Anyone had a homebirth following a third degree tear?

[Gem13]

By the time D? appears DS will be 19 months old.

To cut to the details rather than getting into the emotional stuff () he was a bit of a bruiser at 9'11 and 63cm which midwife said was probably wrong but he was very long!

He had his arm behind his head and I had 5 hours of second stage labour, with failed ventouse then forceps and then an hour of repairwork.

Apparently I healed very well and passed all the checks. I do have a prolapse however, as a result of all that pushing.

So... not wanting to go into hospital this time as it was so horrible last time, I was considering a HB but don't know whether this is foolish and whether I'd be better off with an elective c-section (as per the Royal College of Obstetricians and Gynaecologists recommendation for third degree tears).

I am planning to discuss it with the professionals but wondered if anyone here had been in a similar situation.

Research suggests that you are less likely to have a third degree tear if you have a home birth. Also it was probably actually caused by the forceps, rather than by the babies head. If you manage to avoid forceps next time then you are unlikely to tear so badly.

gem13 - is that true about the recommendations for 3rd degree tear? Where do I find out more? Sorry to hear you had a bad time.

I also had such a tear, but personally would feel safer in hospital, but I think this is each to their own sort of issue.

I had a fourth degree and have been told that next time - if there is a next time - I'd have to have a c section. Have to say that, having experienced first hand just how bad these things can be, I would be very wary of going against advice and contemplating a vaginal birth again, let alone a home one. I, personally, wouldn't - but that's my opinion and others will disagree.

monkey - there is a document here

It was brought to my attention by anto in a thread ages ago. What happened to her?

It's one of those things where most the midwives I have spoken to have thought it was a one-off (DS's positioning happens to 1% plus there was his size). So far this time (21 weeks) no one seems to think a HB is out of the question but I don't know whether that's because they're so pro around here. It's that whole thing of feeling out of control but whether that was because I was in hospital or because of my body is difficult to separate.

willow2 - 4th degree tear, poor you Hope you have recovered from that trauma.

I had a hb with a 3rd degree tear and a hb afterwards,with no problems.

Gem - I had a 2nd degree tear after my hospital delivery and a prolapse too after a very long 2nd stage like you. I also did not heal very well....less said about that, the better. Anyway, I was worried about tearing again with my second but was told having a waterbirth lessens the likelihood of tearing as the water softens and makes the area more stretchy. I had wanted a HB with my first (it didn't work out) so I hired a pool and had a HB with my second (born 5 weeks ago). I didn't tear at all this time, just a tiny graze. Labour is vile - I will never do it again - but the pool was definitely more comfortable than lying prone on a hospital bed and I really think it helped with the not tearing. Especially as the tears I have from the first child are in places likely to tear again. It was also lovely to be in your own space once all the awful pain was over, able to sit on your own sofa and have your first child meet your second in your own home. No heat, dirty loos and snoring - features that made my first stay on the maternity wing my last.
As to that prolapse... well, it is a little worse than before but it's early days and I'm doing my pelvic floors whenever I remember (which is not very often).
Hope that all helps your decision.

Hi Gem - thanks for the link. i rad it through & it only suggests that a c-section Might be advisable in cases where there are on-going rectal problems following the birth. Absolutely don't want to pry, but if you'e ok in that respect, then I don't think you need to worry about this recommendation & let it put you off a HB. In fatc, the way you're talking is making me really fancy one myself! I have heard many positive things about water birth greatly reducing instances of perinial dammage. I am definitely trying to have one this time - only obstacle for me is time - it takes 40 minutes to fill and I might not hold on that long - was very quick last time!

I seriously wouldn't let it put you off on that score, but you clearly have other issues to discuss, such as size & position of baby.

when's your next appt?

I had a 3rd degree tear with DS1 (10lb, OP, ventouse delivery)and a straightforward hospital birth with DS2 (opted for an episiotomy when the tear looked vulnerable but no other intervention). Where you deliver will not make any difference to whether you tear again and you can always transfer to hospital for any major repair work should this be necessary.

After DS1 I also healed well and passed all the tests and was told there was no reason I should not go on to have another vaginal birth. No one suggested I have an elective C-section because of the tear.

From the sound of it, all of your DSs weight was in his length (I do know another 63cm baby and he was nearly 12lb!) so the tear was most likely his badly positioned arm and the forceps. There's no reason to assume this will happen again, particularly in a relaxed home environment.

monkey - yes, I am fine I just don't want to make it worse! Last time i was told I was having a mid 7 pounder and nobody picked up on DS's position until he was born.

cha - I liked your line about labour being vile. Seems like a HB can't change that! Good news about the water helping though. I started off in the pool last time but I think I had unrealistic expectations about it easing the pain! Will definitely go for that again.

My main concern now like others on the HB thread, apart from my health and that of D?, is DS. We don't have family nearby and though I know friends would look after him I don't want the additional worry.

My 20 week scan is next week so I'll be able to have a chat with them then.

When is your's due monkey?

I have no business adding to this thread whatsoever other than to offer my sympathy to you torn up Mumsnetters I had my DD in the hospital 3 weeks early and had two lovely nurses "stretching me out" (that is the life isn't it?) for about 40 minutes before I delivered. I had already begged for the epidural when I was 5 centimeters, so I wasn't feeling so bad at all. I had no tearing at all, just a little cut on my right labial (sp) which the doctor sewed up with one of those cute cresent shaped needles. As I hear these stories I am wondering if I have a tremendous " " or if I was just lucky and she was tiny at 5' 2oz. Please tell me I don't have a tremendous " "???

I had a very bad tear during my first (hospital) birth. The midwife who stitched me was a trainee and she did the stitches far too tight, so that 4 months later my GP was talking about surgery to re-stitch the area. I was left with a huge knot of scar tissue.
I have been told that the community midwives who will be there for my home birth this time cannot do surturing, so if I tear more than a little bit they will have to take me to hospital anyway, which leaves me thinking what is the point of having a home birth? If I give birth during the day it's not too bad as they might be able to get a doctor to come, but at night they will have no choice but to get me to hospital to be stitched.

The knack, apparently, is to ease the baby out with a serious of pushes, rather than big hard ones. Massaging your perineum is also said to help, although I can't stand to touch mine! I'm just going to have to keep my fingers crossed I think!

Rhubarb - why can't they stitch you? I had a second degree tear after dd, and in the end they didn't stitch it, but they were prepared to, even at home. And with ds it was the hospital midwives who stitched me then, not a doctor. Or is it that they can't stitch a bigger tear?

Musica - not all midwives have the skill to stitch. It is something they should make attempts to get competent in by working regularly in the labour ward. Unfortunately they do not always get the chance when they are in the hospital setting. Often the community is too busy to allow them to get into the hospital in the first place. I know it is a problem in our area.

Rhubarb - if your community midwives cannot stitch you can bet your bottom dollar they make every effort to avoid a tear
The best way to avoid a tear is to 'breathe' the head out. That means just panting or blowing to allow the head to slide out on it's own. Also pushing is best only done as your body tells you IYKWIM.

Oh I see! Rhubarb, I'd agree with what Mears said about the midwife doing her best to stop you tearing. When I had dd, I don't know why, but after her head came out, the mw made me cough lots of times (any suggestions Mears?) - I wonder if that was to try and stop a tear.

That's a wee trick I use myself It is when the head is almost delivered but isn't moving further forward with the contraction on it's own. A cough is like a tiny push and it nudges the head out very slowly to avoid tearing.

Thanks Mears, I'll remember that one!

Rhubarb - I thought I'd post here rather than the other thread as it is more relevant here.... here is more info on tearing

Rhubarb, I've also been told that not all the midwives on call can stitch. BUT my reasoning is - if its a small tear, no evidence that stitching makes things better, and if its a bad one - well, I think its better to be in hospital with proper lighting and anaesthesia etc rather than grubbing around on the floor with dh holding a torch!! Plus I think if you are transferred in for repair, they are more likely to take it seriously.

Why have a homebirth if that is a risk? Well, firstly, I think you are less likely to tear badly in that environment. Second, there's a good chance you won't need a transfer anyway. Third, hopefully you would just need to be there while the job was done, so would still be home quicker than if you were transferred to postnatal ward after a hospital birth. Of course its not ideal, but I think you have to accept that there are a number of reasons you might need a transfer - and just hope that you don't!

I'm also a bit paranoid about tearing (though in my case I think it is rather less rational)!! Last time my repair was so loose that the community mw said it might as well not have been stitched Functionally its fine, I just worry that any extension to the tear hasn't got anywhere left to go, IYSWIM (probably too much information there!!)

Oooh, Gem, I can't believe you remembered one of my old posts! I am thrilled! Anyway, here is an update:

I had a 3rd degree tear with dd1. It was a nasty experience and a horrible tear and I was lucky to be stitched up very quickly by a registrar supervised by a consultant. I have been told that it's important for healing that you are stitched asap - Mears, is that true?

Anyway, second time round I went for an elective caesarean. It was a totally difference experience and absolutely suited me down to the ground. Very peaceful & tranquil & I had dd2 delivered onto my chest and held & fed her for the first couple of hours (with dd1 she was in a bit of a state so they took her away to be checked out elsewhere and also I was vomiting really badly so didn't get to hold her or even look at her properly for 2/3hrs - horrible). The funny thing is that once they got in there they realized that dd2 was breach...so I would have probably ended up having to have a c-section anyway.

Haven't regretted it one bit. I do still have quite a few probs with my anal sphincter after my first tear, though, and it makes me very thankful I went for a c-section second time round - wouldn't have wanted it to get any worst...

Good luck Gem!

Thanks Pupuce and Elliott!

Just a quick update on this thread for those who are interested... (I'm paranoid about not finishing threads I've started since someone complained about that ages ago )

Anyway, having gone down the homebirth route with everyone being happy about it, my midwife today said that she had been discussing with her colleagues and some of them said that with a prolapse current thinking is that an elective c-section is best. That was even before discussing my third degree tear. I feel it may be a double whammy.

Off to see the consultant next week to discuss it with him but I will post again when I know more. Half excited that I might not have to go through labour, half upset that I won't have a positive 'natural' experience. Feel weird too about planning the baby's birthday and anxious about looking after an active toddler and newborn out in the country not being able to drive, no family around, etc. But then again I don't want to put my health at risk.

Anyway, enough rambling. Will return to this next week.

Meant to say thanks anto for your positive message. It made me feel a lot better!