3rd degree tear - what did you do for next birth?

[notoasthere]

I had a very long second stage with ds - 4 hours pushing before eventual forceps, epis and 3b tear. Don't feel I have healed v well, pain during sex and some faecal urgency too

Pregnant again and debating an elective section

I'd love to hear your thoughts and experiences

Congrats on your pregnancy. Similar tale here, 3b tear with DC1 after episiotomy and forceps. I luckily healed pretty well (some faecal urgency but that's about it) but it took about 5 months and a lot of Pilates to get my pelvic floor back to nearly normal.

Even before DC2 was conceived I was adamant that I'd be having an ELCS. However, after having a scan of my scar tissue which confirmed Id healed well. I spent the last trimester of my pregnancy umming and ahhing about whether or not to have a vaginal delivery. My consultant and the colorectal team who scanned me were happy for me to deliver vaginally, on the basis that the risk of tearing again was low.

For me, the advantage of trying for vaginal delivery was that if it went well (and I was regularly told that 2nd births are generally easier) I would potentially be able to leave hospital more quickly and have a shorter recovery than with an ELCS. I think there was also a completely irrational desire to have another crack at a "good" birth?

In the end though, my desire for control over the process won out. My first labour felt fairly chaotic to me and I didn't feel that psychologically I could face that again. I knew that I wouldn't be able to concentrate on breathing, positioning etc if things started to get difficult. I chose an ELCS but agreed with my consultant that if I went into labour before my EDD I'd go with the flow and try vaginal delivery, on the basis that if I went into spontaneous labour I would have already lost that element of control. I had an ELCS at 40+4, though had I not been willing to try vaginal delivery at all I think they would have delivered at 39 weeks. The ELCS procedure was the complete opposite of my first delivery: calm, controlled, and I was able to spend time with my baby straight away (was taken into 1.5hrs of surgery almost immediately after DC1). My recovery was straightforward (up within 24hrs, off painkillers completely within 10 days) though I did need a fair amount of support at home in the first few weeks, mainly for lifting my toddler! There are loads of threads on here about recovering from ELCS which I found really helpful when deciding.

I was lucky in that I felt very supported in my decision making process by my consultant. Previous 3rd degree tear is one of the medical criteria for ELCS in my NHS trust (and the NICE guidelines I think), and while they were happy for me to deliver vaginally I never felt under pressure to do so. I was also lucky to have access to an excellent integrated gynae/colorectal team for scanning and assessing how well I had healed, as I felt I had the information to make an informed decision. Might be worth asking for similar if it is not routinely offered by your trust? Before the scanning etc, I was advised that if they found significant issues remaining from my first labour which required surgical correction, they would advise delivering vaginally then fix it all in one go afterwards, rather than having to have a surgical delivery then more surgery later, with two recoveries. If you feel that you've not healed well this might be something to think about.

Hope this makes sense, aforementioned DC2 is currently snoozing on my chest!

Thanks for taking the time to reply so comprehensively

DS was meant to be born at home, so the eventual birth was as far removed from what I wanted as it could be just about. I'd love another home birth, but the possibility of 'failing' or tearing at home and then having to transfer in again for surgery, is a worse prospect than going straight for the section. I hated being seperated from ds for what was nearly 2 hours, poor love was starving as well - and as you say, there would be no separation. I didn't get any time with my dh either as he had to go home not that long after I got back from theatre. At least with a section we can all be together for a good proportion of the day before he gets kicked out.

I was planning a postnatal doula anyway but it will be an essential rather than a luxury if I choose the elcs

Hi, I had a third degree tear after forceps too. When I fell pregnant again I was quite keen to try a natural birth again. My consultant was however very concerned about the risk of further tearing. I healed well first time but might not recover so well if it happened again. I took the advice and had an elective section. It was a very calm and positive experience and baby was on me as soon as she was delivered and BFing very soon after. I felt well again within a few days unlike the tear that took me months to recover from.
I would suggest you talk your options through with your health team. You may well be under a consultant this time because of your previous tear.

I had a second degree tear although we have no.plans for baby no2 my midwife says I should be okay to go through normally, is your gp able to offer anything more conclusive or even a gynae referral? Good luck x

Thanks lindy

They don't offer endoanal scanning up here, although in some nhs trusts it's offered as part of follow up care. It's so hard to know what to do - even with a successful vb and no tearing, there is still a 25% chance of permanent damage leading to incontinence. There is the argument that the chance of a bad tear again is small, while if you choose a section you are guaranteed a scar and painful recovery, but looking ahead to the future, the full extent of the damage can't be seen till you are menopausal anyway.

I had the third degree tear with DC1 due to ages spent pushing the poor bugger out. Like you it was a home birth so then had to go into hospital for surgery and was very upset.

However I healed well with no problems and consultant was happy for me to have another vaginal birth.Had DC2 at home with very supportive midwife who helped me to "breathe" out my son rather than push and he arrived causing no damage.

I then went onto have DC3 also at home in a speedy 45 minute delivery with no midwife present (too quick!) and due to the speed I did have a 2 nd degree tear so hospital again for stitches. However recovery fine and no fanjo issues since.

Hope this helps, I think having a good midwife and a plan for slowing down the delivery stage is key. Good luck!

Lovely to hear you had rwo lovely home births after tour

*two

Hi OP your birth sounds exactly like my first - 3 hours pushing at home, ambulance transfer, another hour pushing in hospital, delivered Ds, taken straight to theatre and missed first two hours of his life (which I've never come to terms with). Many months of problems after, just as you described.

I planned once again a home birth for Dc2 but were in a really awkward breech position all the way through so I ended up with an elcs. Was very calm and recovery was so much easier than I had with the vb. since had an emcs but that's a different story

You have to speak to your midwife, consultant, do some research and weigh up what is most important to you. It's not always a given that you will tear so badly again, but you have good grounds to ask for a section.

Congratulations!

I had a 3rd degree tear with a difficult recovery, and even after physio etc was left suffering from faecal urgency. I opted for a CS for my second, and it was the best decision I have ever made.

The birth was calm, peaceful, we had skin to skin immediately and she latched on pretty much immediately too. She lay in my arms the whole time while I was being sewn up, it was wonderful.

Yes, I hurt a lot for the first 48 hrs (but then I am allergic to opiates so pain relief options were pretty limited once the epidural was out) but overall the recovery was a walk in the park compared to the tear, and much shorter. Also i found it much easier psychologically to deal with the recovery from a visible wound in my abdomen than the tear.

I really do feel that my CS has healed me mentally and emotionally from the damage associated with the first birth.

I spent quite some time worrying that I should be attempting a second VB, but for me the 1 in 4 odds of being left with worse incontinence was too much of a risk. Birth is just one day, incontinence would be for ever!

There is a midwife in theatre during a CS, and she made it clear to me that she was my advocate in the room in terms of things like skin to skin, delayed cord clamping, early breastfeeding, etc. Having a CS doesn't rule these things out!

My experience was just like Kernow.
I had a 3rd degree tear after shoulder dystocia with ds1 and still suffered from faecal urgency after healing. I was very distressed after the experience and felt I had failed. I wanted to have a natural birth the second time around to "heal" my feelings over the first birth.

However, I decided to go ahead with an elective section and am so happy I did. I had a very supportive consultant who implied he thought it was the right decision. The birth was lovely and I felt I came out of the operating theatre the same person as I was when I went in, which I could not say the first time around. I didn't feel like I had failed as I had prepared and chosen the birth this time around. We had no issues with latching on, bonding etc. In fact I would say it was much easier second time around without the trauma.

Recovery was different but no worse than recovering from a tear. I look back happily on my daughter's birth but still a bit sadly on my sons. Although I no longer have the ever present guilt and upset over my sons birth since having my daughter (maybe because I know (hope?) I won't have to make the decision again).

Good luck this time around whatever you decide x

I felt wholly violated after my tear, like they had butchered me - so it's reassuring to hear your elcs was a healing experience. I think I'm pretty set on my section now - every time I hear of a lovely home birth after third degree tear, I wobble, but ultimately, with still having some issues I know in my heart of hearts, an elcs is the sensible option for my family as a whole

notoasthere, I don't envy you. Reading your posts I remember the awful confusion and anxiety I had as I neared term in my second pregnancy, and the terrible burden of choice.

I had a 3rd degree tear with my first baby (home birth, transfer to hospital for repair, waited hours bleeding and shivering and left alone, it was about 7 hours before I was seen to and by that time I was so cold and hungry and you can tell in photos how much blood I had lost, I was blue, and then grey for weeks afterwards)

I was told I could have a vaginal delivery for my second, and had the bum-scan which showed good healing. I was supposedly under a consultant because of the tear the first time, but he didn't show up to my ante natal appointments and I never got a chance to ask the questions I wanted to ask to make any decisions.

In the end, as a very emotionally driven choice with no one to discuss it all with, I went to the MLU and had a water birth and got off almost completely unscathed. I was walking (to the loo) minutes later and felt myself throughout and immediately afterwards. the relief at not tearing was incredible. I was lucky but I was so very very anxious. If I had to choose again I don't know what I would do.

My first baby was 9lb and they scanned my second baby at 39 weeks and she was only 8lb. can you find out if you have a big baby or not?

The midwife the second time knew exactly what to do and exactly what I was scared of. She coached me not to push and the baby was born very gently. the first time I pushed hard and panicked and I think I caused the damage. can you meet your mw and find out what they can do to support you if you have a vaginal birth?

My thoughts are with you! I went nearly mad with worry over this

congrats with the pregnancy

Just wanted to briefly echo other posters... I had a 4th degree tear with dds birth - and the repair and recovery was very traumatising.

I was admanant that I wanted an ELCS for Ds' and I did. As others have said it was an excellent decision. Very calm and positive. Better bonding as I felt great after and managed to breastfeed.

Wishing you all the best.

Thank you all for sharing your experiences, it's been a great help!

3rd degree tear with DD in hospital after 3hrs of pushing. I did get to feed her first before being taken to surgery and actually all in all had a good birth experience.

DS was born at home (planned) after a very quick labour. I had a 2nd degree tear that time, but midwives stitched at home.

Was religious with my pelvic floor exercise both times and have healed with no lasting issues.

Hi Not

I had a few problems with my first delivery. Nobody let anyone know about my epilepsy so I was poorly monitored during pregnancy, baby was quite big, developed pre eclampsia in the late stages then was rushed in with a drip despite already being in labour. Was cut and had a vacuum delivery then straight after had a PPH and lost close to 2 litres of blood. All though no (severe) fanjo problems apart from being sore, the recovery was awful. I was severly aneamic and the iron tablets took a while to work, I was literally out of breath getting out of bed to go to the kitchen and I lived in a small flat! I have a scar down there which can make certain positions uncomfortable during sex as I feel it "stretching" That was five years ago.

So no 3rd degree tear though always being high risk and the recovery was really long, drawn out, the birth was distressing i have chosen an elective this time at 39 weeks (currently 33) so if you ever need to PM me to chat I am here. currently schedule infor the 29th of august so can let you know how it all goes! :)

I had a third degree tear after DS (forceps delivery). I tried for vaginal delivery with dd1 but she got stuck. Failed vac, failed forceps and ended up with emcs. I opted for elcs with dd2 three weeks ago. I'm glad I did. All babies were back to back so I'm certain I would have needed some intervention had I not opted for it. Good luck with your decision.

Hi, reading this thread with interest; I have 3rd degree tear from birth of first baby a few weeks ago (back to back, vacuum, forceps, episiotomy, tearing, and poor recovery so far...)
It's really comforting to read others similar stories; and even tho my baby is so young I can't help but wonder if I could attempt VB again. Currently feel like I couldn't & gutted I would never experience a good natural birth.

Can I just ask if anyone sought counselling after their tear / traumatic birth, and if so where?

notoasthere - wishing you a happy birth this time whatever your decision.

I'm reading with interest too, I had a 3rd degree tear with DS and am also debating an ELCS for DC2.

I didn't have any intervention, but was fully dilated for at least 3 hours with no urge to push. Was eventually induced, and DS was born at mach3 in 3 pushes, leaving a trail of destruction as he came!

Despite being adamant that i didn't want an epidural for the birth (needles terrify me), I ended up with a spinal and surgery for 90 mins and lost a litre or so of blood. I don't actually feel any negativity about the birth, DS was safe and well, I BF'd for 6 months. We were in hospital for a week after, DS contracted an infection and was on antibiotics.

My issues and the reason i'm debating a ELCS is because the recovery was horrible. DS was born in May, I was eventually signed off from the hospital the following January. Spent months on laxatives and have had many poos where I would genuinely rather have given birth instead! My physio was lovely, some consultants spectacularly less so (I should have complained about one consultant, and didn't).

I have a MW appointment on Tuesday, so will start the discussion then. I foresee problems in that where I live now is not where I will be giving birth. I need to do some reading about recovering from CS, I swing between thinking about what would be best for me, and worrying about coping with 2 year old and a newborn.

When I think back, I guess i'm very lucky that I didn't suffer any lasting bad thoughts about the birth - ideally wanted a water birth, but I had no expectations , but also no real idea of how wrong it could go!!

Hope your medical team support your decisions