 3rd degree tear with ds 3 yrs ago and pg again. i actually insisted on seeing the consultant before i even got pregnant to guarantee i could have a section! but thats mainly because unfortunately i had quite extensive damage amd didnt want to risk it being made worse by another vaginal birth.

however i think they are quite open to both options and pretty much leave it to you to see how you feel about having a vaginal birth or section. all depends on how well you healed. i think its entirely how you feel most comfortable but definitely helps to talk through options and ask questions.

good luck whatever you decide!

SoupDragon Tue 04-Jan-11 15:02:21

i had an ultrasound scan something like 10 weeks after DS1 caused a 3rd degree tear and was told then and there that there was no reason not to have future children 'naturally'. I went on to have 2 more and, whilst I tore with both, neither was a significant tear.

clareanna Tue 04-Jan-11 16:12:35

Hi in my case, the cause of the 3rd degree tear was more the matter for discussion with the consultant, we suffered shoulder dystocia during the birth, so the recommendation was for a c-section this time around, she said the tear itself was no barrier to another vaginal delivery. my advice would be to go in there with a good idea of what you'd like the outcome to be (would you like a c-section or not?) so you can discuss your options. They will go through your notes from your previous labour with you. If you do want a C-section it's also worth finding out if the consultant you're seeing is quite pro or anti elective c-sections.
Good luck and I hope you get the birth you want

Eglu Tue 04-Jan-11 16:18:15

I was never even offered an appointment with a consultant to discuss my previous 3rd degree tear. I had a home birth for DS2 and that was no problem. I do think the reasons for the tear are important, and how well you healed obviously. Although nobody asked me about my healing from previous tear either.

flippyfloppy Tue 04-Jan-11 19:19:14

Sorry I'm late in replying, I've been at work and thanks for all the posts. My DD was 8lb 140zs and was back to back, I was labouring standing up and they said I would be in it for the longhaul, my midwife went on a break and I was with the student midwife, all of a sudden I got the urge to push and started screaming this to the student midwife, by the time she crowned it was too late to slow anything down. I think she basicaly crashed down and out too quickly and she was a big baby, this is just my thoughts! I've never actaully been told. Healing wise, I'm much "tighter" than before!? and suffer from leakage if sneezing, excercising streneously, being sick etc.. my pelvic floor also aches if I am doing anything too strenuous over a long period ( we moved house earlier this year and it caused me problems). I am unsure as to what I "want" and I think that is the tough bit, I kind of wish I was told what to do. I am worried that my pelvic floor can't "handle" another VB, but that may all be in the head, it leads me to worry about future sexual relationship etc... but the idea of me having a caesarean is not something I will consider lightly. Interesting what you have said about the gradings of the tear, I have no idea, I was pretty traumatised for a while after giving birth and in hindsight think I would have benefitted from a debrief of the labour, I didn't really understand what a third degree tear was until I researched it myself when I got home. Thanks again for all your posts.

CrazyChristmasLady Tue 04-Jan-11 20:38:15

I've got my second consultant appointment tomorrow to tell them my decision.

I had a 3b tear with DS, 3 years ago. I have healed really well and I tore due to episiotomy and forceps birth which was because DS was in distress and needed to be born quickly. Knowing these things helps in the decision making.

At my first appointment, around 20 weeks, all they did was go over my notes, tell me what I already knew then tell me its up to me and to come back 14 weeks later. They wouldn't guide or advise me on what to do, they said it is totally up to me whether I want to take the risk or not. They did say as I healed so well, I have no greater risk than anyone who hasn't tore before and if the damage had been worse, they would recommend a c section.

My midwife has told me to go with my gut (when she figured out I was hoping for someone to tell me what to do) which has told me all along told me to go for a natural birth. She also said this baby doesn't seem as big as DS was (8lbs 11oz and he was 10 days early, dread to think if I had gone way overdue!) which seems good, but this one may also be breech so it could all be pointless me agonising anyway. smile

mohara Wed 05-Jan-11 10:10:06

I was in the same position as you.....gave birth to DD1 (our first child) in Dec 2007, after a very long labour, ended up in theatre with an epidural and forceps delivery. I suffered a third degree tear (even after the episiotomy) and although I healed well, I DID have some leakage when exercising etc.

I fell pregnant with DD2 in Sept 2009 and had an appointment with my consultant at 20 weeks. He basically explained that, this time, I was AS likely to have a significant tear as any other woman, but not MORE likely. However, he DID offer an elective CS, said that the birth type was my choice and that he and the midwives would support any decision I made. After a lot of thought and discussion with DH, we decided to go for a VB (mainly because I wanted to experience an unassisted VB where I 'felt' the delivery!) However I was concerned that having recovered well after the first tear, another tear would leave me with worse consequences.....

Gave birth in June 2010 to DD2 after a lovely quick 3 1/2 hour labour, with just gas and air (birth was too quick for anything else!). Midwives were very aware of my history and made sure that pushing etc was slow and controlled......unfortunately DD2 presented with her hand up at her face and caused another 3rd degree tear! Cue another trip to theatre, another spinal and 40 minutes of stitching!

However - I recovered well (quicker than before actually) and have no long lasting problems. I count myself lucky that I had TWO third degree tears and have come out the other side fine. That said, we would love to have another baby and I think THIS time that I will go for an elective CS.......I don't want to push my luck!! I think what I am trying to say is that I DID have another tear, but the cause was not my previous tear, but the fact that my lovely mischevious DD2 decided to be born waving at us all! smile

Sorry for the long post, hope this helps!

PenguinsMummy Wed 05-Jan-11 11:43:47

Had an episiotomy on one side and 3rd degree tear on other with DD1. Had very very brief and dismissive consultant appt when pregnant with DD2 and was basically told v common with first baby and unlikely to happen again.

Had another 3rd degree tear along same line with DD2.

Am now pregnant with DD3 and have had 2 really good consultant appts and am having an ELCS this time.

snowmummy Wed 05-Jan-11 17:05:25

I admire those of you who have had third degree tears and go on to try another VB. There was no decision for me, I was and still am too scared to try and opted for the C-section.

yummytummy Wed 05-Jan-11 19:23:08

snowmummy, can i ask have you had the section? how did you find it and how was recovery and afterpain as compared to after the 3rd degree tear? this is something which has been worrying me! thanks

flippyfloppy Wed 05-Jan-11 20:55:26

Crazy Christmas Lady - did you go for you appointment today? what did you decide in the end?

PenguinsMummy - what was the cause of your tears both times? and has the recovery been worse 2nd time, would you say you were monitored more closely during your second birth?

Snowmummy I too feel "scared" that my body won't be able to handle it, and wonder if it is silly to take the risk, just wonder if mentally I can get over that! Did anyone else who went on to have a 2nd VB feel this beforehand or did you have a strong urge that you really wanted a VB. I am concerned how I am thinking mentally will affect my ability to give birth and let go, if that makes sense!

dirnty Wed 05-Jan-11 21:01:20

I was in the same situation, 3rd degree tear with first. I had quite a lot of muscle damage around my bum (sorry can't remember technical term wink) so was recommended to have a section with 2nd. Wasn't ideal but I couldn't risk further damage.

snowmummy Wed 05-Jan-11 22:09:31

yummytummy, my second baby was born by c-section. I am currently pg with my third and I will be having another section in a few weeks.

I had a fourth degree tear. The whole experience and the pain was horrendous and recovery took a long time. I still have problems. Compared to that, the c-section was a breeze. It was a pleasant experience, and recovery, although not easy, was easier.

snowmummy Wed 05-Jan-11 22:15:05

flippy, I know what you mean about being mentally able to try. I know that I will never be able to get over it. The thought of going into labour terrifies me and I know I'd panic. I do sometimes feel sad that I will never experience a normal VB but really that's secondary to healthy children and a mother in one piece!

PenguinsMummy Thu 06-Jan-11 09:22:02

flippy with DD1 they were going to try ventouse and forceps so gave me an episotomy on one side but I had more or less pushed her out by the time they got round to trying the forceps (ventouse didn't work)and tore down other side. She was 8lb 8 and labour was about 6hrs in total. It was quite a large tear and took a long time to heal.

DD2 was 8lb 15 and labour was 1h 50 from start to finish so they put it down to being so fast and another large baby. Tore again down same line but not as severe although still 3rd degree. I healed quicker with DD2 than DD1 and although I have been really lucky and have had no incontinence to date, the strength in the muscle has definitely declined.

With my current pregnancy, they will let me try for another VB if I really want to but medically advise to have ELCS as I am highly likely to tear again along the same line and it is likely to be 4th degree rather than 3rd and much harder to repair as it would be stitching the same tissue for the third time.

So am going to listen to the consultant and go for ELCS in early April. But as I said in my first post, the consultant I saw when pregnant with DD2 was very dismissive and said I would be fine having another VB!

CrazyChristmasLady Thu 06-Jan-11 09:52:41

I did have my appointment yesterday and I have decided on a vaginal birth. I have had no lasting effects, although I did have a probelem controlling my wind for a good few months, but this sorted itself out.

The consultant was pleased with how I have healed and he said forceps etc are far more common in first births and seconds tend to be easier anyway.

I did say that I don't automatically want an episiotomy as I had that last time and still tore so he has put on my notes that it is down to the midwlfe on the day but if I do need one, they have to make their minds up quickly and not leave it too late, which I am fine with.

My midwife has said to go with my gut and it is still telling me that natural birth is the way to go.

Got scan next week though to tell me of baby is breech. MW or consultant can't tell!

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