3rd degree birth with DC1 - do I go for a vb or cs?

[Chilli81]

I posted this in my antenatal group but didn't get replies. Basically I'm 32 weeks and had a doctors appointment today to discuss options for labour and was told that there's no way I'll be allowed to go to the birth centre as I had a third degree tear last time. I guess I understand the reasons and its better to be safe than sorry but I did have my heart set on the birth centre. I didn't get the chance last time because it was full on the day. However I can deal with that.
What I'm most concerned about is whether to go for a vb or cs. The doctor said that if you've had a 3rd degree and have another the risk of long term incontinence is higher. The doctor also said that I can ask for a cs at any point leading up to my due date because of the tear and that some women would rather choose that option than take the risk. Did any of you have a 3rd or 4th degree tear with your first? What did you do/what are you planning on doing this time? Any experiences appreciated. I'm very confused

I had two cs and have ongoing continence issues (I think bladder damage during the op but I'm not sure) so it's important to understand that neither option will prevent issues, although of course it is more likely with a vb.

I think it boils down to how you feel about giving birth again. Do you want to have a vb or are you equally happy to have a cs?

There are risks to you from both options. I think NICE has a paper available which lays them out with percentages. What is the worst case scenario for each option? Which would you rather live with? Which is the risk which worries you the most - and which option gives the least likelihood of this occurring?

If it was me I would probably go for a cs, but I have issues with vb. You will have different views.

thanks schmee. that's really helpful advice.

Chilli I've just had a c section due to pervious fourth degree tear

I do not regret the choice at all

I am in pain but I know I will heal
And I won't have the long term problems from a fourth degree tear

Hello. I had third degree for first. Vb and second degree the second time - in pool in birthing centre. No ongoing problems. The key for us - and I wanted a vb - was to escape the consultants who were pushing for cs and find a hugely senior and experienced midwife who said a) she was happy to have us in birthing centre b) it was absolutely possible to have a good vb. Which it was. So, from our experience, recommend finding someone you trust who will take care of you either way, in our case we had to practically barge down the door of the the right person but it was possible once we had her name... Good luck. Is not an easy decision I know.

Glad the advice was helpful. Huge congratulations on your pregnancy btw!

thanks for the responses. it's a tough one but I think I'm going to try for a vb and then if it looks like it's going on for ages, ask for a cs.

best of luck chilli

thanks White x

Where I work women who have had a previous third degree tear that has healed well usually have a vaginal birth. I am a birth centre midwife and we regularly have women who have had previous third degree tears. I can't see why going to a consultant led unit would be an advantage. The risk of having another one is small, if it were to happen in a birth centre you could be transferred afterwards. This is a different matter for women who have had a fourth degree tear though, they would usually be advised to have a Caesarean.

Sorry posted before I'd finished. I've delivered quite a few women with previous third degree tears over the years. I remember doing an episiotomy once as the woman had a very short perineum but I don't routinely. I've never had anyone who has had more than one third degree tear (thankfully, although I don't think it is the midwifes fault, it would still feel horrible if it happened)

thanks maxbear I think I will ask for their reasoning at my next midwife appointment for not letting me go to the birth centre. I don't know if the fact that I had a 3c tear makes a difference.

I had a 3a tear three years ago. I'm 14 weeks with dc2 and will request an elcs. I was told at my debrief I'd be entitled to one if I wanted one. I don't want to take the risk of continence issues.

I had a 3rd degree tear with dd1 and was allowed to use the birth centre to have dd2,after discussing options thoroughly with the mw.

I had an elective cs with ds (3rd birth) and it was the most difficult of the 3 births to recover from, but it is all so individual to each birth!

Have you had any continence issues so far?

I had a VB with my DD1 and DD2 after 3rd degree tear and keibler forceps with my DS1.

Both subsequent births went very well, I had a minimal tear with DD1 as she came out so fast, and DD2 there was no tear or graze and it didnt sting when I peed a few hours later which was just the most joyous thing ever

I am 36 weeks pregnant and had 3rd degree tear two years ago with DS. I have made the decision to have a VB and have been told I will have a Senior Midwife at the delivery. I have told consultants and midwife that if I go overdue then I would like an ELCS and do not want to be induced (which from research will be more likely to lead to possible epidural/ intervention which could increase risk of another tear or an EMCS).

I am very nervous about whether I've made the right decision and it was difficult to make so in the end I've gone with my gut feeling and what feels right to me. Fingers crossed it goes well.

Good luck in making what is such a tough decision.

I had 4th degree tear with DD1 and two years later had VB and 2nd degree tear with DD2. No continence probs. I was offered cs but said I wanted vb. I had to be in a particular position so they could keep an eye on any tears but all OK. I went with my gut feeling. Good luck everyone x

tired what position did you need to be in/ just curious as when i had my dd
i was on all fours in a birth pool and i was told that was optimal position

thanks so much to everyone for sharing their experiences.
hazeyjane I didn't have any incontinence issues which is probably one of the reasons I am thinking of going for a vb again. sex hurt for a good few months afterwards but not an issue any more (sorry if tmi)
Mondayschild yours sounds like a good plan. I have also been told that I'd have a senior midwife if I go for vb. I think the fall back option of an elcs if you are overdue is a good one.

Fingers crossed all works out for you Chilli (and everyone else). Not an easy choice to make! My friend had similar situation and said the senior midwife helping her second time round was invaluable. Her youngest is now 2 and she said she's had no incontinence issues (although they could of course arise in future). It was good to hear her positive experience though.

I would not risk incontinence do you have people that can help you with the recovery from the section?

If so its a great way to have a baby, I have very fond memories of mine.

I guess one way to look at it might be, if you do end up with nasty issues, and you were offered a sort of get out card, and you are struggling, can you cope with your decision to have VB?

I know that I was very sensitive to the issues I had below after 1st labour and didn't want a repeat, it made me feel run down and hard to relax with baby as was in pain.

whiteandyellow for DD1 I was on all fours in a bed (induced at 42 wks, 5 hour labour, 10.5lbs, retained placenta, 4th degree tear) I do remember crying every time I went to the loo for a couple of months.
For DD2, I had to be lying on my side on the bed so they could watch my scar as I delivered. 9lb baby 3 hour labour and just a small tear that the midwife stitched. Both births were positive experiences, and no long term health side effects.

I had 3b tear 4 years ago with dd. it was vbac. Now nearly 37 weeks with dc3. Was told that because I had good labour apart from tear that Cs wasn't reccommended.
I have opted to try for vb but straight to Cs if overdue. No induction.
I didn't have any continence issues.
I saw consultant mw who wrote in my notes about my concerns re tearing again. So going to try to be on my side at least and push slowly with warm compress on perinium at pushing stage. Fingers crossed!