Third degree tearing during first birth, is c section the best option for second birth???

[KaybeeandZak]

Hi

I had my 20 week scan today and discussed with my consultant the fact i had 3rd degree tears with ds (now 1 yr old). After hearing that I didnt feel like my old self 'down there' and def didnt have quite as much control as i used to, the consultant said that a c-section would probably be best.

My worry is that ds had a big head, and according to the scan today, this next one is the same, so I will probably tear again, leaving the muscles even weaker and the last thing i want is to be incontinent at 32!

Has anyone had experience with this?

No experience but I am in the same position as you. I had a 3rd degree tear with my first birth (DD is 15 months) and am due again in March 2008.

No one has actually suggested anything either way with me although I am seeing a consultant in January to discuss my options.

Am also seeing a support midwife at the moment as think I am suffering with post traumatic stress disorder from my last birth.

Well, I didn't have a 3rd degree but...

I had a very bad 2nd degree tear with DC1 - sitting was painful and it took a long time to heal and a lot of pelvic floor exercises to regain control. Sex was not an option for almost 6 months and a nurse was unable to do my smear test. Floods of tears were common.

With DC2, I had another 2nd degree tear but not quite as bad and it healed much faster.

With DC3, I only had a 1st degree tear and I ran down the stairs to let the midwife in the following morning (homebirth). Poor woman nearly keeled over!

3 years on I can bounce on trampolines without accidents (or I would if I wasn't pregnant again).

I wasn't stitched with any of them and they all weighed 8.6 to 8.12 with head circumferences of about 36cm (which is slightly above average but not huge). And they were born within 3 years of each other. I still have an internal ridge of scar tissue but I can live with it (sorry if TMI!).

I would guess that the majority of women cope better physically with subsequent births but I would discuss this with your midwife.

Best of luck whatever you choose!

I had 3rd degree tears with DS. I'm due DD any moment now... and have been told by several midwives that

1. the 3rd degree tears were almost certainly caused by the doctor who did the ventouse
2. intervention is much less likely in a second birth so bad tears also less likely
3. there is nothing to say that bad tears are more likely if you tore badly first time
4. there's quite a lot that you can do to prevent tears if your midwife is on the ball - watching carefully, compresses, different positions - all fours and semi recumbent are supposed to be good for slowing down and preventing tears.

Also I always heard that a big head is not a reason to tear, it's more to do with the angle of the head and with how carefully managed the birth is iyswim - speed, position, intervention.
hope that helps!

I had a very bad 3rd degree tear ON TOP OF the episitomy (sp) for DS2's birth (ventouse delivery).

I had about a couple of tiny little tears when DS3 was born - so I wouldn't go for a CS just based on the fact that you tore badly with your first.

I had a third degree tear with ds1 (v big baby) and decided to go for an elective c/s for ds2. The recovery from my c/s was easier and quicker than after my 1st delivery.

The c/s was absolutely the right decision for me, I felt back to normal again so much sooner than after having ds1. There is no right or wrong answer though. You just have to do whatever feels like the best way to have your baby, if you go for a vaginal delivery then you risk another possible tear and subsequent pelvic floor issues, but then a section is obviously major surgery.

Not much help, but as you cant see into the future you just have to go on instinct!

you might not tear again, there are positions to give birth in that can help, and water birth is really good for supporting the perineum . also, everything is stretched a bit , so not neccesarily the case you will either tear or tear as badly

head circ, and baby;s size are not definite indicators of tearing, women with much smaller babies tear, and some with much bigger ones don;t!

obviously you must discuss it all with your consultant and make the decision based on what is best for you and your family, bearing in mind a c.section is major surgery. but there are benefits too...

look into all options

I had a c section first, and had 3rd deg tear with dd2, who is now 12 weeks.

I took longer to recover from c section than tear, and also had little control after c section and still dont
Just rememeber with c section they cut though the muscles, so longer healing time and more damage
Good luck, what ever you decide.

Also with a 1 year old, you may struggle as c section recovery is hard. No lifting, driving and things like bathing children for 6 weeks

I didn't have a 3rd degree tear with my first, but I did have a forceps delivery with a hella episiotomy and stitches.

Second delivery was in record time and had nothing but a graze.

thanks everyone for your posts, at least now i know that others have been through this and maybe my second one will go smoothly afterall! I definately want to avoid a c section if poss, as it would be a bit of a nightmare with ds

I think you might benefit from a second opinion.

I've heard that if you haven't got significant problems with incontinence then a vaginal birth after a third degree tear is unlikely to result in further perineal problems.

However, if you already have problems with continence then it may be worth considering an operative birth.

On my part - I have minor problems with my pelvic floor. I leak urine when I run or sneeze and have mild fecal incontinence in the sense that if I have to go - I REALLY need to be near a loo(sorry TMI!). I always think it can't be that bad though as I've never been caught out in public!

My pelvic floor problems are related to a forceps birth with my first 9lbs 6oz baby, and a shoulder dystocia with my 10lbs 12oz second baby.

Despite all this I never, ever would have wanted to have an operative birth with my third - but that is just me, as I would hate to have a c-section, really hate it.

I tried to prepare myself for my third birth by eating a diet very very rich in fruit vegetables and omega 3 oils. I took a supplement (mum omega) and ate my two portions of oily fish a week, plus nuts and seeds. I think that when it came to the birth I was very 'stretchy' - plus I worked on relaxing my perineal floor so I could just let my baby out. My third birth was great - I only had a tiny graze.

I also had a very good midwife.

If I was in your shoes going for a vaginal birth I'd want to meet with a senior midwife first to talk through how second stage was going to be managed - birth positions, breathing, hands on or hands poised (in the sense of whether the midwife would support your perineum during the birth) and try to work on my visualisation and breathing skills for second stage and crowning.

I do wonder how many follow on tears are linked to mothers being too fearful and tense to let go of their pelvic floor, relax their perineum and just breath the baby out , or a surge of adrenaline at the last minute (again linked with fear) causing uncontrolled mad pushing in late second stage.......

My dSIL had a horrific 3rd degree tear after her dd1 which required surgery immediately post birth to put her back together again. She's had homebirths with the next two (first HB was a little unexpected ) and no tearing either time. She's hoping for a HB with #4 too. I guess it's to do with whatever will make you feel least stressed and most in control through the rest of your pg. All the best.

i had exactly the same situation as you and had a cs 10 weeks ago with my second baby. It was fantastic! My first labour was awful and the obstetrician present at my first birth recommended strongly that I has a cs in my following deliveries to have a cs due to the possible risk of incontinence. I decided that having 2 small children this was not a risk I wanted to take and opted for a caesarian.

The cs was calm (even though labour started early) and my baby was born quickly and so far my baby has been lovely and relaxed. The immediate recovery after the cs was painful for a week or two but i was up and about far more quickly and feel much better than after the birth of my first child. obviously do whatever you feel is best for you but for me my cs was a great decision and a very positive experience. good luck

I had a an episiotomy and 3rd degree tear with dd1, with quite a lot of soreness afterwards, but I did heal well, and didn't suffer any incontinence. I had dd2 14 months later, and was terrified, especially as the consultant and nearly all the mw's I saw recommended a cs, ( one consultant even came in to suggest one whilst I was in labour - I was so off my head that apparantly I told my dh to tell him where to go! ). Dd2's birth was very different to dd1's (dd1 - 48 hours, only gas and air, ventouse,3rd degree tear dd2 - 6 hours, induced, epidural, tiny tear)and I was very glad that I had stood my ground ( I found a really lovely MW to go through my notes with me, which helped me make my decision - and I would recommend you do this if you can). However I have a friend who is in a similar position to you at the moment, and has opted for a cs, because whereas my big fear was a cs, her big fear is another tear (and future incontinence) - and really the only way to guarantee not having another tear is to have a cs. I think when it comes down to it you have to decide what makes you feel most in control and positive when you are preparing for your birth. Good luck with your decision and i hope your birth goes well.

I know a lady who had a bad 3rd degree tear with her first and went on to have her second a year later with no problems at all and she positively "enjoyed" the second birth!!

You could work really hard on your KJegel exercises and also do Perineal massage to give you confidence in your perineum.

I'm a VBACer so I wouldn't have a CS because of tears and certainly wouldn't have a CS because of my episiotemy so admit that I'm biased. Good luck with making your own informed choice

its my 1st time on here, hope im doing it right. i had 3rd deg tear 18months ago and i have never gotten over the trauma, i walk alot and sometimes feel like my insides are going to fall out, when im playing with my daughter on the floor i get cramp in my vagina for a few seconds - scary and very painful, this has also happened during sex. im terrified of sex, its all feels tender like its about to rip open and i hold myself with my hand during sex....not very fun. i can count on 1 hand how many times wev had sex and right now i never want to do it again. its all getting on top of me and its all i think about. and my partner has been amazing but i feel cracks r appearing and im getting depressed.

penny You might get a better response if you start a new thread - people will read the first post and answer that, rather than reading your post (I very nearly did!)