VB after third-degree tear: statistics?

[Chacha23]

Hi

I sustained a 3b tear with my first birth, and I am trying to decide wether to go for a C-section or a VB for my second one. I'm really terrified of giving birth again :(

I have read a lot of stories and anecdotal evidence on mumsnet, but I was wondering if anyone knew any actual statistics? (or where I could go to find some?)

What I'm wondering is:

• what is my chance a tearing again after a 3rd degree tear?
• if I do tear again, what are the chances that it is as bad or worse?
• what is the probability of long-term issues after a second bad tear?
• what percentage of women opt for the C-section?

Thank you!

Probably best to ask your consultant. I had a 3rd degree tear with my 2nd after a normal delivery with my 1st and was told there was a 1-2% risk of a 3rd degree tear again. Just had my 3rd and the birth went really well and I didn't have any tearing at all.

I would have considered a CS for number if I had had any fecal incontinence issues after my tear but luckily I didn't. Was there anything unusual about your birth? Did you have forceps?

thanks for replying Geneticsreindeer. I have an appointment tomorrow and I am planning to ask, but I would quite like to have an idea beforehand so I can think of further questions to ask (it usually takes me a while to process information, especially when I'm feeling emotional!)

my birth - took about 40 hours, baby was back to back, they had to use forceps to turn her over. I did have fecal incontinence issues in the days right after the birth, but I'm not sure if it was mostly due to the damage or to the sheer amount of laxatives they gave me (I'm guessing a bit of both)

I almost had problems straight after the birth too but luckily was near a toilet! Forceps probably didn't help. If I were you I would want to know what the risk of another back to back labour is. You could try for a natural delivery and ask for a CS if you end up having another back to bak labour?

Not sure if this is just circumstantial but I did loads of pelvic floor excercise this pregnancy due to pelvic instability and I think it helped me control the pushing stage much better which should decrease the risk of tearing.

Honestly I was worried too but I had a load of friends come over while I was pregnant and pray with me and once I had accepted that I couldn't really control the birth and would just have to go with the flow I felt loads better.

My last birth (only 7 weeks ago) honestly couldn't have gone more smoothly. So don't worry it can turn out fine. I would listen to the consultants advice though.

Hi Chacha - I had 3rd degree with my DD. Thinking ahead of future DCs - would be interested to know what your consultant said today?

Hi Bridezilla, they said absolutely nothing - my post should have made it clear, I'm not pregnant! Just thinking about getting pregnant again, and I was having a follow-up appointment for my tear today. I thought we would discuss what it meant for future births etc, but not at all, the appointment was over really quickly and the consultant left before I really had the opportunity to ask anything.

Now terrified they won't take my fears seriously when/if I'm pregnant again, can already imagine a second forceps birth... shudder

that is rubbish They should have explained things a bit better than that. Could you ask your midwife? or make another appointment with the consultant?

3rd degree with DD1 after forceps etc. DD2 was 2 lb heavier and natural and quick. They were aware if my concerns and i had an amazing midwife. No tears or stitches.
ds was back I back and was awful (3rd baby) I refused to let them anywhere near me with forceps and ended up having emergency section as he was completely stuck with brow presentation. They said it would have damaged me using forceps! Section was worst recovery really as I recovered quickly after the tear. They should monitor you during pregancy keeping an eye on baby's position and if baby is back to back then you can request that this time you have a section.

I had 3rd degree tear with DD (30 hour labour, back to back presentation, 2.5hr pushing) Fortunately repaired and healed well. Just had DS (7hr labour, normal presentation, 20min pushing) and had 3rd degree tear again, tearing along the scar from before. Again have repaired and healed well so feel very fortunate in that regard but wanted to share my story as it can happen again.

I was under consultant care due to previous tear and they talked through the options at first appt. They said it would be very unlucky to tear again but they could not rule it out and the only way to be sure is to go for a CS. As I didn't have significant symptoms from the first tear I went for VB again and was unlucky I guess.

The link below is to a study looking at perineal trauma and subsequent events with the take home conclusions below. It seems you are no more likely to have a severe tear with a second baby as a first and no more women opt for a CS than with first so I think that is reassuring. I think it is a decision you need to consider early and discuss with your midwife and consultant.

tear here

CONCLUSION: Primiparous women who experience severe perineal trauma are less likely to have a subsequent baby, more likely to have a related surgical procedure in the 12 months following the birth and no more likely to have an operative birth or another severe perineal tear in a subsequent birth. Women giving birth in a private hospital are more likely to have an associated surgical procedure in the 12 months following birth.

thank you for your input, everyone

November Ali this is exactly the sort of study I was looking for, so thank you so much. Of course your story is not what a woman in my situation wants to hear (and very sorry it happened to you twice), but I'd rather be prepared and know the risks.

I have done quite a bit of research on this as I had a 3a tear with my first and I am 36 weeks now so I share all your concerns! Risk of another 3/4 degree tear varies between studies but I would say that in average is about 5%, so 1 in 20. It is higher if baby is big, mother is older or in case of instrumental delivery. Back to back baby increased risk too. Personally i am going to try a vaginal birth but i put on my birth plan 'absolutely no forceps' and i am going to try and stay upright and mobile to help baby come out. however, i have requested a ELCS if I go very overdue as big baby definitely increases the risk a lot. Hope this helps.