3rd degree tear first time round should I be having a C.section for second

[sweetiepie1979]

I'm 33 weeks and was all set for a vb but met a friend today who says if I tear again I'll be double incontinent for rest of my life. Apparently she knows someone who it's happened to. The appointments I've had with OB have been quite positive about natural delivery for
Me they say I tore badly first time round because I dilated so quickly. I also had a full bladder and they didn't pick up on that and it was hard to push baby past that. Plan to bE in birthing centre this time or hospital. OB has said that if it looks like I'll tear this time then they will do a cut to the side. So what do people think? Any experiences? Stories? Thanks.

I had a third degree perineal tear and two second degree tears to the sides with my first.

Last week, I delivered DS with a small nick to the perineum that didn't need a stitch, having dilated from 1cm and delivered in under 2 minutes...

So, IME, a CS isn't necessary!

I had a bad third degree tear first time. Debated the same as you for second time. Received much better midwife care and had a second degree tear but recovery was easy least compared to first time. . I am definitely not incontinent but do have a prolapse but I am sure that's as a result of the tear. I do think a ceection is harder to recover from so I feel I made the right decision..

Sorry - typo - I'm NOT sure my prolapse is due to the tear.

Stupid fone....

Ok this is sounding good so far thanks ladies, keep the stories coming......

Hi, I had a bad 3rd degree with my first and panicked about having another baby. The mw told me that if I plan on having another then cs could be an option. When I eventually caved in and agreed to another I was referred to consultant who said elcs was not the best way forward as there is no evidence that you would tear again. I am not always too good at getting my point across when it's needed and walked away feeling confused and petrified.
Through out my pregnancy I never saw the same mw twice and felt as though I was banging my head against a brick wall trying to explain my fears, as every time I tried to talk about it I got the same response, there isnt any medmedical proof that says it will happen again. By about 35 weeks I had given up, I new deep down I would tear again and told any mw I saw. My birth plan stated that if it looked like I was going to tear I wanted an episiotomy, that decision made me feel more in control. The mw who delivered my dd was very understanding and picked up on my fear very quickly. Part way through labor they gave me a jab to numb the area just in case, 10 mins later as she was ready scissors in hand to cut, she had to drop them and catch dd. Rather amusing to watch. Almost straight after she moved the other mw out of the way and talked me through the damage. She was very good. I had a 2nd degree tear that time and was pleased I didn't need to go into surgery to be put back together. I did have a very smug I told you so face.
2yrs and a lot of wine later I discovered I was pg again. I new before anyone could say any different I would tear again. It helped me more going through the whole pregnancy with the mindset it would happen again and there is nothing I can do about it. Low and behold I was right again, I had another 2nd.
Recovery was much quicker from the next 2 tears, no surgery and home within hrs of having them. Apart from a few scars everything is ok and even kind of ttc again.
The two things I found really helpful was seeing a mw to go through my birth notes from the first experience and going through the pregnancy with the mindset it will happen but I'm in a better position to understand what I will need doing, it's scary stuff thinking about actually tearing (sat here cringing at the thought).
I appear to have rambled but I just wanted you to know it's possible to tear repeatedly but come out the other side ok.

I had a 3b tear with dd because she came out with her hand on her ear. I was told by the consultant that there wasn't much of an increased risk of a bad tear in a future birth.

2 yrs later ds was quite big and got stuck and almost needed forceps but came out himself with the aid of an episiotomy and a gr2 tear.
I am certainly not incontinent but my pelvic floor is a bit pathetic for star jumps, playing on the trampoline
or running fast down steep hills...

I had a 3b tear with my first baby and am due to have a section next week with dc2. This is at my request as I had no risk factors for a tear and just remember a horrid recovery last time, although I have healed fairly well.

I was concerned that scar tissue does not stretch like normal tissue and psychologically I could not imagine pushing effectively enough to deliver the baby due to my fear of tearing. I'm well aware of the risks and recovery associated with a section but accept these completely. I think it's a very personal decision - hats off to those who have posted and had subsequent vaginal deliveries.

I had a 3a tear and a shocking recovery. Whilst I had no continence issues I will b having an elcs. I had two consultants agree it in writing 3years ago so I am armed this time round.

I had a 3a tear with DD (another one with hand up by head) and am now 36+2 with DC2. Have discussed this at length with both docs and mws and have agreed to having a VERY close eye kept on me and an elective episiotomy if nec. Did all reading and it terms of management and subsequent recovery it seems to be the way to go.

That said, am booked for a Cs at 39 weeks as this drama llama is transverse and doesn't seem interested in moving .

Try not to make your decision based on anecdotes - good or bad. People who've had 3rd degree tears are statistically more likely to have further tears in subsequent deliveries. You sound like you're in a better situation because the risk factor of a full bladder at least shouldn't repeat. But this question is always being reduced to whether or not a further tear is more or less likely when it's not really about that at all. Even if you didn't tear again, subsequent vaginal deliveries can cause further trauma to a pelvic floor which is already weakened.

The more important question is whether or not you had problems, as in incontinence, after the first tear. That's crucial. In an ideal world everyone with 3rd degrees, but especially those with symptoms, would be offered an ultrasound so that a colorectal surgeon could assess your recovery internally and advise you based on that. It wouldn't be foolproof but it would be better than the crossing fingers and hoping for the best advice being given right now. In the real world caesareans look more expensive to the bean counters, that's where hospital policy comes from and that's what consultants have to implement.

In considering recovery too, people always seem to focus on the recovery period from the c section. Bear in mind that for the vast majority of healthy people with an ELCS that's a few weeks or months at most. Recovery from pelvic floor damage can be much longer than that and the repair surgeries are not a reliable fix. The damage might not even be symptomatic until post-menopause.

If you've had symptoms since the tear make sure that that's being taken into account and push for an assessment if you do want a VB.

Thanks Sioda sound advice. Have meeting with ob this week to further discuss.

I think that's really good advice Sioda. My argument was that, yes a section may be more expensive than a vaginal delivery, but if you ultimately require corrective surgery in the future due to another tear then that will cost more. That's not including physiotherapy services etc. For me the risk of requiring further surgery and needing a general anaesthetic was too much to consider.

Great advice Sioda. In my case, I've had no issues since the birth of my daughter. I had great physio support which helped I think. I'm very nervous about a vaginal delivery again but don't like the thought of a c section recovery either. It's so hard to decide what to do.

Sioda - your advice sounds very sensible. You sound very knowledgeable - is this your area of work or do you have a special interest

I had a third degree tear with no continence issues and a good recovery. Second time round I "only" had a second degree tear but I'm left with a (moderate IMHO) prolapse but GP not interested since relatively minor continence problems.

If I'm lucky enough to have another child I'm going to ask for a csection purely on my concern of a worsening prolapse. They say its pregnancy that causes prolapse and not vaginal delivery but I don't believe it!

I had a third degree tear with DC1, due to a fast labour. I had a first degree tear with DC2 as I had a more controlled birth.

I also went on to have DC3 and unfortunately had another 3rd degree tear as dh delivered DD, sice the mw did not get there in time.

I can assure you I am not doubly incontinent.

I had a third degree tear with DS and my recovery was not good. I had incontinence issues, flashbacks to the birth and was really nervous about how another pregnancy and delivery would affect my body.

As my recovery was not so good, and my pregnancies were close together (DS was 11months old when I fell pregnant with DD1) it was recommended by my consultant that I had an ELCS with DD1. It was also discovered I had a prolapse during that pregnancy.

I recovered really well from the CS, in fact, I was amazed at how much I could move around compared with the recovery after DS. I went on to have a second ELCS with DD2 as the incontinence issues had not resolved.

I am still suffering with double incontinence as a result of the original tear. I am 37 and I worry that I am not in control of my body and I do worry how things will be in 10, 20, 30 years time. I know that without the CS for my second and third babies, it all would have been much worse.

I think that it really depends on how you have recovered from your first delivery. These anecdotes show how different our bodies are. Good luck with whatever you decide.