Are you offered an elective c-section with 2nd pg after 3rd degree tear with first?

[Nellybell]

I had a 3rd degree tear with my first preg that took a long time to heal and left me in a lot of pain. Now I'm pg again and feeling anxious about the birth. I've read that some women have been offered c-sections after experiencing a tear wiht the first and wondered if this is offered as a matter of course to women who have had 3rd degree tears with the first. Does anyone know? I'll be seeing the midwife in a few weeks and I'll ask then but wondered what other people's experiences had been?

I had 3rd degree tear too in October 2005 so I can relate to what you say about it taking a long time to heal. I think it took kme about a year to feel back to normal again, though I've heard from others that they recovered in no time at all. I wonder if it depends on the surgeon...?
I was told I could have a natural birth but they would want to do an episiotomy to make sure I didnt tear as badly again (though I've heard from others that episiotomy is a bad idea as it makes you prone to tearing again). I've thought a lot about whether I can go through with a natural birth ever again- I was traumatised for a long time after my first birth. I'm swaying towards a c-section as at least it guarantees no further damage to your bits and I dont want the risk of being doubly incontinent. I know people will say c-section is a major operation, which of course it is, however how many of these people have been through a third degree tear and suffered for months afterwards in agony while trying to look after a newborn...
Sometimes I think I cant make up my mind! Lots of mumsnetters report having a third degree tear followed by eaiser births where they havent torn as badly, or didnt tear at all. Its so hard to make a decision, so I feel for you!

I had 3rd degree tear with dd1. When I got pg with dd2, I had to see the Consultant to discuss the tear history and I imagine you may have similar. My Consultant advised that, as I had healed well with no incontinence issues, then he was happy for me to go for natural birth with a kind of 'take it as it goes' approach towards episiotomy etc.

And, as it turned out, dd2 was over 1lb heavier yet came out beautifully and I didn't need a single stitch, no episiotomy or anything.

If you really feel strongly, I don't think they would deny you a c-section on these grounds, just don't necessarily talk yourself into it being the only option as a second labour can be VERY different.

If you do not have any bowel problems following the healing of the third degree tear then it is OK to have a vaginal birth. It is no longer recommended to have an elective episiotomy as third degree tears are often associated with episiotomy in the first place.

I have seen many women with previous third degree tears deliver normally with no stitches at all.

Often second babies deliver much easier than the first. It can be harder to have a CS with a toddler around so that is worth considering. No lifting. No driving.

You need to weigh up the pros and cons and discuss it with your midwife/obstetrician. It is unlikley that you would be denied a CS if you felt that was best.

My 2nd pregnancy after a section with twins ended in a 3rd degree tear. DD had a huge head and was in an awkward position. It did heal relatively well though, no incontinence issues.

Next time with ds#3 i had a home birth (planned) and only 2nd degree tear that healed fine. I have gone on to have 2 more births both 2nd degree tears but healed fine.

Thank you for your messages
I had no bowel problems following the tear but it was almost like it had been sewn up too tight and it think it led to fissures as within a few days from coming back from hospital, it was excruciating and bleeding every time I went to the loo. At the 6 week check and a further doc appt I booked they seemed to fob me off a bit as they couldn't see anything wrong and I didn't press the matter as i just wanted to forget about it. It lasted with pain decreasing for about a year and has gone now but now I'm pg again I've realised that it has left me quite traumatised as I keep getting really panicked about the birth and remembering how miserable those first few months after DS's birth were. I know this one could be completely different although I don't think I will be as calm as last time.
Thank you for listening, I feel better for getting this off my chest.

I'm in the process of making the same decision myself. I had a large episiotomy (not a tear) and healed badly, just like you. I have a supportive midwife and when she found out about my last birth (which was traumatic in itself, not counting all the issues since) she immediately offered me an elective CS. I'm not sure I'll take her up on the offer, but it is really reassuring to know that it is there. What I'm doing now is to get a gynae consultant opinion on my scar and whether it will stand up to a VB (as others on here have said, continence since the last delivery seems to be a big issue here) and also I'm going to talk to the people in the hospital where I'd like to deliver. It sounds as though they will be much more respectful of my birth plan than the hospital where I had DD (where I was strapped onto my back with an OP delivery and given an episiotomy without my consent).
Good luck.

Hi!

I had a fourth degree tear which resulted in slight bowel problems and incontinence. I am now preggers again and went to see the consultant. He said that with the tear on its own it would have been fine to have a VB but since my muscles have been damaged and I now have problems it will likely to make a 'managable' problem worse - regardless of whether I would tear again - due to the strain childbirth puts on your muscles. So I guess if you you didn't have any problems after your tear eventually healed they probably won't offer a C-section. Oh and he said I only had a 5% of tearing like that again.

Are you pregnant again MrsTittleMouse?

Yep! Due in October. I've found the past few weeks quite frustrating as (understandably) no-one wants to talk birth plans with me until there is a very good chance that I will actually give birth (i.e. my ultrasound scans are OK). But it means that things are still up in the air, and I think that I'll feel better when I have things sorted in my head.
Unfortunately, although the counselling that I had after DD's birth worked well enough to let me have more fertility treatment, it obviously hasn't taken away the trauma completely as I've found my feelings of anger at being treated so badly coming back again. As things (ahem) swell and shift around a bit, it's pulling on the scar too, which makes it difficult to forget.
So back to the counsellor for me I think!

I had a 3rd degree with dd1 in 05, when I got pregnant again I said I was unhappy to have a natural birth, and after a chat with my consultant was told I could have an elective c section, he did try and convince me to go for a natural birth, saying it wasnt likely to happen again, but in the end he said it was up to me and I went for the c section, for me it was a million times better, and I was up and about and feeling like myself a lot quicker than I had been after dd1.

Congratulations MrsT. I hope that you get the discussions you need and that this next birth is a healing process for you, whatever you decide to do.

As a midwife I would say that most women who have had third degree tears first time around do not have them again. Obviously some of them have sections, but lots of them don't and in 14 years I can only remember one woman who has had more than one third degree tear. In general as Mears said it is not normally necessary to do an episiotomy but of course each woman should be treated individually and it might be appropriate in some cases. The problem with having a cs is that it guarantees a long recovery period, if you go for a vaginal birth you might have a long recovery but you probably will not.

I had an episiotomy AND a 3rd degree tear with DS2's birth (which was also horrendous, had flashback for a long time afterwards).

DS3 I had an amazing labour and birth and only a tiny little tear.....

I had a doula for that one too and I'm sure that was also a major factor in helping my fears subside...

maxbear - I hope you don't mind me asking, but I thought that there was a problem as scar tissue doesn't stretch (which is why mine is complaining now). My episiotomy is a whopper and extends almost to my cervix. Wouldn't that make me more likely to tear next time, as I have this huge ridge of vagina that can't stretch to accomodate birth?

Excuse me responding but although scar tissue may not stretch, the healthy tissue surrounding it will. As it has already been stretched in childbirth, it is more likely to stretch further than a first birth. So although there is a risk of the inital scar tearing, this is offset by the fact the rest of the tissue is more pliable and therefore tearing is less likely.

Often a subsequent birth stretches the area that has been problematic and therefore resolves the existing problem. HTH.

Thank you mears.
I have to admit that all my instincts go against a CS, which is strange because logic tells me that my biggest fear is lack of control, and an elective CS gives me complete control and will ensure that every single discussion that I have with the medical professionals takes place when I am not having contractions and therefore not able to be bullied.
Although, as I pointed out to DH, I have a very bad opinion of OBs, and an elective CS is a sure way of being under the care of one!

I had a 3rd degree tear in Oct 06 with DD1 (after a forceps delivery) and was not offered a CS when I gave birth just under 13 months later in Nov last year. I did have a chat with a doctor (who didn't ask me if I had any incontinence problems) who told me that a vaginal birth was better for me and the baby. I felt quite stressed when I knew I was in labour but I gave birth naturally without tearing.

Good luck!

I had an 'almost' 3rd degree tear and was told by the consultant at my 6 week check that I could have a CS in the future if I want to. I healed fine- really quickly and painlessly, the labour and birth was not at all traumatic or even painful, therefore I will opt to try a natural birth again. TBH I was really surprised that he offered a CS as an option in my case.

Mrs T glad to see that Mears answered your question, I would certainly agree with her (as usual ) I would also say that about 15 - 20 years ago people routinely had episiotomies because they had had a previous one. In my experience currently I would say that lots of women who have had previous episiotomies do not tear at all or only have small tears. I would not necessarily even expect that she would be more likely to tear. Someone like yourself who has had a badly healed tear in the past may be more likely to tear again, but if that tear is sutured well it might even improve things for the long term. (you could ask for a registrar to suture you as you had problems with healing last time) Although midwives are often good at stitching, they don't do it anywhere as much as obstetricians.

Interesting that you feel more in control having a cs? Although I can see where you are coming from, you would not be able to move from the chest down, doesn't seem too in control to me iyswim

Just found this thread and have found helpful, I had 3rd degree tears with dd1 after forceps delivery. Am now 28 weeks pregnant and feel that my insides are falling out with the weight/pressure. What do you think this is?? Also I never felt normal after tear (in 2004) I still feel as my bottom is odd!!!!

rusmum, I had this feeling for ages after my baby was born (I had 3rd degree tear too) and was told the dragging heavy feeling was due to damage to my pelvic muscles, maybe your new pregnancy is putting weight on those muscles. The feelings went away after a few months, hopefully things will improve for you too. Hope you dont mind me asking, but what do you mean by your bottom still feels odd, do you have problems going to the loo??

my friend had an elective c section after 3rd degree tearing and subsequent bowel problems. She made an appointment to see the consultant and had no problems convincing him it was waht she needed

nellybell I don't want to worry you but I had a c-section and ended up with an awful anal fissure. The painkillers made me constipated and everything went a bit wrong down there. It truly was the most miserable and painful time of my life, I barely ate and it took about 4 months to feel ok going to the loo. So if you do get a c-section to avoid tearing the fissure might still come back. Sorry if thats horribly depressing, I just wanted you to know that things still aren't 100% great after a cs. I am pregnant again and just planning on taking as many laxatives as I am allowed after the op, and if neccesary to stop bf to take stool softeners, i can't say i'm not scared I'm afraid!

maxbear - sorry for the delay, I've only just got back to this thread. The point about "being in control" is that normally I'm not bad at standing my ground and arguing my case, but by the time I was the OB last time I'd been in labour forever, vomiting constantly, and was in agony with the contractions (because I'd been forced onto my back with an OP baby). So when the OB bullied me into everything that I didn't want, I was in no position to fight back properly. If I have an elective CS, I will meet the OB as a normal person and be able to argue my case.
I am still nervous that if I go for a natural delivery in the MLU again this time, and if the baby gets stuck again and I end up in the CLU, what is different from my first delivery? If I get another bully, how can I fight? My CMW thinks that I'll be in a better position as I'm likely to have a shorter labour, so I'll be stronger to fight my corner, but that's a big if.

PS Nellybell - sorry for the highjack.

I was offer an elective this time around after 3 degree tear and PPH etc but I refused and I am trying for a home birth (again)