c/s after third degree tear?!?!?

[lilsmum]

i suffered a third degree tear with dd, i do want another baby but i am little concerned as to what will happen with the birth... would i have to have c/s? or how would they deal with the fact i had 3rd degree tear 1st time round? is it likely to happen again ? or what would they do to prevent it?

I had a 3rd degree tear with DS1. This was followed up by a delightful ultrasound scan 8 weeks ish after the birth and I was told then that there was no reason I could not have a "natural" birth with any subsequent children. DS2 duly arrived and the tear did begin to go again (in the middle, oddly enough, like a button hole!) so I opted for an episiotmy to help protect it (as per my birth plan). It didn't tear any more and all healed fine. My midwife knew of the tear and was keeping a close eye on the site to ensure it was OK.

HTH

thanks soupdragon, did you have to ask for the scan ? as no one ever mentioned it to me.. they checked me (physio) 4 wk after birth but nothing since... xx

dd is 7 mth old now... x

I had a 3rd degree tear with number one, and went on to have 3 further births with less tearing each time. Last time I didn't need any stitches at all.

I think I was told to make the appointment although it could have been made for me - those days are rather hazy. I had to clench and unclench and they took U/Sound pictures of the repair (I didn't take any away for DS1's baby book!).

You could always make an appointment to see your GP to discuss it and ask for a scan. also search on MNet for old threads - I've certainly recounted my story many a time!

AW soups, and there was me expecting you to direct us to your baby website so we could all have a peek

You could see the line of the repair!

Why did the man (yes, it was a man) doing the scan think I wanted to see??

Sounds horrid although it can't be too bad if mums have gone on to have three more babies! Why does tearing happen and especially why does it go to 3rd degree? (Had C/S's so no idea of natural birth).

In my case, it was because 10lb DS1 shot out in one push (and pull I guess) when they went for a ventouse delivery. The registrar delivering him almost had to catch!

I think it's mainly when the perineum hasn't had time to stretch sufficiently or I guess there could be an inherent weakness in that area. Episiotomies can cause tears too. It all depends which way the tear goes.

What type of delivery did you have Lilsmum? Third degree tears are more associated with instrumental deliveries such as forceps/ ventouse and also with episiotomies. They can happen with a natural delivey too but much less often.

The position you deliver in can contribute to tears. Sitting propped up in bed is a common position but it does not allow the sacrum to move back to make room for the baby to come out so there is more pressure on the tissues down there. Holding your breath and pushing as hard as you can contributes to tears too. Much better just to go with what your body is telling you to do at the pushing stage. As the baby's head emerges it is best not to push but to pant or blow, to let the head slide out on it's own.

I have delivered women normally who have had third degree tears in the past. Sometimes they have not needed stitches at all. I watch the area very carefully and if I thought the tissue looked as though it was going to tear, I would do an episiotomy to redirect it away from the back passage ( needs careful consideration as episiotomy can lead to 3rd degree tear).

I do not think that C/S is necessary but it depends how you feel about it all. HTH.

(Pigs, just lost this post in the ether)
I had a third degree tear with my ds2 - 1yr2mth - (ds 1 a cs). I was given an appt 6mths postnatal with both gynae and 'bum' consultants who strongly advised me not to have natural birth again. While this may be because of particular problems I've had, they generally presented this advice as 'current thinking/rcog guidelines post 3rd degree tear'. Would strongly advise you to discuss with your gp and request consultants appt/scan.
Do of course entirely defer to guru Mears though...

I am aware of the current RCOG guidelines but we certainly haven't adopted them in our unit. There are some RCOG guidelines that I haven't agreed with in the past - waterbirth being one of them They had to actually withdraw it in the end because it was slated. Obstetricians do not manage perineums in the way that midwives can. They do not comprehend how to breathe a head out and prefer to be in medical control. A C/S has risks of it's own and it is weighing up the risk/benefit ratio for individuals.

you are right though jamiesam - needs proper discussion.

Wow, thanks mears!
Wonder if it's fair to say that as post 3rd degree tear, you're likely to be treated as a 'difficult' birth and therefore given more attention and maybe even more qualified midwife?

I'm reading this with interest too as I had a third degree tear with DS and am now 7 weeks pregnant. I didn't have a scan afterwards to assess the damage. To what extent is it possible to tell now (three years after the event) what the chances of further damage might be?

I had a third degree tear as dd came out face first and needed forceps but I healed fine and have seen the obstetrician who has classed me low risk and fine for vaginal delivery with no automatic episiotomy.

I am now going to ask if I can have home birth this time as I'm hoping a more relaxed setting (and a better presentation of the baby) may help protect my perineum better. The obs. said whilst there is always a chance of it tearing, it's by no means a certainty with an experienced midwife.

I had 3rd degree tear, not follow-up ultra-sound, then with next also had 3rd degree tear (slightly worse damage) altough strangely healed up quicker & better. Def. not automatic c-section. If you want another baby I would def. go for it. even if you have worries about the birth, they can be dealt with. Even if you have a bad time, they wil pass, but you can never take away how wondderful a baby is!!!!!!!!! Honestly don't mean to over-simplify your worries. I was extremely concerned before last birth. & yet it was terrrible, but strangely healed up much better & in better shape down there than before & with fab baby to boot.