Giving birth after previous 3rd degree tear

[zoobaby]

Can anyone offer any advice/info about their experiences of giving birth after previously having a 3rd degree tear?

Spoken to numerous staff at my hospital and they all have varying opinions (and levels of sympathy).

One obstetrician believed vaginal birth would be easier, another said they'd intervene earlier (episiotomy, which I had first time around with the tear), a midwife was non-commital, a consultant said consider CS.

It's 2 years later and I'm very emotional when talking about the entire experience. Obviously more traumatised than I thought. I think my greatest fear is urinary and faecal incontinence if I get another tear.

Please share your thoughts.

Obviously I'm biased, because I opted for ELCS a without a second thought (and a lot of relief) but is there a reason why you're hesitant about choosing one?

Doris would you consider coming back in a couple of weeks to tell us your decision and overall experience? I agree about wanting a VB. But, more than that, I want optimum control over my toileting functions.

I have another massive impediment to accepting a CS (oh, gawd, good grief, the saga continues). I had a mole removed previously and it healed as a keloid scar - a very angry, red, raised, sore, irritable scar. That one scar on my chest was maybe 3cm in length but it caused untold grief practically every minute of every day for 9 years until I worked up the courage to get it fixed. I just keep visualising a keloid scar located right across my abdomen.

The joy!

The sheer terror!

Thanks for sharing Chalala - great, an increased chance! Very low numbers admittedly, but still not ZERO are they? Now, that's what I'd like to hear! Besides - I "won" with just the 1% chance, didn't I? If only the national lottery had such odds. Sometimes I think anyone could be a doctor. You just to have the bog-standard repsonse "well, there's no way to know the answer to that" or "it's different for everyone". Just repeat and alternate those answers for every question . On a serious note, I read somewhere over the last few days that chances are a second tear would most likely occur on the same site as the old injury. But imagine if it went the other side. Ouch!

Cross-post seaoflove. I'm thinking keloid, keloid, keloid. Plus the whole no lifting for 6 weeks, etc, etc, etc. You said you're due in May, so your ELCS was locked in very early! Have you ever quavered?

I had a friend counsel me with this advice... make a decision based on all the information you can get hold of, make the best decision that you can (least worst), then stick fast to that decision and do not second-guess it.

Sound advice I think.

Ah, you're prone to keloids? I've actually never had any surgery before, but I have to say, the prospect of scarring doesn't bother me - my abdomen is already disfigured with really severe stretch marks from my first pregnancy, I'm wondering whether the stretch marks will develop stretch marks this time around...

I did get the CS agreed early, but apparently that's the done thing around here. I don't have anything booked, just an agreement that it's allowed and I need to go back to the consultant around 32 weeks to book a date.

I remember lying in recovery not long after leaving theatre, and saying to myself that I was never giving birth vaginally again. And I have never wavered AT ALL Maybe it's because, tear aside, I actually had a textbook waterbirth (natural birth is so overrated imho!) so I don't feel I have any scores to settle? I didn't have any of the risk factors associated with 3rd degree tears - apart from it being a first baby - which kind of makes me more certain that I tore due to my anatomy not being up to the job of delivering a baby. That just makes me more determined not to try again.

One other thing, since we're talking stats and probabilities, there was this. The numbers were too high for my liking.

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.

I had a third degree tear with my first baby.
With my second my consultant felt the risk of further damage and long term problems was quite high and encouraged me to have an csection. After a lot of deliberation I agreed but I was never under any pressure to make that decision.
The csection was very calm and positive. I felt well again very soon (thank goodness as I had my 2year old to look after as well as my newborn). 4 years on I can't even see any scar although my older appendix scar is still very visible. If I was having a third I would opt for a csection again.

Seaoflove where does that info come from? That's high isn't it.

Most people have counselled me to go for vaginal delivery but they don't have a busted bum.

Zoo yes I'll keep you updated!

Haha - doris - "busted bum" - you put it so succinctly!

Seaofloves stats are RCOG. Just been downloading a few of their guidelines and patient leaflets. If anyone else interested:

RCOG Guideline 29 - Management of 3rd and 4th Degree Tears. There is another sentence that was left off which states "The risks of a subsequent vaginal delivery after third-degree tear were examined in four studies,5,49,53,54 which showed between 17% and 24% of
women developed worsening faecal symptoms after a second vaginal delivery. This seemed to occur particularly if there had been transient incontinence after the index delivery".

Patient Leaflet about 3rd and 4th tear

RCOG Guideline 26 - Operative Vaginal Delivery.

Patient Leaflet - Assisted vaginal birth

Does anyone on here have access to OpenAthens (online journals)? There's a literature search mentioned by Shrewsbury and Telford that apparently gives 2013 data.

Wishing I hadn't read this thread as I've scared myself now.
I had a 3rd degree tear 12yrs ago with first pregnancy. It didn't heal great and I needed it cutting and re stitching nearly a year later. I've never had any bowel or incontinance problems. To be honest nobody has ever discussed with me that I might.
I'm now 36+4 with dc2 and although I'm being consultant led (retained placenta 1st time around) nobody has discussed elcs because of the risk of tearing again.

BTW Seaoflove... you've given proof to something else I read somewhere... it said that women will often decide on the method of their next delivery straight after the experience of the first delivery.

Sorry to hear that donkir. Sometimes access to information can be a mental preparation curse.

[I promise that DS not being neglected by me for a second day straight, he's happily playing].

Right, I think that this RCOG Press Release just about sums it all up for me. It is repeated verbatim at the BJOG website and also found it quoted on a couple of other websites.

Just reading this thread brings it all back for me.

Zoo I totally get why you think the episiotomy caused the tear but I guess you will truly never know and here's me thinking an episiotomy would have saved me from my tear!

Who knows but please be rest assured that an elective c section was much more bearable in every single way.

Re the scarring you can hardly see it, only if you look very closely, I never think of it.

Very interesting thread. Thanks zoobaby.
If you had forceps first time, I think things become a little like the chicken and egg story. In the majority of forceps deliveries, an episiotomy is needed to winden the passage to let the forceps in. So is it the forceps, the episiotomy or both?
Colorectal surgeon confirmed faecal incontinence can happen after forceps with NO tear. He seemed to say that the forceps v prolonged second stage as cause of damage is another chicken-egg story. Damage is probably already caused by prolonged second stage but because forceps become the only option, it looks like forceps are the only cause of problems.

Thanks for link to BJOG re deliveries after severe tears.

Thanks to all who added their experiences and thoughts. You've all helped me to formulate and rationalise my own thoughts.

Best of luck to everyone currently expecting!

Such a helpful thread. I know 11 years later to the party but still so pertinent. I had a 3c tear with my first and looking for people's experiences of subsequent VBs after it!