3rd deg tear - CS or VB with epidural for DC2?

[Bridezilla3521]

I had a 3a degree tear after having DD1 and have had issues ever since (anal fissures, physio etc) and have had hospital procedures and operations since to attempt to fix this. I still take medication to make it easier to (sometimes helps, sometimes not). I suffer with great anxiety now because of the issues I have, but I'm good at hiding it.

I am not pg, but just thinking about the future as I would like just one more DC.

Just after experiences and wondering whether a vb with an epidural would make my anxiety easier to handle if I couldn't feel the pain as much? And if the midwife may be able to control risk of tearing better?

I had a 3b tear and, by the sound of things, recovered better than you did.

I will 100% be asking for a section if I have another baby.

Some doctors and midwives will say that it's unlikely you'll tear as badly again because you've had a baby before and will be more stretchy (I'm being delicate!). Personally, I know my body and doubt that would be the case. I couldn't have sex for two years due to pain.

So, bearing in mind that your recovery has been long and difficult, and you would feel very anxious about delivering vaginally again (I know I would be terrified) you are more than entitled to a section.

Also bear in mind that another bad tear might cause you big problems with incontinence. I wouldn't want to risk that.

There are RCOG guidelines (can you tell I've been researching this?!) that say women who are still having problems post-third degree tear should be offered a section. I can post you a link if you like?

Thanks for you're reply. Yes please send the link!

I think I'm umming and arring as I found labour itself to be fine and I coped well, no pain relief etc. But then the aftermath was/is horrible. I also had a water birth last time and I'm unsure as to whether they would allow me another one as I've already been told I'll be under consultant care next time.

You can have another water birth yes. An epidural increases the risk of a third degree tear. If you have any ongoing issues though, even if you don't tear again there's still a 1 in 4 chance your symptoms will worsen.

I had a 3b tear and will be having an elcs with this baby despite being all for natural and home births

I am currently pregnant with dc2 after a 3rd degree tear last time. As a result I am consultant led this time. Despite the fact that I haven't had anywhere near the problems you have had my consultant has basically said that the choice is mine, he would support a vaginal delivery if I wanted one but if he were in my shoes, he'd be having the csection. However I will be getting a scan at 34 weeks, not of the baby but to see how healed I am, he will let me make a decision that late on I think.

Snap Bridezilla! I had a water birth, absolutely textbook, coped really well... but the aftermath of the tear, having to go into theatre, and the following days in hospital were so traumatic I think I developed PTSD.

I'm not sure if you would be allowed a water birth again. They would want the delivery of the head to be slow and controlled, and I don't think that's easily achieved in water. I'll just go and find that link now...

www.rcog.org.uk/files/rcog-corp/GTG2911022011.pdf

Have a look at point 12: Future Deliveries

All women who sustained an obstetric anal sphincter injury in a previous pregnancy should be counselled about the risk of developing anal incontinence or worsening symptoms with subsequent vaginal delivery.

All women who have sustained an obstetric anal sphincter injury in a previous pregnancy and who are symptomatic or have abnormal endoanal ultrasonography and/or manometry should have the option of elective caesarean birth.

The risks of a subsequent vaginal delivery after third-degree tear were examined in four studies, which showed between 17% and 24% of women developed worsening faecal symptoms after a second vaginal delivery

Those three points seemed particularly relevant.

Also, don't underestimate your mental state. I laboured in a good, positive frame of mind last time, but I know that couldn't happen again. I would be so scared, and I'm not sure I would even be able to push effectively because I'd be so scared of tearing again.

Thanks for all your replies.

I know it will affect my pushing as (TMI WARNING!!) I can't even push when I'm on the toilet :/

I just thought an epidural might act as a distraction.

Oh, bless you! It's shit, all this stuff.

Although, tbh, if you can't strain for a bowel moment, you wouldn't be able to push as it's essentially the same manoeuvre. An epidural only impedes pushing because you're numb.

If I were you I'd plan for a section without a second thought. I decided I'd never give birth vaginally again when my DD was about five hours old. It's been three years and I haven't changed my mind.

Personally, in your position, I went for a Caesarian. It was an absolute pleasure, and recovery was really fast and straightforward compared to the first delivery. I couldn't cope with the thought of further damage.

I met a consultant before getting pg to be sure of cs. Pg turned out to be twins who were breach so definitely cs for me. It was actually a lovely experience. Mind you with dd1 my mw was useless so so a lot of my issues were psychological.

Motherofdragons how did you go about arranging to meet consultant? Did you get referred from GP or Mw? Did they give you written guarentee that you could have CS?

Hey OP I had a 3a (and some other mish mash of tears) with DC1. Recovery was straightforward and quick and no ongoing issues. I had my DC2 six weeks ago. Hard to describe but my body pushed her out I didn't consciously contribute (not a hypnobirthing thing this is just what happened!). She came out quite fast but I would think pretty optimally as it wasn't "forced" in any way (there was a lot of directed pushing in my first birth, an induction, and I couldn't feel a thing due to epidural so felt pretty impotent). Not sure if I am describing well but my main point being I didn't tear along the old scar but had 2x 2nd degree tears either side. The MW said this is because the scar tissue has probably healed rigid and so had no "give" on exit.

The fact you have ongoing symptoms, that an epidural means you can't feel to push and therefore work with your body (plus it often slows labour down) - which increases the chance of instrumental delivery -, and the fact that previous scar tissue may effect your perineum stretching like it did me, means that I would go for a c-section in your position.

I know you from experience you have to be very strong and clear with medical teams. If you decide this would be the best route (as it obviously carries its own risks), it sounds like a meeting before getting pregnant would be great. Would it happen in the same hospital as first birth? Have you ever had a birth debrief with them? If not then maybe a good place to start would be to contact them and that would be a "way back" into the system. I have also found the Supervisors of Midwives incredibly helpful. You can usually get their contact details off the hospital website and contact direct. They can refer you on as appropriate.

If it is something that would end up preventing you from wanting to get pregnant again, then I would get something in writing before you start trying to conceive, for your peace of mind. And if and when you do conceive get the consultant to give you a date asap and then ignore what anyone else says (there are some great threads on here to help you do that!).

All the best OP. Hope you have a nice weekend with your gorgeous DC.