Previous 3rd degree tear - how to deliver 2nd baby?

[houseoffallenwomen]

Hello
I had a third degree tear with my first baby and now due in a few weeks for 2nd. I'm not sure if I should risk another tear or go for c-section. The hospital have asked me how I feel and I am not sure. I don't want another 3rd (or 4th) degree tear but I hear that recovery from c-section takes a while and am a bit nervous of that too. Anyone got any experience of this? Thanks

I think you're brave to even contemplate another vaginal delivery. I had a 3a tear with fortunately no continence problems but even though I have none now, my gynae told me the risks of subsequent natural births raise the risk of bowel problems dramatically and so have advised on all counts an elcs and at 38 weeks to ensure I don't go into labour naturally. Obviously it's a personal decision but I think why take the risk?

FWIW there are loads of threads here about CS recovery. Mine was great. Not as fast as a straightforward VB, but perhaps no worse than after a bad tear. Having said that, I did not have a DC1 to look after at the same time!

I have been planning to starts similar thread as we're contemplating trying for a dc3 but I had a 3b tear with ds2, and am terrified of tearing that badly or worse again. Will be watching this with interest.

yes mine was a 3b too. Was painful for quite a long time. I am starting to think why take the risk too? I can't see the reasons for going for a vaginal birth really, though of course if it goes ok it's better when having a DC1 to look after. It just feels like a bit of a gamble. What the doctor suggested was induction with 'low threshold' for a c-section. They want to think about induction if nothing happens by 39 weeks due to other issues too. I think he means if it starts to look as though the labour may be long/difficult they will do c-section. I just worry that it will be a whole different team then and they may not follow that or listen to me if I ask for it. Excuse ramble, I am a bit confused...

I think it depends on why the tear happened. FWIW I had a hb after a third degree tear with no problems. But my boss has been told it would be best to have an elcs after she had one. Also should point out that cs was never mentioned to me.

I'm having a vaginal birth after a 3rd degree tear. I don't think a CS is enough to avoid future (potential) incontinence problems because carrying a baby puts a fair bit of pressure on the pelvic floor anyway.

I tore last time because DS was a compound presentation (arm by his face) and I delivered him standing up so he came out very quickly!

To avoid one this time I'm going to try and avoid standing up, use a pool and go slowly.

My consultant said as I had no symptoms of incontinence or pelvic floor issues then the chances of future problems weren't significant (whereas if I did have issues then it would be a different story). I really don't like the idea of a CS - especially the idea of taking baby out too early and it's major surgery.

I had a vaginal birth after a 3rd degree tear and episiotomy. I was offered the option of a cs and discussed this at length with obs and mw. To be honest, it's down to what you're most comfortable with. I had healed well after my tear, had interesting scans up my bottom to check repair and felt comfortable with my decision.
My second labour was a lovely experience, ds was 2lbs 9oz heavier than dd had been, but I only had a 2nd degree tear. Talk it through with everyone involved in your care and I hope all goes well.

Iggly - this is what concerns me, the conflicting advice. Both you and I have been fortunate enough to not suffer ill effects post third degree tear, but yet I've been encouraged to have an elcs (which I'm delighted with btw). How can top consultants in the same field give such different advice?!

It does come down to individual cases I guess. Which of the 2 options do you really want and feel happiest with? My friend has had 2 planned cs, recovery was good (I believe it tends to better/easier than with emcs) bf both succesfully and was able to rest properly. With a vaginal birth it can be easier to think/feel you should be up and about, with a cs you have medical reason to rest!

first to me the differing advice means that it isn't clear cut - so you can have subsequent deliveries without issues and a CS won't mean you can 100% avoid incontinence when you get older. I don't think CS is "safer" for a mum than a VB hence some reluctance to recommend them so easily. Consultants are also influences by the cases theyve seen personally as I found when speaking to mine!

Wouldn't it be easier in a way if NICE just literally said "all women who have sustained 3/4th degree tears should have X for subsequent pregnancies", then we don't have to stress over making the decision or listen to conflicting advice! Amen!

It's such a difficult decision. I had an ELCS with DD1 (breech) and a VBAC with 3b tear with DD2. Am wishfully thinking of a DC3 at some point in the future but would be very concerned about delivery. I much preferred my VBAC to my ELCS (admittedly not during contractions ) but my recovery was much quicker even with the tear, and mentally/emotionally it was better. But I don't know if I would want to risk bowel problems, it's so scary.

if only!

first I wish they would do that to. I kind of want to be told. My tear healed well too (i think but not had any interesting bottom scans). I thought when they asked about any 'problems' they meant bladder control but the doctor explained that actually it's bowel problems that they are talking about and even if they don't happen straight away over time it can become a problem.
Iggly that's interesting - mine was due to big baby and forceps delivery. This time they think the baby is smaller so could be better. It's good to hear some positive experiences thank you. I have another week before anything else happens (i think) so will see how I feel about it.

I had a 3b tear with DD (7lb14 but compound presentation) and wanted a waterbirth with DC2 so cs wasn't even discussed.

With DC2 I was big for dates all the way through, and although I had consultant approval for a water birth, DS was 2 weeks late so I lost that option.

DS was on the large side at 9lb8, (I'm only small), with a 37cm head. He got a bit stuck and I needed an episiotomy and had a second degree tear.

I confess that the idea of a cs with a newborn and a toddler and being on my own most of the time (DH was due to be on his final PGCE placement) terrified me.

It is a hard decision to make, I know. I spent ages deliberating this but knew deep down I'd go for a vaginal birth.

I had a 3c in 2009. DD2 was born 2 weeks ago at home, in a pool. She came out with her hand by her face but I had no problems. A 1st degree tear which didn't need stitching and a graze - also unstitched.

For me it was absolutely the right decision but that doesn't mean it is for all women who've had tears.

The risk of repeat tear is 5-7% from everything I can find.

I knew DH would only get 2 weeks off this time and I didnt want a CS recovery, a toddler and a newborn.

Though recover from a tear was very hard anyway so a VB is no guarantee of an easy time.

Whatever you choose to do will be right for you. Good luck!

House - Size of baby is not always that relevant - DD came out superman stylee (arm over head and back to back) which was why I had such damage with her, where as DS, who was 8lbs 1oz, was a much more straightforward birth. If you've not had to have any rectal scans to check repair, I would assume you didn't do as much damage to your passages as I did to mine! And I have never had any problems since either of my children. But, as I said before, every case is different, so it doesn't make it any easier for you!

First - thing is, it's good to be able to have the choice. I would have hated to have been told what I had to do, whether it was CS or VB. I was able to make the right decision with all the relevant health professionals giving me advice and giving me the time to decide. I spoke with 2 obstetricians, 2 senior midwives and my GP, so I felt well-informed. Same as kellykettle, my DH only had 2 weeks efore being back at work, so I needed to be on my feet looking after a toddler and a newborn.

I had a 3a tear with dd. She was 10lb 2oz and back to back.

I was stitched up and never recieved any follow up care.

I then went on to have DS3 vaginally, had a 2nd degree tear with him.

Am currently pregnant with DC5 and tbh i have terrible continence problems. So much so that i constantly have to wear a tena pad. If i cough, sneeze, laugh or even pick DS3 up, i leak. Am awaiting an appointment with the continence nurse.

I don't know if i should go for a vbac again this time, of if a csec would help my fucked damaged pelvic floor.

Just to update. He arrived! induced and pretty fast - one hour from waters breaking. Baby much smaller this time 7lb 6 and came out fast. midwife had left the room so passing midwife came to rescue while DP tried to update her on situation (previous 3rd degree tear). I was trying to deliver on all fours but she said I had to get on my back to prevent bad tear and did a 'guarded delivery' - I still tore - at first they though ok and I wouldn't need stitches but on closer inspection was 2nd degree - but straightforward they said. Pretty painful recovery but think it could have been worse and I am kind of glad I avoided c-section - though i suppose time will tell if any long term problems.