third degree scaremongering or what - help???

[alipeepee]

Hi. My story: I had my first baby in March 06. Gave birth in the midwife led unit. When waters broke there was meconian (spelling!) in them so they had to send me upstairs. However, I never got out the room as it all started happening rather quickly so midwives just monitored him after each contraction. His heart rate dropped at one point so had to push hard and fast when I have to say, I didn't feel "the urge". He came out with one arm by his head and with me practically standing. I had a third degree tear which was stitched under spinal block in theatre afterwards. I don't have particularly bad memories from it (in fact, it didn't even really hurt that much apart from the obvious), I wasn't traumatised by the tear and I've never had a moments incontinence from day one. However, I'm now preggers with no 2 and am terrified of c section and also of being left incontinent as I've ben told that there is a chance of DOUBLE incontinence if it tears again. I would like to know how many people actually do have another third degree tears second time around and of those, how many are left incontinent. Is this a midwife vs doctor thing - who do I trust????

I've no personal experience but when I had my dd I made a friend with someone who had a 3rd degree tear when she had her dd a few days before me.

Fast forward 12 months and she gave birth to ds with hardly any trouble and she positively ENJOYED his birth! So it doesn't have to be a nightmare scenario!

You could try perineal massage to improve your chances and also look in to labour and birth positions (scroll down to get to pictures and descriptions) so that you know better what you could be doing in any given situation. I recall that my hospital mws for both births were as much use as a chocolate fireguard in that respect. Nobody suggested any positions at all!

I don't know about 3rd degree - but I had 2nd degree with dd. Then had ds two years later with no tearing at all to speak of - i think I required 1 stitch!!
Had no incontinence except imm. after del. Have suffered slightly from pressure incontinence in this pg - but not a prob and mw expects it to be ok after - as long as I do my pelvic floor excerises!

I didn't risk it, i had a section 2nd time around.

I had a 3rd degree tear with DS1 but not with DS2 or DD - I did tear though and had an episiotomy with DS2 when the tear looked vulnerable.

Did you have an ultrasound scan to check the repair? I had one a couple if months after having DS1 and was pronounced fit for vaginal birth.

Thanks guys. I've heard about having an ultrasound but only on this site. Was never offered it at my six week check. I'll ask about one when I go to the hospital. Will def do the massage too. The doctor had a look at six week check and said she couldn't even see the tear it had healed so well (find that hard to believe) but 'you'll probably want a section next time'. I think she assumed the experience was awful except it wasn't and I think that's what I'm struggling with. It's almost like I don't understand the fuss but I have this nagging feeling that it would be so awful to make the wrong decision. I've only ever heard of people either opting for sections for second time so therefore guaranteeing no tear, or going through with it and not tearing so much. No one seems to be able to give actual stats of the liklihood of it happening again. I think so many factors contributed to it happening first time - meconian in water so rushed, heart rate dropping, hand above head and MASSIVE head - like off the scale! I mean seriously can they all happen again???? Why can't we all have crystal balls?

You are right about the factors which caused the tear, and it sounds like baby delivered fairly quickly, so there is no reason to think you wont be able to have a straightforward birth this time. You shouldnt need a c/section, as the midwives will be prepared for the likelihood of another tear and can help prevent it.

By this I mean slowing the birth down, and if you had a quick delivery first time, then semi-recumbant on the bed or mats will slow the birth and give you time to stetch the perineum. (I know some of you are grimmacing at being on the bed - but this does work!)

Also a 'hands on' delivery to slow down and guide the head will help, and finally, if it looks like you are going to have a big tear, then have an episiotomy, to guide the tear away from the anus.

Hands and knees position is also good to take pressure off the peri, but its difficult to do an epis like this if it is needed.

In most cases, 3rd degree tears are caused by instrumental delivery or poor practice and I have helped deliver many babies to mums with previous 3rd degrees, with intact peri or small tear or epis, so dont get too stressed out about it.

Finally, there is no reason to think you would be incontinent following a second 3rd degree, (if the worst happened), as its all down to the skill of the doc repairing the damage, and to how you heal, rather than the number of tears you have had.

Sounds to me like you'd be mad to risk the possible problems of a section when you had no healing or incontinence problems. Unless of course it looks like you have a mini elephant on board!

No exp. of 3rd degree here but had 2nd degree with Ds1 and sustained no damage at all with Ds2 14 months later weighing in at over 10.5 lbs.

As my mother told me, with which my lovely midwife agreed, the first baby paves the way for the next! lol

Look at it like this, you can do whatever you can to minimise risk of another tear...

or you can have guaranteed major abdominal surgery....

to me it's a no brainer!!!

But then I'm a staunch VBACtivist so you must bear with me!

I had an episiotomy (sp) AND a very nasty 3rd degree tear with DS2's delivery.

DS3 I did tear a little, but it was only very slight.

I had a 3rd degree tear with DS1 and a c-section with DS2. I was told that if I had any incedents (sp?) of incontinence then I should have a c-section... otherwise I could have a normal birth...

I had 3rd degree tear with my 1st ds, and am now 32 wks preg.Still unsure how to have this one,dont want c section as the thought of recovery and a 2 yr old and a new baby to look after is all to much...BUT with 1st baby that weighed in at 11lb 3 and fairly difficult time getting over that perhaps section is best way to go. Am thinking induction at 39 wks so this one doesnt get chance to reach great weight of 1st.Major surgery to have baby or surgery to repair a ruined pelvic floor...Dont think there is a right answer just have to do what feels the right thing at the time.

Good lord Flo23, 11lb 3 owch. I think you're rightthough. It's so tricky -I have a friend who's so totally scared of giving birth she's desparate for a csection whereas I'm the opposite. I think the only way we can go is to do what feels right. I'll have it all inspected!!! and make my decision. I'm pretty sure I'll go with vagainal birth though and try all the tricks I've read about here. It's interesting to read mintpurples's response as it was just what I suspected. It seems to me there's a percent chance of it happening again, then there's a percent chance of if it did happen of it not healing properly. I mean even if I did tear, I still may end up like I am now which is all working and dandy! Haven't come accross a midwife yet who's said have a csection. Flo - check out radical midwives website. They have a great discussion board on this too. let me know how it all goes and what you decide. Why can't it be like the movies eh - a couple of loud straining pushes and out! xx

Will do..Had same info as you alipeepee when saw Consultant, risk of double incontinence,colostomy was also mentioned but I guess worst case scenario has to be discussed..However am going to have growth scan at 36 wks and decide after that(not that I think for 1 min that I am growing a small baby!)Have heard of women having 3rd degree tear 1st time,but having little or no tearing with subsequent deliveries.I'm also thinking vaginal birth is the way to go,think chance of another 3rd degree tear is less than risks assoc with c section especially if I dont have such a huge baby!

I just wanted to say I had a 3rd degrre with DS (now 18 months), and have had a lot of pain probs since so I will be having a CS IF I do have another. There is just no way I will risk this again.

A recent visit with a colorectal specialist was interesting, as he very strongly recommended CS after the tear. I guess they are the ones that see the results of the unlucky few who do tear again. I don't mean to be a downer, but he also mentioned something that most people won't tell you: that anyone with a 3rd or 4th degree will eventually see some deterioration with time no matter how well repaired, or how well they are after the delivery.

I had 3rd degree tear after episiotomy with first baby. Same as you, ds heart rate was dropping and everyone in the room was twitchy to get me ready for cs.
Baby no2 I had an episiotomy but didn't tear.
Next 7 babies, no problems.
I didn't do any special preparations for them either.
Vizbizz What timescale did your specialist give for deterioration. How can you tell whether any problems are related to the tear/repair or whether it is normal due to age/menopause?

Tearing is normal and there are risk of all sorts but the rarely come true. I would definitely trust a Ob/GYN over a midwife. The key is find a highly qualified doctor. Ask around your area and I am sure someone will recommend a great doctor who can ease your fears.

juuule, he did say that even people without tears can experience some deterioration, but in his experience all who have tearing to the sphincter will experience it to some degree somewhere along the line. There is no telling how much or when. The lucky may just have a bit of incontinence with wind or with diarrhoea, but more severe problems are not at all unusual. It took a direct question from me to get even this much of an answer. It seems they are reluctant to talk about it. I first found out about it reading gynae publications.

He added that all the women working with him elected to go CS with their births! I guess they just saw too many of the unlucky ones and didn't want to risk it.

Could it be, though, that the ones he sees are the ones with problems? Surely he wouldn't get to see the ones who didn't have any problems following on from the tear.

so now I'm all worried again from being very ok with the whole thing. So I'd like to know the actual stats for the risk of being left paralised from a cs and the risk of being left incontinent from vb. Anywone???

Sorry I can spell really - anyone

I guess that is always possible, but publications have also backed that up. Studies do tend to cover that kind of stuff. That was why I asked him, to see if his experience matched what I had researched.

Found this - it makes me feel better. Honestly, my hormones are already all over the place - this discussion is turning me into a yoyo. My fault for starting it I know.

A second vaginal delivery after a third degree tear that has resulted in a functional deficit predisposes to worsening function. When there is no residual anatomical defect and no functional loss, there is no evidence of increased risk of incontinence following another vaginal delivery. Conclusion 

Vaginal delivery will continue to be the main method of delivery and will continue to generate a low incidence of pelvic floor morbidity. The management of injury to the anal sphincter is facilitated by close co-operation between obstetricians and colorectal surgeons.
Keywords: Anal sphincter; third degree tears; pregnancy; risk factors; prevention; recurrence risk

Document Type: Research article

DOI: 10.1111/j.1463-1318.2005.00801.x

Affiliations: 1: Obstetrics and Gynaecology 2: Colorectal Surgery, Royal Bolton Hospital, Farnworth, Bolton, UK

Ali, see a professional about the stats. MW or ob/gynae should be able to give you that info, or do some online searches and find the info yourself. There is a lot of info out there.