Home birth after a 3rd degree tear

[mamablondie]

Hi all

I posted some time ago about whether to have an elective Csection or attempt another natural. Anyway, I’m now thinking of going the complete other way and having a home birth for DC2.

Can I get views on this/hear from anyone who has done the same? I’m consultant led so will bring this up then but just wanting to have some opinions to go with the google research x

I'm not sure if you will be able to if your consultant led that's due to issues from past labour then I think u have to give birth in hospital I had a c section then a normal vbac then a forceps delivery and was consultant led for the last 2 currently pregnant with my 4th and a home birth has never been an option. But discuss it with you consultant your area may be different. I think if it was me and I had had a difficult first birth I would want to be in hospital for the second just incase issues arrive

I was also under the impression that if you're consultant led you at not be able to have a home birth, absolutely may be wrong of course so definitely ask at your next appointment.

I had a 3b tear with my first & had a waterbirth in a midwife led unit for my second, wasn't a home birth but had no more medical intervention than you would have at home, it was amazing.

Good luck with whatever you decide

I'd be very surprised if you were allowed a home birth when consultant led. I think home births are only suggested for the lowest risk pregnancies.

No such thing as allowed. If you want a homebirth then you can have one.

However, discussion with health professionals is important and helpful, your consultant can go through your last birth with you too see if there were any factors contributing to the tear and can discuss the chances of it happening again so you can make am informed decision.

You don't 'have' to have anything, you are 'allowed' to birth wherever you choose. Obviously it might be against medical advice, but it's your body and your baby and you have the right to make your own decisions about this.
From my own point of view, my first birth was very long, back-to-back, excruciating and ended with distressed baby, episiotomy and forceps. The postnatal ward was awful.
Consequently I opted for a home birth with DC2 and it was amazing. I did the Positive Birth Company online course, learned loads, felt overwhelmingly positive about labour and it was magical. 4.5h from start to finish, in the birth pool, with a lovely hands-off midwife who just let me get on with it... I did tear but I was just so euphoric I didn't care. Best day of my life.

I'd be very surprised if you were allowed a home birth when consultant led.
Err no, your body your choice. I fine the whole "am I allowed to" very difficult, should women really have to obay medical professionals? What about autonomy and informed decision making? However it's important that it is an informed choice. The Birthplace Study is good place to start as it gives an evidence based view.

And @TillyTheTiger I could pretty much have written your post word for word as my own experience except that I didn't use a birth pool for my home birth. 😀

I was told after my first that I would need to have a hospital birth for my second as birth was v fast with 3rd degree tear. Anticipated second would be faster and likely to tear again. Second born at home (absolutely not planned) with little warning - quicker than a midwife or even ambulance could get there. Same tear - sown by the midwife when she arrived and no need for hospitalisation. But ... there are many variables, many we don't know. In my case, speed was predictable and a known factor in tearing. I didn't get the birth I planned for or the one they told me I would need. I was worried about the birth throughput the pregnancy as a result but it was wonderful getting into my own shower and seeing the children meet at dawn. I would take their advice on board, we don't know how the variables play out (neither do they). Wishing you all the luck.

@TillyTheTiger did you have to go to hospital after for stitches?

Basically my tear was also due to the speed of baby’s delivery/involuntary pushing. Plus I was stressed, being told repeatedly not to come in yet and wait another 30 minutes bla bla. So I figure a home birth would eliminate that part?

@mamablondie nope - midwife stitched me up on my sofa!

I had a third degree tear with my first and had a home birth with my second.

I did tear again with baby number 2 but it wasn't nearly as bad as the first time around and I didn't need stitches again.

I had a homebirth after a nasty 2nd year episiotomy that didn't heal well. The midwifes did refer me through to the consultant to check but they were fine with a homebirth. They did recommend I transferred to the hospital for stitching though - the light and position with you on stirrups is much better so they can do a better job.

I got my homebirth, which was absolutely worth it, but did have to go in for stitching afterwards as I tore. I was glad I went in as they were very careful with the stitching and it healed very well.

It is not just about being “allowed” to. If your consultant feels it is dangerous you may not be approved and therefore will have to get a private midwife who will have no insurance (assuming that’s still true!) Plus if your consultant thinks it is dangerous there is a REASON for that. The risk is higher. Chances are you will still be fine but there is a reason they risk stratify. They are not doing it just to be mean. If you want to take that risk then you need to fully understand it and think about what could happen.

I had a 3rd degree tear with my first and an elective c section with my second.

Personally I would not have chosen a home birth after having had my tear. I would want to be closer to the more specialist medical facilities incase there were difficulties again.

@AvocadoOwl can I ask what your reasons for home birth were? I feel like people are misunderstanding my reasons here. The chances are I wouldn’t make it to hospital anyway, my DD1 came very very quickly.
No intervention/forceps/induction etc. I tore because of the speed. So I’m kind of trying to avoid the stress of an unplanned home birth OR arriving at hospital when it’s too late for pain relief etc (that’s what happened before)

So as others have said, you can absolutely choose the birth you want.
As a Consultant obstetrician, I would absolutely support you to birth at home in these circumstances.
I would explain that you have a 5-10% risk of a repeat 3rd degree tear and IF that happened, you would need to come into hospital to have stitches in theatre. As you were being transferred, there would be a delay in getting those stitches so you could lose more blood than if you were already in the building.
90%plus, you wouldn’t need them though so it depends entirely on your own view of risk etc.

@mrbob
That’s not true
In the U.K. we have a duty to send you out a midwife wherever you want to have your baby (field / car park / home!) - regardless of whether we agree with your choices or not.
We also have a duty to make sure that you understand the consequences of your decision / worst case scenarios etc.
Women can make decisions about their own bodies and should be supported to do so with all the available evidence, without scaremongering.

It’s your choice where you birth. Obviously the consultant should talk through risks and benefits with you to inform your decision. But ultimately it’s a choice whether or not to go into a hospital to give birth. Drs don’t suddenly own your body when you are pregnant. Even choosing to see a consultant and attend appointments is a choice.

I would get all the information I can on all your options (planned c-section included) and have a careful think. I think it’s one of those situations where many women would make different decisions so choose what is right for you.

You can absolutely choose to have a home birth at any point, even if you've had a c section.

However, please consider the options very carefully. Do you have a birth centre as part of the hospital you could go to instead, so in an emergency (hopefully not) then you are near specialist help!

Midwives are wonderful humans ask them what they think, then ask another one and she what they think. Speak to your consultant about worries, ask their opinions, but don't follow them, if you aren't comfortable.

I'm pretty sure with 3rd degree tears, you can easily opt for a c section as well.

You ultimately need to do what you think is for the best with as much information as you can gather.

Good luck xxxx

Also to add- it’s the woman who does the ‘allowing’. Consultants can recommend (in some cases strongly recommend) certain care or procedures like induction and then the woman is the ultimate one who decides whether she will ‘allow’ that or not.

No such thing as not allowed. I had forceps and episiotomy with my first and a HomeBirth for my second.
I had a second degree test but to be honest I knew I would tear as I sometimes even tear a tiny little bit during sex, just very tight there.

I would contact the HomeBirth team to discuss

Not quite what you asked, but I had dc1 in hospital and had a bad 2nd degree tear. With dc2, a home birth, no tears at all. Completely different type of birth. Dc3 also at home, a minor tear that didn’t need stitches.

So every birth is different and just because you tore first time round doesn’t mean you will next time.
Dc2 was also born very quickly, after very short labour. I was glad I had planned a home birth- if I’d been trying to get to hospital, he would more than likely been born on a dodgy country lane in the middle of nowhere as we lived so far from the hospital. Far better to have a planned home birth than a baby born at the side of the road en route.

Forceps delivery and hard-to-heal episiotomy with DC1. Homebirth 2nd time, small tear stitched up on sofa. I did a bit of reading up / listening to cds etc on hypno-birthing before DC2, and found it really helpful.
Good birthing!

I had a 3b tear 6 years ago. When pregnant with #2 I was initially consultant led, but because I had no significant lasting issues they signed me back to the midwives as I told them I didn’t want a csection. Otherwise they keep you consultant led until 36 weeks as that’s the point where you would get a cs booked.

I had thought about a home birth (speedy labour first time, so worried about logistics, giving birth in the car etc) but dh wasn’t keen and the consultant advised that fast births can have a higher risk of bleeding and as I was on the fence it made up my mind to go to a birth centre based at the hospital.

#2 was again fast, so much so that we only just made it to the hospital and I had no pain relief (I’m talking asking dh to pull over on the motorway - he didn’t- abandoning the car outside the unit, wheelchaired in, straight in the pool, baby out)
I had a 3a this time but only just. I assume due to speed again, but he was also over 9lb.

Can your consultant sign you over? What is the reason for staying with the consultant?
Definitely think about all the reasons why you want a home birth. You can call the labour ward and even if they say wait at home, turn round and say “no, I labour fast, I’m coming in”
I spoke to my midwife about this and worrying about coming in too early and getting sent home as I didn’t want to stay home and end up caught on the motorway. She told me that the hospital policy (for my hospital) was that you have to stay for 1 hour after being checked as they are cautious of those women who will go for 0-10 very rapidly.
This time, in hindsight, I should have gone earlier. But I was coping fine at home and am quite a weakling pain wise so thought it would be ages. I should’ve remembered last time and how fast my body goes once it really kicks off.

Hello! I haven't birthed yet but if you are someone with quick labours have you considered using evening primrose capsules in your vagina for a few weeks prior to birth, and perenium massage (assuming that is where you teared)... Ive heard these things really help chances of not tearing!