Birth after third degree tear

[Ericadm]

I had a 3a degree tear with my first baby (forceps) and now deciding between elective c-section and vaginal birth for my second baby. I wonder what other mums in the same situation chose, and whether they would have changed their mind with hindsight?

I have opted for an elective CS and this has been allowed by the consultant, despite having no major problems from the tear and episiotomy form my first birth. I am due in December.

I chose this option because a) I am worried about the same thing happening again and b) because the birth was so appallingly horrific I can't even think back to it without feeling sick and depressed. I wouldn't want to put me or another baby through that again.

If it wasn't for the trauma from the first birth, I would consider a natural birth much more readily, despite the 3rd degree tear.

GeppaGip, so sorry that your first experience was so traumatic. I was very upset after mine, but I think I am over it now and inclined to vaginal but scared of the risks. Did your consultant run you through the statistics and gave you any ideas how likely it is to happen again? My appointment was very disappointing, the consultant was useless and did not really tell me anything concrete. All I know about it is what I have learnead through internet. :(

I had a third degree tear with my first baby, went on to have a much bigger baby second time with an episiotomy and again third time. Stitches each time but no problems like the first delivery.
You have to choose what is comfortable for you, my best delivery was the third, home delivery and much more relaxed all round. Good luck whatever you decide.

I didn't get any info at all from the consultant. At my 'consultant' appointment, a doctor did all of the leg work, culminating in 'So, we'll go for a v birth again then?'. I stated categorically that I wouldn't consider this as had been promised the option of a c-section following first birth and I intended to take them up on it. She then went and got the consultant, who came in and told me that she wouldn't try to talk me out of it and to relax and enjoy my pregnancy. I think they assumed (rightly in this case) that I had done plenty of research myself. They didn't even have my notes out so they had no idea what happened first time round.

I think when you have a birth like my first, the known risks and stats from c-sections pale into insignificance.

GeppaGip, it sounds like your consultant appointment was very similar to mine! Mine also said to relax and enjoy the pregnancy, it must be their special catch phrase!! Good luck with your section, I hope you have a much more relaxed experience this time! :)

I had an ELCS after a 3rd degree (and cervical) tear (and pph to boot!). I did some reading that suggested that the long term prognosis for continence issues was much worse after another VB even if i didn't tear again. Plus I was a wee bit traumatised by the whole rushing into theatre, discussion of lost swabs (how much of a car crash must it have been?!) and lack of appropriate care afterwards - general assumption I had had a normal birth so should care for my baby, despite spinal for surgery etc.

Oh, and ELCS recovery was a dream compared to tear recovery!

All the (well that's only 3) people I know who had a serious tear went on to have CS for subsequent births. From what they said, I understood that the risks of tears being worse the next time were much greater.

I'm going for ELCS this time, mainly because of the risk of continence issues (17-24% with a subsequent VB even without another tear- check out the RCOG guidelines on management of 3rd degree tears for more info.) Both have their risks/ benefits, but this was what swung it for me (haven't had the c-section yet though so don't know how it will work out!) Good luck with whatever you decide.

I read the RCOG guidelines but I had some doubts on those figures and the questions I would have liked to ask to the consultant (if she was not so useless) would have been: 1. presumably 'worsening of sympthoms' means that if you have no sympthoms because you have healed OK, then there is no risk of worsening?? 2. the studies on which the guidelines are based on are small studies which pooled togheter women with 3rd degree tear of all types (a to c) and women with 4th degree tears (I have a scientific background so I tried to find the original articles and that's my understanding). Presumably the risk are higher the worse was your tear? So for 3a are lower than the general 17-24% figure quoted on the guidelines?? I find that it is very difficult to make such a big and important decision without these answers!

I had a VB after 3rd degree tear. I had no long-term symptoms after the tear. I don't think ELCS was even an option second time round. My major decision was whether to have episiotomy or not. Consultant suggested it would be better. My reading suggested that episiotomies don't heal as well as natural tears. Discussed it with the midwife when I went in and decided to opt for nothing but would reconsider later if necessary. Dd was born within an hour of active labour with no serious damage - I think she left a slight tear that a junior doctor put a stitch in but was borderline whether it needed anything. We were back home within 24 hours. It was such a different experience.

I had a 3a tear, mrop, pph and rectocele. Ill be having an elcs this time no question. Not only do I not want all the great repair work undone, the whole experience was so traumatic for me, noone could pay me to attempt vaginal birth again.

3rd degree year first time, healed v tight, no one even mentioned c section for nest time, 18 month gap, 2nd degree tear, had to be stitched by consultant due to scar tissue, off my head on gas and air and told her not to make it too tight! Healed v well, reccomend salt baths and arnica tablets, 12 years on no problems at all, can even trampoline! V glad didn't have section as would have had buggered stomach and fanny!

ericadm- i think that those figures only apply to women who have already had symptoms (even if they were transitory after birth) and I agree- will def make a difference how bad your tear was. But having said that, the general population risk of incontinence later in life after menopause for eg is much higher for women who have had VBs even without tears. But I don't know the figures I'm afraid. I guess in my case I kind of wanted an elective c-section anyway, so those figures were a useful way of persuading the doctor, whereas if you really deep down want a VB then you might want to look at it in a different way if that makes sense. Good luck with whatever you decide.

Ooh, another thing tea made me think of - I had fantastic repair work done after my tear, and I knew that on the off chance I tore again I wasn't guaranteed the same standard (seems to be almost luck whether the repair is good when the damage is that bad!) so might have more problems even if tear wasn't as bad.