Giving birth after a 3b tear

[TiptopJ]

Has anyone got any experience of this or is there anyone currently in the same position and deciding on what to do?

I had a 3b tear after my first 2 years ago and whilst its healed well I have been left with minor pelvic floor issues. During my physio I was advised I could be considered for a c section if I wanted or I could attempt a vaginal birth with guidance from the midwife on controlling the labour a bit more. I prefer the idea of a c section for the delivery but the recovery afterwards frightens me. However I'm also worried that I may cause lasting damage if I have a prolapse after a vaginal birth if I cant control it. If I'm honest I'm also worried about the pain of labour again. I'm considering an epidural to help with pain management and also to stop me over pushing to get it over with which is what i think help contribute to the tear last time.

What did you do or what are you planning?

I suffered a 3b tear in 2013 after quite a fast labour.
During both my consultant and midwife appointments this time we discussed the possible reasons and all agreed it was likely due to me pushing too hard and too fast, not breathing through it at all (I panicked and I told them that's what I thought had happened before they suggested it)
I decided to go natural as wanted to avoid a Cs and I hoped that by using hypnobirthing I'd be able to avoid a repeat scenario.
Thankfully I wasnt suffering lasting damage from 6 years ago so they were supportive of my choice.

I had another fast labour in October 19. I mean en route my husband almost pulled over on the motorway as I was ready to push and we only made it to hospital with 2mins to spare.
The midwives were really happy with the birth, he delivered in a slow and controlled manner (thanks hypnobirthing), but hello 3rd degree tear #2 😔
This time it was a 3a and only just a 3rd degree as well. Again I had surgery to stitch me up, but I did find I lacked a lot more bladder control in those first weeks.
I'd stand up when I needed to go and it would already by flowing out. I thought it would be my life.
Now 14 weeks later and a few physio appointments and my control is a lot better. Only slight leaks each day (and I mean a small damp patch in my knickers)
I do however now have a rectal prolapse where it pushes through from my bowel into my vagina. It's not a bad one though and causes me very few issues, sometimes I have to push it back through to allow my bowels to clear.
The physio said it's such a common thing regardless of the tear and the gp says they don't fix it unless it's severe.

I think you really need to fully discuss your concerns with your team. Sadly every birth carries risk and even if you hadn't torn last time, you could suffer an almighty tear this time and it cause lasting damage.
I believe the chances of tearing badly after an initial bad tear are around 7% (which isn't much different from badly tearing first time which is 5%)
I've come to the conclusion that my body just isn't designed to stretch down there (I did have some issues pre babies during sex) and there is nothing I could have done.
Looking back I question if I should've gone in a lot earlier and had an epidural or gone down the Cs route, but the thought of the Cs recovery still makes me feel like it was the best outcome regardless even though it wasn't perfect. And I'm not sure the hospital would have admitted me any earlier as I seem to. Go 0-60 in no time.

What started out as a horrific labour due to an over effective induction, became a really pleasant experience with an epidural! When I say I felt no pain I literally felt nothing bad! I got a walking one so had full motion of my legs and felt pushing but none of the discomfort that came with it😅 I didn’t feel her crowning in a painful way, and I didn’t even have bad pressure as she came out which actually meant when I did get to have skin to skin I was really comfy! It was amazing! I did need forceps and an epistomy which I am sore from today, but this was in my birth plan due to a heart issue so it wasn’t that the epidural caused it. In fact they were confident I could have got her out without intervention just baby needed to come out fast for both her and mums health at the time, so I was only allowed ten minutes to push. But really now I wish I had been given the epidural early as was in the plan because I would have walked away with such a positive experience stitches and all due to the difference it made when I got it. And just to add, getting it was a total walk in the park too, no scary soreness and was over in a jiffy, it also took action nearly straight away not the half hour they warned me I might have to wait! I am now the epidurals biggest fan let me tell you!!! Also I seemed to get really good pain relief from it afterwards for a good while too while being mobile! It made a huge difference for rest!!

I had a 3c tear in 2015 with DS after he was back to back with his head tilted up. Healing was long and painful without very much support from the hospital after I was discharged. I also suffered from urgency incontinence and was basically prescribed Imodium and told to get on with it.
I had DD in June '19 and agreed a C section at my 24 week appointment, and the consultant agreed that it would be best to protect my pelvic floor. I had an elective and it was an absolute breeze compared to my first birth, I was up and about in the shower after about five hours, high on endorphins and felt AMAZING. We went strawberry picking when DD was a week old, something I couldn't have done at all after my first experience, i could barely walk for almost four weeks after my tear. Pain relief after the section was really robust and aftercare was much much better organised.

Yes, I had a section. It was amazing. @Frizzy1986 the prolapse thing sounds terrible.

And it's true about pain relief and aftercare. The tear was so much more difficult to recover from than the c section.

Thank you for the responses. Fizzy1986 your first labour sounds very much like mine. He was a big baby and out in 3 hours so maybe the next one might be longer but more controlled.

Teejayem- thank you for sharing a positive c sanction story. It's so often seems on here posters are against them or only talk about the negatives, it's nice to know recovery can go well and it's all doom and gloom for 6 weeks

I had 3rd year from my first but healed quite quickly and had no problems so I had my two subsequent children vaginally. 2nd labour the midwife helped with slow controlled pushing stage and that worked, no stitches required.
My 3rd child popped out in record time before help arrived so I needed a few stitches after that but I had no problems and 8 years on am still fine. So one bad year does not necessarily mean you'll have more. Good luck with whatever decision you make, there is no correct answer just go with what you feel most comfortable with.

*tear not year!

I had a 3b tear in 2017 along with a pph. I decided to go for an elcs after discussion with my consultant and it definitely seemed the safer option for me. I had the cs 12 weeks ago and it was brilliant! Straightforward, quick and easy. We were discharged the following day. I was in pain the morning after but it was brought under control with the painkillers and each day the pain significantly reduced. By 10 days post partem i was in no pain at all and taking no painkillers (after my tear I was in pain for weeks). I felt totally normal after a couple of weeks. Of course you need to be careful lifting stuff and don't drive if you don't feel up to an emergency stop but other than that recovery is straightforward. I would definitely have a cs again.

I had a third degree tear with my first.

When I was pregnant with my second baby the consultant strongly advised a c section. He was worried about a second birth worsening the damage already done.

I took his advice and had an elective c section. It was a lovely calm experience. I felt well again very quickly ie within a few days. It took me about 6 months to feel anything close to normal after the tear.

The c section was a much better experience for me.

@npowerarebastards it's not ideal but I've found from the physio that 10% of women have what I have (a rectocele) and some women just get them through growing older and the muscles sagging.
Thankfully my aftercare both times has been excellent with tear clinics, physio and I was pain free within 2 weeks both times.
My friends who have had c sections have suffered with pain for at least 4 weeks and some have urgency issues that haven't been addressed as its the pregnancy that can screw you over not just the labour.
@tiptopj fast labour's are nice that they are over with but a bit too intense for me. My first was tiny (6lb 5oz) which is why I wonder if I'm not so stretchy as most midwives are surprised I tore so badly with such a small baby.
It's hit and miss with labour and sadly you just don't know which will be the right choice for you until afterwards.
I think making a pros and cons list and look at which outcome you'd be most happy to live with/go through.

Hi! I had a 3b tear with my first and had some issues with controlling wind and numbers 2s in the months following birth (no accidents but just felt more “urgent”). To be honest it shocked me to my core when I learned the long term damage from childbirth (when it goes wrong) and I was so angry that its never really explained to you. I had no epidural and no assistance and a long pushing phase.
Anyway when pregnant with my second it didn’t really entertain the idea of a natural birth because I knew that if there was another bad tear ultimately it’s me and me alone that has to live with the consequences.
So I was super organised- pre cooked and froze lots of meals, had shopping delivered, budgeted to increase my older sons nursery days for 2 weeks and then took everyone up on any offers of help.
In my experience the planned c section recovery (both physical and mental) was a thousand times better than my first. The only issue I had was that the pain meds made me constipated which isn’t good for my very weakened pelvic floor. But that was sorted easily enough.
I was up and about after 2 decent weeks of rest.
If you can get the support for that first week then you will be fine!
Saying that I also have friends who have had second births after third degree tears and been totally fine !
Good luck !

I might be edging back towards a c section now then. Im really happy to have heard some positive stories and its does make me think 6 weeks of hard recovery vs a possible lifetime of pelvic floor problems.

Hi OP, if you are worried about prolapse then definitely have a section. My prolapse, although supposedly mild, makes me life miserable because I just can’t come to terms with it and the fact I can no longer do the things I used to love eg running.

You will hear people tell you, correctly, that you can get a prolapse just from the pregnancy. But a vaginal birth significantly increases the risk, especially if you have forceps, and of you want an epidural for the pain, then that increases your risk of forceps so bear that in mind.

There is no right or wrong way to give birth so just decide which risks you are more comfortable with

Oh also, I have prolapse from my first birth and hate it so much- i used to run 10 in 45 mins and haven’t been about to get back to it at all because of my pelvic floor. Everyone’s bodies have different breaking points and mine was obviously pushed to the limit with just one birth. I only wish I could go back in time and have a c section first time round and have no prolapse at all :(
But if you don’t have one now then I defo wouldn’t have a natural birth because it surely has an impact pushing something big like a babies head out of the pelvic opening rather than just carrying it ?
Mine didn’t get any worse from pregnancy anyway
Sorry if I sound anti natural birth- I’m not really. But I feel like a 3rd degree tear is a good enough reason to think that maybe a c section is a better option !

I only wish I could go back in time and have a c section first time round and have no prolapse at all

Me too. I lie awake at night obsessing about how much I wish I had a section

Sproutmuncher - how far post partum are you?
I was completely OBSESSED for the first year. Like , couldn’t stop thinking about it. Beating myself up- flashbacks. Regrets and re living every part of the birth. Then I got diagnosed with PTSD and learned to accept what had happened little by little. I got back to exercise in a different way (tho nothing has matched the runners high!). It does still bother me but I’ve had another child and I don’t think about it that much really. I’m 3 years post partum now from the prolapse birth .So hang in there, it does get better (both symptoms wise and emotion wise - which are definitely linked)

Thank you immaback, that’s really encouraging Nearly 2 years now. I am going to get a birth debrief so hopefully that will help accept things.

Sorry to hear what happened to you

@Tiptopj I am on the same boat with a 3c 3 years ago. I've had an initial meeting with the consultants team at 16w and they reassured me that they will support my decision and it would be understandable but asked me to try not to dwell or stress about it in the early weeks and try to just enjoy the pregnancy.

At the moment at 19w I am swinging between ELCS and a niggling maybe VB will be fine this time around and I can avoid major surgery... I think I will end up with ELCS as I would probably worry less leading up to it.

I had an EMCS with DS1 and a normal birth with 3B and 2.5L PPH with DS2 (2yrs ago). I’m under urogynae at the moment, awaiting physio. Mild anterior wall prolapse and dodgy pelvic floor but all something that can’t be improved.
I am looking to have a 3rd baby in a couple of years time and most likely go for another vaginal birth as long as I can get on top of my pelvic floor.

Hello OP
I had a 3a tear with DS 2 years ago. He was biggish (9lbs) and born really quickly. I had surgery to stitch me up afterwards, just with an epidural so not GA. no major issues after unlike yourself but took a while to feel normal and obviously doesn't look as er.. nice? as before!

Anyway I just had DS2 8 weeks ago. He was also 9lbs and born very quickly but this time i has a water birth and took the pushing faze more steadily and only suffered a 2nd deg tear which the midwife stitched up afterwards. No issues afterwards either despite the previous bad tear.

Do what makes you feel the most at ease though, sounds like the consultants are being supportive.