Really worries me just how many women end up with 3/4th degree tears...

[puccaupunderthemistletoe]

I had a 3rd degree tear almost 3 years ago, and actually thought it was quite a rare thing tbh, but have noticed lately (and in talking to different women) just how many women have gone through this.

My delivery was fairly normal until the end when i wasn't told to pant when the head was crowning hence dd shot out like a cork and i got badly damaged.

Why is this happening so frequently? why are women not prompted to do pelvic floor exercises MORE (if that does help who knows) and most importantly...why are women not forewarned about this? i have never read a single thing on this subject in any book or magazine i have bought, i did ask a MW once why it is a taboo subject and was told...."if women knew before hand they could end up incontintent none of them would have natural deliveries)

This subject makes me very as i found it quite horrific tbh.

lanismum, I asked for elective section after horrendous episiotomy which left me in pain for 3 years. Believe me, a section was like a walk in the park after that.

It was no more painful than episiotomy ( in fact less painful I think) and recovery was much much faster. In fact it was the best moment of my life
I'd rather have my stomach cut and stitched than "other" places!

fizzbuzz, thats what i thought, hopefully they will agree with me, would be nice to go to the loo without being terrified

hey, choosyfloozy, that is a valid point. We in our developed corner of the world have it so good that we can be discussing choice, risk and expectations rather than whether we/our baby will survive the birth.

I agree that a lot of patients cannot cope with too much info. When I rock up to appointments with my mn list of questions, the health professionals tend to be a little taken aback.

But it is all very well not to know the gory details. It is only when it happens to you that you ask "now why didn't someone tell me!!!". Who is to know whether you luck out or not?

On a positive note, my hospital and delivering midwife was really good re tearing. I had a 3rd degree tear with DS1 nearly resulted in surgery, becuase he had both his hands over his ears!
I had an induction and an epidural, tons of gas and air and a quite traumatic birth.

When i fell PG with DS2 i decided things would be different.

So when i was in a very relaxed natural laboutr with DS2 i said to the midwife about tearing and she was great and erm held me open whilst i was pushing and helped DS2 out as he to had his hands were both by one ear, i got a tiny, tiny tear that needed 1 stitch, i felt great afterwards and wasn't even sore.

I swore I wasn't going to read this thread but hey ho- couldn't resisit.

I tore very badly with DS1 resulting in 20 internal stiches, sex has been agony ever since, DS2 was a very quick easy birth and the MW actually explained what was happening i.e don't push now or you will tear, result no stitches.

But number 3 is due in 16 days and I am staring to worry again

Yes, remember clearly that terror of going to loo after 1st birth. It was really really traumatic

No fear at all after c section. I asked for a section as first birth and delivery was not nice, very scary and unpleasant. Consultant agreed straight away. It was a big teaching hospital and they obviously saw a lot of this. However even if first consultant doesn't agree, then you can ask for another opinion.

It really was a cinch compared to first birth

Choosyfloosy...I have to disagree with you.

I know all people are different but i am in the camp of i would rather know...

Also i feel women would definately take doing pelvic floor exercises alot more seriously if they knew of 3/4th degree tears, i didn't think they were that important when i was pg with my dd therefore didn't really do them how many other pg ladies out there don't do them?

I know that pelvic floor exercises are not going to prevent bad tearing obviously but they must help quite alot if done before hand.

I personally blame the MW's in charge of me during pushing, as i said in OP i wasn't told when to pant or to ease off so was pushing like the clappers as the head was crowning hence the bad tear, this was my first birth so no i didn't know that burning feeling means ease off.

I weighed up my options with my 2nd pg, and had already decided to go with whatever the consultant advised..which was elective section, and no i didn't have a plain sailing section, my BP dropped half way through...and i ended up with a badlt swollen leg (ended up having the daily blood thinning injections), and infections both inside and out...but was still a whole lot better than my 1st birth.

Would definately (would probably have to) have an elective c-section if having another.

dd(1) was arm by head 1st degree tear - no problems.ds(2) was also arm by head 2lb heavier but still under 9lb third degree tear.

However, would agree a good midwife can make a difference - at the head crowning stage of ds my husband was shouting at me to pant while the midwives (trainee and supervisor) were telling me to give a really hard final push.Wish I'd listened to my unmedically trained husband! - he had the pleasure of seeing the perineum literally rip right down.Also, subsequently repaired by an SHO which I now discover isn't the recommended person for a bad tear.Do not trust implicitly in the trained professional as all are not equal.Remember a bad tear could (but not always) leave you incontinent of faecaes which often gets worse with age - I had absolutely no idea about this.After all who wants to discuss it.Everything is so close down there.

I don't want to scare anyone but I wish I'd been more aware of the risks.I thought I was unlikely to tear any more than my first birth as the perineum had already been 'tried'. My advice would be to discuss tearing with the midwife in early labour and ask her to help easing the baby out if at all possible - no champagne corks.
With respect to how often it happens a published BMC research report I read said it was thought 0.5-3% of vaginal deliveries have overt anal sphincter injury but the advent of anal endosonography identifies further occult(not necessarily symptomatic) obstetric trauma to the sphincter in 35%! of primiparous women.Also despite primary repair of the sphincter up to 59% of these women suffer persistant anal incontinence and anal incontinence can present many years following and can deteriorate with time.

I was subsequently told 3rd degree tears were rare but in my small town (probably about max 15 deliveries a month) 3 women had had them in the same month as me.Presently 2 of us are seeing a colorectal sugeon although anal sphincter defects are hard to fix- recent research following up secondary repair in symptomatic women showed although the surgery appeared to work in the short term after 5 years the effect had worn off and no patient in the study was fully continent in long term follow up.Not a cheering thought for me.

So ... Yes I do think they are more common - perhaps less senior midwives in the NHS now doesn't help? and please discuss with your delivery midwife if you can before giving birth , don't be fobbed off by the uncommon view.Also insist a consultant stiches you up if the worst happens.

BTW my thoughts are probably influenced by presently being incontinent myself!

Am going against the swell of opinion as I would have my 3rd degree tear anyday rather than have a C-section!
I had a 'normal' delivery aside from the tear as DD was 8lb 12oz and face to pubis. Went to theatre to be stitched and thus had a spinal block, so ended up in the same recovery ward as the c-section ladies. From our conversations, they seemed to be in a lot of pain compared to me.
Plus I've healed properly and don't get any incontinence or other embarassing problems, compared to friends who had minor tears that were not stitched at all.
I agree that there should be a lot more info out there in the mainstream books and mags about the kind of tearing that can happen and any ways to avoid them. Also how to aid healing after stitches.

I agree that more info should be given in ante-natal classes about likelihood of tearing and/or incontinence.

I didn't understand what was happening when i got out of bed to go to the loo after having DD and loads of 'liquid' came out. Once I realised it was wee not locchia etc I was really embarrassed that i couldn't stop it and someone had to clean it up. When it happened the second time they arranged for a physio to visit.

I am definitely wanting an elective section this time round, as it took many months with the physio to get back to something 'normal' enough to live with.

I should also add that I didn't have a 3rd/4th degree tear but felt it would be OK to add my opinion/experiences here anyway.

recently I was talking to a consultant about the increase in 3rd and 4th degree tears over the last 5 years.

She said that she didnt think that they had actually increased but that midwives and doctors and had got better at recognising and reporting them, where I work a clinical incident form is filled in. There is follow up care and future deliveries are discussed as well.

its a hard one about providing information antenatally about this, some women are so worried about labour and delivery that its an additional think to worry about, others need to know its hard to get it just right, I agree the information is limited

Arrr I had 4th degree tear 3 weeks ago! Surgeon sais it was a bad one too.
Took one and a half hours in surgery to stitch me up. After 3/4 of an hour of stitching she said, ' ok now im just going to sewup the skin'I thought ' Crap what has she been sewing all this time then'?
Pretty scary experience. But all stiches healed now with no incontinence.
Although got to have physio for it and see obstetrician in march.

But now im a little worried after reading this thread. Some comments here seem tp imply that although you can be continent now, years down the road you will not be!
Is this true??
Should i stock in Tena lady and adult nappies now?

has anyone heard of the epi-no device? It has been used in Germany since 1997. I wondered if anyone had used one.
details here

small poor you its an awful thing to happen, it sounds like they did a really thorough job of the suturing it can take ages there are quite a few layers to stitch.

Hopefully the hospital gave you some information about the tear and the physio will be able to tell you how and when to do the pelvic floor excersises that help to prevent incontinence, it is fairly common after birth (incontinence)anyway which is why the pelvic floor excersises are important.

I wouldnt stock up on the tena lady just yet!!

Re epi-no : home birth and bad 2nd degree tear despite religious use before delivery by a friend.She thinks it didn't help despite having bought it on recommendation.

its becoming more and more common isnt it. with my first baby (9 years ago) i suffered a 3rd degree tear resulting in 38 stitches inside and out, my second i had an episiotomy and had to have 8 stitches. the first was large at 8lb 5oz, and the second was 7lb 2oz. with my 3rd i had a slight tear needing 2 stitches, my 4th and 5th had no tears at all. also the last three were all born back to back and i had really quick labours with them- 2hrs 15mins, 4hrs 37mins and 1hr 28mins respectively. the first two were both born the right way round but had much longer labours- 8hrs 50minswith first and 32 hours with second. also was induced with 2nd- 5th babies as the first was sb.

How do we know it is becoming more and more common though?
I agree with morningpaper, until some proper research and statistics are produced, it is anecdotal.

Took me

More from NHS , still giving stat as 0.5%, but I think some sources might take it up to 2%.

Several studies I found said that the vast majority of women with 3rd degree terrors are "normal" by 3 months post partum. Sorry to hear about those who aren't.

To each their own, but I think that compares favourably to C-section.

it is not easy to research the incidence or apparent increase in these type of tears because previously they were not as well documented as they are now, also tears are a bit subjective (think thats the word I mean) in that what some would call a 3rd degree someone else would call a nasty 2nd degree even thought the guidelines for dealing with 3rd and 4th degree tears (at least where I work) are very clear and very different from the way 2nd degree tears are treated