2nd birth after 3c tear

[Whatelsecouldibecalled]

Just after some thoughts. I'm delighted to be expecting our second baby. With first baby I was induced due to ivf pregnancy. The induction went well 17 hours start to finish. Waters went naturally and only had drip at very end to extend contractions. I had gas and air and one shot of diamorphine.

However I was left with a 3c tear requiring repair in surgery. I found the recovery so very tough. I had three back to back infections and prolapse type symptoms. However baby was born April 2020 so start of the pandemic. I never saw a midwife after discharge (I was discharged 24 hours after delivery) have never seen a HV (little one now nearly 2!) 6 week check never happened. I had no help as it was illegal to see anyone and my DH was a key worker so had two weeks paternity and I was left to it. (He helped where he could and was brilliant but he did work 12 hours shifts!) so....was my recovery just crap due to social factor as apposed to it being normal to be that awful??!

I'm consultant lead care and he is happy to support ELCS if I want one but also said I could try naturally again if I want. And I just don't know. ELCS means no tear. Calmer etc. but still major surgery. If they said they could guarantee it wouldn't be a 3rd or 4th degree tear then I would happily go natural again. But there's a lot of scar tissue and no one can guarantee anything. He also said 25% of labours end up in crash section which I thought was really high!

Anyway. After all that rambling. Would love any one's thoughts or opinions!

I had a 3c tear previously and I am now booked in for an elcs next week! The recovery after my first birth was horrific and that was pre covid so I can't imagine how difficult it must have been for you with such little support. I also sustained quite a lot of damage to my bladder so that was a key factor for me.
I'm feeling really positive about the elective, I've researched it a lot and I'm hopeful for a better recovery this time round!

I believe you have about a 10% chance of another 3rd degree tear if you’ve had one already. And this chance is a bit higher as it was a 3c rather than a 3a. Have you still got any ongoing symptoms?

I had 3c tear, surgically repaired. Fortunately no infection or bother and healed well. Obviously uncomfortable but able to get on with, with extra care of course.

Had a vaginal birth with dc2 18 months later, 2nd degree tear and stitched by the midwives on my sofa (home birth). Fortunately healed well, again needed a bit of extra care and to move carefully but I was back at toddler groups on day 3 albeit in a penguin waddle.

It was a worry of mine and I spoke with the midwives, we decided they would coach me through the pushing stage and apply pressure to the perineum as DC crowned.

You poor thing though, you've had a rotten experience of a nasty tear and poor aftercare. Could you speak through your options with your midwives? A consultant, although they know their stuff, aren't exactly on the front line and midwives might be able to help you weigh your options or offer advice and possible solutions.

That sounds like really bad care. After my 3a tear the midwives checked me every home appointment and then after 6 weeks I had a specialist appointment at the hospital to check the tear was healing. This was pre covid however. Then when I was expecting my second I had an internal scan towards the end of my pregnancy to check that everything looked ok and that it would be safe to have a vaginal delivery. I’m on a birth tear Facebook group and it seems that this aftercare is not the norm at most other hospitals which is very disappointing.

I had a vaginal delivery with my second and everything was fine. I just had a graze. However my recovery after my first was good, I didn’t have any problems and it was not as bad a tear as a 3c.

Thank you very much for all your replies.

@QuebecBagnet yes I still have some lasting symptoms. The GP diagnosed me with a double prolapse at 9 months pp but when I finally saw the specialist at 12 months pp she said it was normal wall laxity. When I finally got into womens health physio that was stopped due to covid at 14 months pp I saw lots of improvement and it wasn't as bad. However it appears I am quite numb inside which I think it nerve damage.

@AllYouCanEatBrestaurant when I delivered DS they coached and supported the perineum. I also did massage religious before he was horn as I was so worried about tearing. And still ended up
With a 3c! But will definitely be talking through with the midwife.

@Hlglu56 sounds like you had excellent aftercare!

The evidence doesn’t say that supporting the perineum reduces tearing. NICE guidelines say it makes no difference. So advises HCP to either have hands on or poised. As far as I’m aware the Finnish grip trial hasn’t been a success. So I wouldn’t put too much hope into thinking having the perineum supported next time will be a magic answer.

Your experience sounds absolutely appalling. I’m so sorry you went through that. It makes me so angry how postnatal women were just deserted during Covid.

Anyway, I had a 3a tear with some other complications (before Covid). For my second birth I was offered the choice and after a lot of back and forth I went for the c-section. No regrets. For me, recovery was 100 times easier than the recovery from my tear. I was walking slowly round the local park on day 6 - I could barely shuffle to the loo on day 6 after my VB.

I did enlist a lot of help around the house and with my toddler for the first six weeks after my CS, which I think was crucial.

I had a bad tear first time and had and elcs with my second. It was the right decision for me as I found the recovery much easier than from the tear.

@Chasingaftermidnight how did you enlist the help? Professional or family? My DS with be 2.5 years old. That's my main concern being able to look after him too.

I keep telling myself it won't be like last time. I can have help where possible. It won't be illegal to have my mum come help me

I had a third degree tear with my first. He was 9lb1 and I delivered on my back, feet in stirrups.

I was stitched by a very good midwife.

I'd assumed that one tear would mean I'd have another. No one suggested a section to me for my second.

My second birth was AMAZING. Lovely water birth and I delivered on all fours. She was 9lb3 and not a scratch! I couldn't believe it when the midwife told me. Id had the same one both times and she was very impressed with her own handiwork.

There are 2 years between my kids.

Similar situation here, I had 2nd degree tear with first, 3b tear & episiotomy with second, 2 hours repair in theatre after birth and now due my 3rd baby next week..suffered with bladder prolapse following second birth which slowly improved with time. I was advised by the doctor in theatre not to have another vaginal delivery. We since moved to different town and different hospital care. I am having a c-section next week, I was pressured by consultant every time to go vaginal despite what happened previously and the advise I got from the person who actually did the repair. Same as you, if I can see now how it would go if I was to go for vaginal delivery I really would prefer that but the risk is just too big to take for me, I know it could be great but also know it could be a disaster and I might end up struggling with bladder/bowel for the rest of my life. I think c-section is the safest solution for me in this situation.

[quote Whatelsecouldibecalled]@Chasingaftermidnight how did you enlist the help? Professional or family? My DS with be 2.5 years old. That's my main concern being able to look after him too.

I keep telling myself it won't be like last time. I can have help where possible. It won't be illegal to have my mum come help me [/quote]
Mostly professional - he was in nursery 3 days per week in any event and they let me increase his days for the first 6 weeks. My DH’s employer also kindly agreed that he could WFH for the first 6 weeks, so that meant he was around for all breakfasts and baths and bedtimes. And my DH’s family came to help a bit too. I basically didn’t look after my toddler alone until 6 weeks pp. I know that isn’t an option for everyone thoigh!

I don’t know what your setup is but if your mum and partner can be around to help you as much as possible I think you’ll be ok.

To be honest, I felt 95% back to normal after about three weeks - much better than I felt after my VB - but I waited until 6 weeks to lift DS/other heavy things because the consultant told me it was really important to wait even if I felt ok!

I had a 3a with dd1. I had prolapse repair surgery when she was three months too. Dd2 and ds (three weeks ago!) both followed with elcs.

I'm in same situation and 100% going c section. Its not so much risk of tearing again as it is the risk that tbis causes significant life long problems. I view it that i escaped these the first time, luckily no lasting damage from my 3c tear that has impacted my life, and for me i'm not risking it the 2nd time

@onedream if you don’t mind, may I ask what could have contributed to you having a worse tear with your second than first baby? Was your second baby much bigger, or faster delivery? I had a bad 2nd degree tear and other tears with my first and now deciding between ELCS or vaginal birth for my second. Recovery from my tearing was actually ok, but I don’t want a worse tear second time round. Most women seem to have less severe injury second time round, so I’m interested to know what factors could contribute to it being worse for number 2.

I had a 3b year first time - healed well with no problems.

For the second, I just had this nagging feeling that I wouldn’t be so lucky again. I had an elective c-section and baby weighed 10lbs, so I was glad I made that choice.

@Peelspeelspeels
I think it was the speed he came, my waters were broken at 4cm and within 30 mins I was fully dilated and he was coming..midwife said to me after he was born that it all torn same way as first 2nd degree tear plus more and although she tried to cut in different direction there was nothing she could do..he wasn't big at 7'3'..
I only had time for gas & air, my placenta wouldn't come out after he was born so I had to have manual removal before going to theatre it was the worst pain I have ever experienced in my life that's another reason I wanted c-section to avoid things like this..plus the prolapse is not very nice, it is a inconvenience affecting every day life and I can't risk any more damage..

@onedream Thank you for sharing and I’m sorry you had to go through all that! Totally understand that you don’t want to repeat that or risk more damage again. Best of luck for your c section and new baby!

@Peelspeelspeels thank you and good luck to you too xx

would love to have an update to this thread. Did OP go on to have a natural delivery or a csection?

@Mrsherdington not sure about op but I was In similar position, baby 1 2nd degree tear and episiotomy, baby 2 3rd degree tear, I opted for c-section for baby 3, it's been a year now since the c-section and would definitely choose it again looking back, recovery was ok and now a year on I could not be happier with my decision, it was calm and positive experience with no surprises or with not knowing if I tear again so overall great and I do hope OP ended up with a positive experience too hopefully she replies with update

Thanks for the reply. So happy you had a good experience

I had a 3b tear and luckily for me it healed very well, I am about to give birth again only 16 months later. I am going for another home birth after a very reassuring chat with the consultant midwife who said that there's no guarantee I would tear again and if I did not necessarily as badly. She was more interested in the kind of recovery I had and I think her advice may have been different if there had been issues. I really don't want to be in hospital, I found just going in to get sewn up horrible so really it's a matter of guaranteed hospital with a C-section or chance of hospital with a home birth.

I'm going to post a link to a video that helped me decide what to do. I hope it works!

www.instagram.com/reel/CplFihFNciR/?igshid=OGRjNzg3M2Y=

I posted on this thread originally when trying to decide how to give birth to DC2 after a bad 2nd tear with my first. A women’s health physio I saw during pregnancy (and after) recommended the following risk calculator https://riskcalc.org/UR_CHOICE/
you input your stats and it gives you percentage risks of different outcomes (from various research). Of course it’s no guarantee of anything but if you find numbers helpful to rationalise your decision, it might be worth looking at.

I decided eventually to have another vaginal delivery, mainly because the unknowns of a c section were more daunting for me than the risks associated with a vaginal delivery. I had very clear instructions on my notes about delivering baby slowly and a low threshold for going to c section if it looked like baby wasn’t coming out on her own accord, rather than try instruments. Ended up with a 37 minute labour (induced thankfully so was in hospital!), but the midwives were incredible, delivered baby really, really slowly and carefully with a warm compress on my perineum and I only had a graze on my perineum and a couple of tiny tears near my urethra which required one stitch. Definitely the right decision for me, but it was such a hard one to make - best of luck to anyone reading this!