2nd pregnancy following a 3rd degree tear with 1st...

[pucca]

Was just wondering if anyone on here had a 3rd degree tear, and what happened with subsequent pregnancies?

Did you get a chance to talk about it with a consultant? and what was advised?

I am pg with no 2, and i am starting to fret a little about giving birth again, i am not concerned about the pain of tearing again (wasn't really that painful!) it is just i did have a few "bathroom" problems for a few weeks afterwards(i am ok now though), and i am scared of being left with a permanent problem if i tore as bad or worse with this one iykwim.

Hope it goes well x x x

Thanks hunker!
Mumsnet: the only place where you feel somehow comfortable posting a blow by blow account of a rectal exam.....

ROFL Spub - perhaps MN Towers could consider that for their strapline?!

Hope it went well.

Hunker

Yup. I feel a career in advertising beckoning!
Maybe we should start a thread on alternative straplines for Mumsnet. I imagine we'd get a few doozies!!

It all went ok yesterday. Had a very thorough exam with the surgeon. The most cringeworthy bit was when he had his hand inside my sphincter and asked me to squeeze!!!
Apparently my muscle tone isn't too bad but he was surprised that my 3rd degree had come about independently of any intervention such as ventouse, forceps or an episiotomy.
He thinks that I was lucky and "got away with it" without too much trauma last time but given that it did happen and that I also retained the placenta he's recommending an elective section.
I'm okay with that on the basis that the outcomes are more predictable though I'm fully aware that a section is no easy option either.
Basically:
Have section - deliver baby and placenta with no risk of incontinence though 6 week recuperation and all that entails including wound management, no driving etc.
Have vaginal delivery - things may be fine
Have vaginal delivery - various scenarios possible including okay delivery but surgery to remove placenta or not an okay delivery which might necessitate surgery to remove placenta, repair to another bad tear and/or future surgery on the sphincter. None of those options are great with a toddler and newborn on the go!

If there's any more news I'll post!
Best to all!

Hi spub, I have the same dilema as you. Had a bad 3rd degree tear last time and am due in less than two months. The hospital suggests c/s but they never offered any examinations to work out how bad the tear was. Did you have to ask to be seen by a surgeon? Is there any other test/scan that can be requested? I have almost decided to go for the elective c/s cause I don't want to be incontinent but I realise that I still haven't got all the facts.

Also, like you, I still don't know why the tear happened as there was no intervention involved. It was a very quick labour, but apart from that no other complications and baby wasnt very big either.

Hi spub and isidora. Can I just say I'm a bit that you both tore w/o intervention. Mine was a failed ventouse, forceps delivery, so at least there was a direct reason for it. What happened to you? Do you know why it happened?

Spub - glad you survived the examinations. I've been thinking of you.

Isidora - I didn't have to ask to be evaluated - but I did have to beg for physio. The reason I didn't have to ask was because I developed frank incontinence a few days after the birth. Mind you, I was discharged with painkillers and antibiotics etc, so if I hadn't gone on to develop incontinence and be readmitted to hospital, maybe I would never have had the follow-up ultrasound?

I think you should ask lots of questions and push to get seen if you think you don't have enough information at the moment to make a fully-informed choice about c/s.

I would go for c/s next time, but this is after being told I have a 40% chance of permanent faecal incontinence if I have another vaginal delivery - WAY too high odds IMO.

Good luck - to both of you.

Hi Verso and thanks for thinking about me!
Isidora, I was referred to a general surgeon by my consultant. It maybe helped that he was the same consultant that I had last time and was the poor sod that got woken up at 2am to come in and fix up the tear for me.
The only anal examination I had post birth was from the midwives on the ward and then with the Health Visitor at home and that was really only to make sure that the tear was healing without infection.
I saw my consultant 12 weeks post natally and he didn't examine me. I explained that I had had ver bad incontinence for the first 6-8 weeks but that it was slowly improving and that seemed satisfactory.
When I saw him again a few weeks back for this pg I explained that whilst I had never been incontinent I also didn't have great control of my bowel and felt I'd been lucky to always be close enough to a loo when I had the sensation of needing to poo! That sensation is often when things are pretty close to call; I don't seem to have the advance warning and ability to hold it that I used to. I think these symtoms propmted him to seek a second opinion.
Whilst I didn't have more than a physical exam this time I have heard of ultrasound being used to assess the area.
The surgeon I was referred to suggested that I may just have a natural dispensation to this type of tear given the lack of intervention. Isidora, it is worrying; I just decided to cut my losses and go for a more predictable outcome.
My dd was quite big (nearly 9llbs) and was also a quick delivery plus she had her hand up at her face just to add insult to injury!
When are you due?
Hope we all get through this as intactly as poss!!

I'm very late to this, but thought I'd dive in.

I had a 4th degree tear after my son was born by forceps last September, which was repaired immediately in theatre and a colostomy performed. I was told it was for 6 weeks to let everything heal, although I still have it 9 months later. i had all the delightful bum tests including the comedy balloon. Alas the repair was not successful as I have wrecked sphinter muscles. That said, it 'seems' as though I might be continent as I have also had the 'porridge test' where they put porridge up your bum and make you walk round the hospital to see if you can hold it in. Lovely.

So the reversal of the colostomy is booked for September.

Exept....I just found out I'm pregnant again! My colorectal surgeon told me the day after my baby was born that any future deliveries would have to be by section, and early, because even a few hours of labour could do irreversible damage to my pelvic floor, or what is left of it.

So, as long as this pregnancy progresses, i will be having a section next Jan. And then have the colostomy reversed later in the year, once I've finished breastfeeding. And if I'm not continent, I will be having a pacemaker fitted - a new technique which works the sphincter muscles. It's major surgery.

x

What we do for our babies!

Spudballoo, I'm sorry that you had such a horrific time.
I had my elective c/s a week ago and it was fine. I'm very relieved not to have exacerbated any problems with my bowel and not to have taken a chance with another tear.
Very best of luck with your pg and next delivery and also to Isadora.
Best wishes

I have posted on the birth announcements thread...

Spudballo poor you. I had a third degree tear with my 1st baby and and I am expecting again and trying to work out what to do. The hospital is fine about me choosing natural or elective. I have no idea what to do but I am sure if I have another largish baby that is posterior I will tear again. I have been fortunate to have regained control after v. undignified physio (Wind is an issue that seems worse now I am pregnant again.) Think the c section may be the safest way.

Hello

I didn't have a third degree tear but had some bad pelvic floor probs after my first. I posted about it recently, and a couple of people responded who did have third degree tears. Might be helpful to you to read the thread.

www.mumsnet.com/Talk/1365/377750

Good luck with it all. I'm just embarking on ttc number 2 now and feeling really panicky about the birth already (not even preg yet ).

Hi

Has anybody got problems with 'wind' after 3rd degree tear. I am months down the line and still having problems with wind - I have control but I have loads of wind every day. Have changed my diet numerous times so I know this isn't the issue.

Hi
I had a 3rd degree tear with my first baby after the doc had to use the air suction method to remove the baby.
Had to be stiched up by a surgeon. I then fell pregenant 4mths later with no 2 and had her naturally as well and tore with a 2nd degree. I have had two anorectal ultrasounds done to check the spincter muscle and have been been lucky enough to be seen by a specialst in our hospital who deals with tears. They measure how the rectal passage is doing. My measurment after the first baby were well withing the normal range. Now three year on I am pregenenat with baby 3 and was scanned last year for some reasercher and they have found that certain functions in the rectal passage have decreased considerabely. I have opted to have this baby by csection as there is too much risk I can tear again. Which will make me incontinent permanently. If you feel you body can take another natural delivery I would consider it. Depends on how the neather region is with water works and the other department. I wish I had had a csection with baby two. All things considering.Good luck and hope all works out

Happy, I suffer incontinence of faeces & flatus following a 3rd degree tear in Jan. Mine was misclassified as a 3a when in fact the tear extended to my internal sphincter too. I am an extreme case though ans

Have you been to follow up perineal clinic? Womens health pysio? Scans can check how your tear has healed.

There is a support thread for women suffering problems following birth injuries here

Feel free to join us. There is lots of support, advice & positive outcomes