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VB after previous 3rd degree tear - advice please

(8 Posts)
scienceteachermum Sat 15-Aug-09 19:27:57

Hi
I am 15 weeks pregnant with DC2, and I had a 3rd degree tear with DS1 following a completely straight forward labour. Had to have a subsequent repair of the tear when DS1 was 16 weeks as the stitches did not dissolve and went all lumpy and uncomfortable.

my mW has said I would qualify for an elective c section this time and has referred me to a consultant, but I really want to have a natural delivery again. However I was wondering if anyone knew the likelihood of the same thing happening again, or if there was anything I could do to minimise it happening again.

Thanks

TortillaDeMaiz Sun 16-Aug-09 00:16:55

Not much advice here, but I'm in the same situation. I went to physiotherapy for quite a while after my first birth and my physiotherapist told me an elective C-section might be better than another tear.

I'm PG with DC2, but I am going to wait until the last few weeks to make up my mind depending on how do I feel. I will probably ask for a scan to see if the size or position of the baby can make it difficult for a VB. I have my appointment with a consultant at the end of September and I will ask for more details abouts pros and cons.

TheDMisfuckingDeemented Sun 16-Aug-09 09:48:35

I too am in a similar situation. I had a 3rd degree tear when my dd was born - she was vbac.

I think perhaps if you can identify possible reasons as to why you tore last time, it could be a start in tyring to avoid them this time. For me personally, they decided they couldn't get a good enough trace on DD, so they decided to break my waters and put a probe on her head, thus meaning that i was stuck on the bed completely, i wasn't allowed to get up and walk around or even get myself into a comfortable position, i was effectively flat on my back, and as i have back problems anyway, that really didn't help, especially as DD was back to back.

This time, i am aiming for a home water birth. I haven't even considered a ELCS - there doesn't seem like a reason to. Yes, i know i tore badly, but i believe that i can take steps to stop that happening again. I've already had an appointment with the doctor who was horrified at the thought of a home birth, but at the end of the day it's my decision and one i'm not going to rush into lightly.

I do have some links to articles about 3rd degree tears and reoccourance - let me see if i can dig them out.

TheDMisfuckingDeemented Sun 16-Aug-09 09:59:08

Links

recurrance risks

causes of 3rd degree tears

preventing tears

Hope these help.

LionstarBigPants Sun 16-Aug-09 10:02:31

Also had 3rd degree tear after first birth - pushing for 3 hours, episiotomy & DD arrived with hand up to cheek. Healed well (after 2 weeks of agony) and am now planning a home birth for this one - midwives have been nothing but supportive, though they did get me checked out by consultant to make sure all looked OK down there.

Kyte Mon 17-Aug-09 09:00:14

I'm having an elective cs but only because:

* I had a 3rd/4th degree tear and still have a damaged sphincter

* The scar tissue gives me no discomfort, but it is quite rigid and very likely to tear again & at risk of needing a colostomy bag if I do

* I'm hypermobile (muscles stretch too easily) and a lot of muscle damage was done during a 4 hour pushing stage and has caused incontinence problems which would be made worse by trying to deliver naturally again

* I have a mild uterine prolapse caused by it all which could be made worse

Given all these risk factors, I'm happy to go for a cs. Just so you know, I was a home water birth that got transferred in and the water didn't stop me tearing because the tear was caused by an straight down episiotomy that had a forceps inserted into it.

If you end up having intervention, you may still tear again. However just because you tore badly once, doesn't mean you will tear badly again, especially if you use perineal massage beforehand (My mum was a midwife and has seen people tear very differently from one birth to the next, sometimes not tearing at all in subsequent births). It is the rigidity / fragility of the scar tissue that is a major factor and your consultant should be able to give you an idea of how problematic it is.

mumtojennifer Tue 18-Aug-09 14:15:35

I am 16wk into 2nd pregnancy and extremely anxious about tearing/an episiotomy again.

I had what in my notes is described as a '3rd/4th degree tear' when in fact I was cut from front, right to back through all muscles (my scar comes to the top of the crack in my bottom!) by the senior registrar after my dd got stuck and we were too far along for an emergency C-section. DD was 7lb 10oz - a whopper for 36wk and a giant in the special care unit!!

Anyway, the senior registrar was great and I was properly 'repaired' in the main hospital theatre - no ad-hoc suturing in maternity! He did a fantastic job and I have had no problems toilet-wise in these past 2 1/2 years. My concern is that after doing such a great job 1st time fixing me up, if I were to tear/need an epi again then because it's through scar tissue it would be more difficult to repair the damage and could thus lead to future problems. Something I am loathe to risk.

I am going to go through my notes with my consultant in a few weeks time so I fully comprehend what happened before. At the moment I would still prefer a VB to ECS but think I'm going to wait until nearer the time to make a decision either way.

scienceteachermum Tue 18-Aug-09 20:14:37

Thanks for all the advice / stoires, i helps to know that there are others in the same boat! I am going to wait and see what the consultant says but I really don't want an ECS. My scar gives me no trouble and I am hoping the tissue is not fragile. I think I tore because DS1 took an hour to push out because he had his hand up by his face, he was actually only little 6lbs 3oz (37 weeks) so don't think it was his size, I think it was his hand. Don't know if they can check this beforehand with a late scan this time??

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