Birth after fast labour, 3rd degree tear and Fenton’s

[suzief2019]

Hi All,
I have found out I am 5 weeks pregnant with my 2nd which we are delighted about. However I do have a lot of fear over the birth and don’t know what to do. I had a very fast first labour under 4 hrs and would have been much faster if chord wasn’t round his neck. I was eventually delivered by forceps. I was 10cm dilated on first examination after only being in hospital about 20 mins. I had a 3rd degree tear from the forceps and was sutured. This didn’t heal well and left me experiencing pain during sex for a year until I had a Fenton’s procedure which improved things but I still wouldn’t say I am ‘pre child birth’ comfortable downstairs.
Considering all this I don’t know whether to push for a c section or just risk delivering in the way to hospital and tearing again.
Thanks for listening

Are you at any greater risk because of your previous experience? It’s worth asking. But there’s no right or wrong way to give birth - if you’d be more comfortable with a section, ask for one!

Is a home birth a consideration for you? I'm planning one for similar reasons.

I had a severe third degree tear with my first. I had C sections for my other two kids because I didn't want to risk damaging the area again. It can be more difficult to repair. Talk to your midwife about your options.

Congratulations on your pregnancy. I had a third degree with my first and have just had my second via elective c section. My section was an absolute breeze compared with my traumatic first birth. Not planning on having any more dc but if I did would go for another section in a heartbeat.

I found both the midwives and doctors very understanding and I didn't have to push for anything. The midwife referred me without me asking at booking in and the consultant went through the options and left the decisions up to us.

Good luck with whatever you choose.

Congratulations! I'm a midwife would say that based on your previous complicated recovery of a 3rd degree tear that required further surgery to repair, Consultants would probably recommend an elective caesarean for you anyway. They wouldn't want to risk further damage for you.

I had a bad episiotomy and forceps delivery with my first (also had other complications, haemorrhaged etc) and chose a section for my second (5 weeks ago) and it was the best decision I ever made.

Like you, I was really worried about delivery and this took all the anxiety away and it was such a calm / planned experience. Recovery was much much better than first time too (although, still recovering a little now).

Congratulations and good luck xx

If you have already had one 3rd degree tear you are at higher risk of another. Sadly the consultants don't tell you that. I was shocked when it happened to me.
Personally I would have an ELCS, I'm 15 years down the road from my tears and have some issues. And tearing again with my second was horrid.

www.rcog.org.uk/en/news/bjog-release-new-study-examines-mode-of-delivery-following-a-perineal-tear-and-recurrence-rate-in-subsequent-pregnancies/

Your birth experience sounds very similar to mine. I had corrective surgery a year after the 3rd degree tear also.
I'm now 16 weeks pregnant & like you I was also scared. I was able to have a birth reflections meeting with a senior midwife to discuss my options going forward and talk through exactly what went wrong last time. Found this so helpful. The other option to c section is elective episiotomy but she did say that this is no guarantee that I wouldn't tear further. You are more likely to tear after having a previous tear.
I personally don't want to take that risk. I was in such a bad way after my first birth and had such a long recovery and I feel it ruined those new born days.
I've just seen a consultant who supports the c section decision and I am going to a birth choices meeting to make sure I'm sure and fully understand the options. But my decision is made really.

Good luck

@QuentinWinters That article is really interesting. I knew you were more likely to tear again but didn't know the chance was that much higher.

I’m in a very similar situation, but I’ve opted to try for a ‘normal’ vaginal delivery this time (DC2). I’ve seen two consultants who have both said they would support this and haven’t pushed me to have a C-Section.

I figured it why swap the risk of a cut/tear for a guaranteed cut (major surgery!)

Consultant told me risk of a second tear was 10%. I was released for midwife led birth centre, had same tear again. It has healed very well though so right decision for me overall. I wouldn't have chosen a c section but given you didn't heal well I would say it might be a better decision for you. I think my consultant would have supported that as well.

Tbh table both have up and down sides (I had an ELCS with my third). I cannot describe the bliss of being able to go for a poo after my third without worrying. And sit down. And not have stitches etc.
However the recovery is different, I was a lot more tired and while the section scar was less sore to start it took far longer to stop hurting.

The repairs to my tears took 2 hours each time while my section took 30 mins. And I could have ds2 with me after delivery where I had to leave the previous 2 while I had surgery.

I know a c section is a big deal but I think perineal repair is too.

Both my friend and I had 3rd/ 4th degree tears and no issue in subsequent births. A third had a normal birth having had previous repair.... but data isn’t the plural of anecdotes.

It’s very very personal and you will hear stories of both, all I can say is push for what you feel you need.

My first was similar (including Fenton’s). I was under consultant care for number 2 who opened my file and went, “so how do we feel about c sections?”

Listen to all the advice, but I think you’ll probably be given option of csection. Decide then what’s right for you.

I had a third degree tear that also required surgery to repair (God, isn't it awful!) I was offered a C section but chose to have two further children naturally - both births were fine (great even). However, I didn't have fast birth and so that is an extra complication x

Hi OP

Your birth sounds pretty much identical to my first. I had an ELCS 2.5 years later for my second. I requested one at my booking appt and that was it. I doubt you’ll have to push for a c section in your circumstances!

I was referred to a ‘birth choices’ clinic just to find out my chances of tearing again (3c tear previously) and the midwife there took into account a load of factors and determined I’d be very likely to tear again. But a c section was already planned, that appointment was more just for my interest. Maybe you have a birth choices clinic in your area your MW can refer you to.

Good luck and congrats on your pregnancy!

Ps my recovery from ELCS was light years better than tear recovery! Would take the ‘major abdominal surgery’ over a year of pain and incontinence any day! Was driving within 3 weeks.

I had a third degree tear with my first and was advised to have a c section for next pregnancy

Just to add I would pic a c section in a heartbeat as it was a breeze compared to my first delivery.

At your booking in visit ask for a referral for an apt with the consultant to discuss your options, they'll be able to talk you through what happened last time and go through risks of both types of delivery so you can make an informed decision.