Birth options after third degree tear

[jamiesam]

Hi

Keep searching for discussions on this topic, but not found anything yet. Apologises if I've missed chapter and verse...

Is there anyone in the same position as me out there. I had a cs with ds1, and a vbac with ds2. Felt very smug about vbac until gradually realised consequences of associated third degree tear. Sorry for horrid details, but suffered from some faecal and urinary incontinence and faecal urgency, although would consider everthing pretty much OK now.

My consultant at 6mth and 12mth post birth follow-ups strongly advised that if I have any more babies, I have a cs, to prevent likely further damage to pelvic floor/nerves. Yet when I asked him for details of likelihood of this happening (to compare with risks associated with cs) he simply said that there are no statistics, it's just a view that Doctors have reached through experience.

Tried searching sites like nice and rcog - did find paper on latter but only says things like 'the option of a caesarean section should be discussed'.

Has anyone else been in this position? What decisions did you make and what outcome? Did you find any other advice/research to inform your decision?

Birth options may influence whether I get a chance to try for ds3/dd1 - husband not keen on another baby and will be even less keen if I'm going to be 'laid up' for 6 weeks afterwards(in my dreams!)

Jamiesam, sorry I have no experience but just wanted to say it's probably worth bumping this up to the top of the list tomorrow morning as it's quite late now and the boards will be going a bit quiet, and I know there are some people posting on here who've had third degree tears (Soupdragon for one).

And I can very much sympathise with your problems...have had a chronic anal fissure since birth of ds1 and am now considering my options for birth of ds2 in Nov. So I'll be interested in the replies too.

I had a third degree tear with my first birth, although didn't suffer any of the problems from it that you did. I had a natural birth the second time around without any trouble.

Don't know if that's any help. I'm sure there will be others with better info for you.

Were you really 'laid up' for six weeks' after your first cs? I certainly wasn't. And my friend who had two cs's went home after two days with her second and was fully recovered in all practical ways after a week. An elective section, where you don't go through labour first, is IMO much easier on your body than the worst of both worlds - a long, tricky labour then a section. It has to be absolutely and totally your decision but I had such a straightforward recovery from my section that I am quite surprised that after such an awful experience you wouldn't want a section.

I wasn't laid up for six weeks after either of my c-sections. Agree 100% that an elective section is easier without having 'done' labour first. I was out after 5 days and 4 days respectivly with mine. Was doing most things by 2 weeks after. By 6 weeks I was doing an aquafit class.....and I had never done a fitness class before.

I did indeed have a 3rd degree tear with DS1. However, in my case this healed well following what I remember as 2 hours of repair work. 10 weeks after the birth, I had an ultrasound scan (delightful!!) and the consultant there said there was no reason I should not go on to deliver subsequent children naturally.

DS2 duly arrived 2 years later (and 2lbs lighter) and without any tear although I did have an episiotomy when the tear looked vulnerable (started to button hole in the middle apparently). The midwife was watching the tear closely and spotted the weakness before it went again. Everything still fine down there, luckily.

With regard to elective, non-labour c-sections being easier, this is not the case for everyone as 2 close friends had dream 1st emergency sections and nightmare elective 2nds. Like any other birth, there are no guarantees.

Did you have an ultrasound scan at the checkups you mentioned? I think that had my consultant told me I risked further damage by giving birth naturally, I may not have had DS2.

Is it possible to speak to your GP, say you are considering a 3rd child and arrange a scan to see how strong the repair is now? It may be that it is now stronger than it was at your last check up.

I had a third degree tear after an episiotomy with dd although like Soupdragon mine healed well and although I ocasionally have to watch myself sneezing etc and can't use a trampoline (which doesn't impact my life greatly) I had no fecal incontinence.
I have just delivered ds naturally and although he had to be delivered by ventouse and I therefore had a small episiotomy this also seems to be healing well and did not impact the first tear.
The first episiotomy was a straight cut and this one at an angle which presumably kept the tow separate form each other which probably helped.

But as others have said, all the elective cesarians that were in when I ws in with ds were home after 3 days so the likelihood is that you wouldn't be laid up for that long if you did decide to go the cs route.

Good luck with whatever route you choose.

Wow
Thanks all
Gingernut -how do I bump?
Aloha - no, I generally think that I recovered very well and quickly from cs, but I just enjoyed the natural birth more...
Soupdragon - consultant has said that he will 'ask if I can have an ultrasound' - if answer no, perhaps I should get awkward. Physio recently advised me that pelvic floor is pretty good, but because I am now a bit 'numb' down there, I can't really feel it working,iykwim?

I had 3rd degree tear last time, not with the probs you mentioned and consultant said he would want to discuss any further births before they happened. I'm now 7 weeks from due date for no3 and have consultants agreement to go for natural birth.

I would have thought you could insist on a ultrasound given the problems you've had.

It does sound as if the damage you sustained was worse than me or the other posters though. I would press for a scan, see what the consultant has to say and then go by what he says given the lack of information elsewhere.

Bumping simply means posting a message to bump the thread to tot top of the active conversations list. No need to do it as people have posted anyway!

Did a search last night and found some great advice/opinions on association of radical midwifes site - in uk midwifery archive. Views of individual midwives rather than of asso. itself but promoting all fours or ?side lateral? position during the pushing stage, to reduce risks of subsequent tears after 2nd or 3rd degree tear.
Any non-radical midwives (who I might come across in the NHS) out there who could express an opinion/tell me how your prof. body responded to rcog advice?

Oddly enough, I delivered DS2 on my side. This wasn't because of the tear - had no idea it would be good for that. I think all fours/side are the better positions to give birth in anyway, with all fours being the best.

Dd2 (9lb5oz) was born so quickly I didn't have time to get onto the bed, and I delivered her standing up with my upper body leaning forward onto the bed.

Coincidentally or not, hers was the only one of my three births that didn't result in a tear.

jamiesam - as a midwife working in the NHS, my experience is that women deliver subsequent babies which ever way they choose in my hospital. They are not advised C/S per se, but if they request it they will get one. I have delivered many women vaginally after a third degree tear and have had no major problems. Third degree tears are more associated with operative deliveries and episiotomies, but they can happen on their own. I would definately support the advice not to deliver lying on a bed sitting up, but rather on all fours or on your side. This allows the sacrum to move back to give the baby more room for exit.
Remember that your choice is paramount, doctors/midwives can give advice/opinion but you make the decision. HTH.

Mears, does a waterbirth have any positive affect on tears? I thought it helped precent them ordinarily but would it help preserve an existing repair?

Helped prevent them, not precent them!

There are less episiotomies with waterbirths but there may be increased tears because of that. Episiotomies aren't done because the midwife can't get in there .
I am auditing outcomes of pool use for an international waterbirth audit that we have joined, and since February there has been one third degree tear (1ts baby) out of almost 50 pool deliveries.
The water itself supports the perineum and the position of the woman in the pool is better at allowing the perineum to stretch.
I have personally not looked after someone with a previous 3rd degree tear in the pool. My gut feeling I think is that I would prefer to keep a closer eye on what was happening at delivery and that is not easy in the pool. However, you know how much I like waterbirth. A bit of a dilemma.

Soupdragon - getting in the right position second time around sounds like this feminine intuition I keep hearing about!

Thanks Mears
Interestingly enough, I think DS2 was stuck as I was pushing for a very long time. Episiotomy to help but didn't so 'threatened' with forceps/ventouse under epidural, in theatre, so if no success could go straight on to c/s. So keen not to have c/s, I suddenly remembered advice about changing position if not progressing. I got off bed and onto all fours. Then got back on bed and DS2 emerged with a few strong pushes - don't recollect him coming out as other people say - head/shoulder/body - just the whole baby in one go. Perhaps if I'd not been on my back (on advice of midwife who I have to say was brilliant) then pushing stage would have been generally quicker and I wouldn't have been in such a rush at the end.
What's HTH?
Take your advice re water birth. I had been starting to dream about home water birth, thinking it's ludicrously optimistic with my history. Think what I was actually trying to do was avoid consultant!
BTW do you get 'radical' midwives in the NHS or are they 'independent'?

mears, could you not use one of those funny-angled mirror things that they use for checking under cars for bombs? Or what about the mirror things that people incrowds use when watching royal weddings?

Sounds sill, but you never know

Interesting to follow.
Had 3rd degree with DD1 (one and only at moment) and was on back after exhausting labour. Had an episiotomy but tear happened anyway. Maybe should have been on fours but was tired so maybe thats why MW advised on back after I asked if I should turn over onto fours before pushing??

Healed well though I leaked when used trampoline last wk maybe have to do more PF exercises. Otherwise back to normal.

Wondering how Ill get on if ever get pregnant again.

Good luck