Nasty 3rd degree tear with DC1 - want another baby naturally. What should I get checked?

[Fidgetsmum]

Hi. DD now 7mths. Failed ventouse, forceps delivery with episiotomy and 3rd degree tear down to bum. Took 4mths to stop being really painful and another 2 months to stop being very uncomfortable. Had infections in stitches twice. But I suffered very little front or back incontinence which went away quickly (unless I push my luck downing a pint of water etc). Now scar is ok, although sore with 'certain marital activities' if you get what I mean. Call me crazy after that birth experience, but I want another baby. Was offered elective cs by consultant who saw me at 13 weeks but I really want natural birth. Have read a few threads on similar topics, but I want to know what I should have checked out before I decide on natural or CS e.g. bum scans, ultrasounds on the scar etc. And also 2nd birth experiences after 3rd deg 1st births. I need to be as sure as possible what risk I am taking with the next dc as if I am very likely to tear and be incontinent, as sad as it will make me, I think I would have to opt for CS. Fed up with being fobbed off my GP so want to go in armed with as much info as possible. Thanks.

Bump - am seeing docs tomorrow afternoon - would love advice before then. Oh, just remembered it's fathers day so everyone's probably a little busy.

I had 3rd degree tear with DS1. I didn't actually have any problems after it though. I think you need to know from your first birth if they know the reason why you tore. I had a HB with my second as my MW told me that they didn't know why I had torn first time so couldn't say if it would happen again.
I ended up having a 2nd degree tear with DS2 so not as bad. My mw said the birth was as controlled as it could have been so I was going to tear whatever, but it was okay.

I would ask for your hospital notes from the first birth and see if your consultant can go through them with you. It sounds though that it may have been becaue the baby came ou so roughly, and you never know the next time it may be easier.
Good luck

Hi Fidgetsmum - I had a 3rd degree tear and I have chosen an elective C-section this time, I am just too scared to repeat my experience, so I guess that my advice is not very helpful to you!

I would not choose a section under any other circumstances and I am very scared of having it done but baby has only two ways out!

I think that you should see a bum specialist, to asses your recovery. It took me 6 months before ahem, "ladies and gentlemen" type activities where comfortable again, but I have no lasting problem with incontinence, do lots of pelvic floor exercises though!

I spent time working with a midwife, she believed that a woman tears this bad because the baby is too big for her pelvis and vagina. I would ask for a scan to determine the baby's size. If it is the same as the first I would ask for a c-section. This is what I would do though, I'm sure there are mnetters that would tell you different.

i think that i would look back in more detail at your first birth, and why a ventouse was necessary.. did you have an epidural? that can increase the risk of an instrumental delivery quite significantly for first time mums. Also, the postion of the baby and your birth position can have an impact.

also, an episiotomy can increase the risk of further , more extensive tearing.

waterbirth can be incredibly helpful in supporting the perineum and allowing tissues to soften and stretch. that is worth bearing in mind.

get lots of opinions and lots of different advice and make yourself aware of pros and cons

women tend to grow the size of baby they can birth , but the way birth is (mis) managed can lead to interventions and issues that might not have occured otherwise

avenap, if a woman was carrying a baby too big too pass through the pelvis, it would not get to the stage of passing through the vagina and causing tearing .

I had a 3rd degree tear with DS1 (ventouse delivery of a 10lb OP baby) and had a probe-up-the-bum ultrasound scan about 10 weeks after to check the repair (no photos were offered to me ). At that stage the consultant said there was no reason for me not to have a natural birth (I laughed at him and informed him there would be no more SmallDragons.

Anyway, my next 2 were vaginal deliveries with 2nd degree tears both times (number 3 was a home waterbirth). I've healed well all 3 times with no problems.

Agree with lulu (as usual)

Your 3rd degree was most likely caused by having a forceps delivery which does not give the tissues any chance to stretch consequently is more likely to extend into the anal sphincter.

If you were to have a normal birth, it is unlikely you will have another 3rd degree, but when I am helping deliver a woman with prev 3rd then I will suggest an episiotomy if it looks like its going to be a repeat of last time. This will 'guide' the cut (tear) away from the back passage. As it happens, I seldom have to do the epis, and I had this same situation a few days ago and she had a small 1st degree tear only. I have never had a 3rd degree tear in the next delivery, (I cant actually remember having seen this ever in fact). I suppose it can happen but very very rare.

Good luck whatever you decide.

I had a 3rd degree tear with DS 2 and then no tear with DS3. Just because you have torn once does not mean you will tear again. Good luck

I have the "birth after nasty epi" fear at the moment (due in October). I have talked to the midwife about it, and the biggest concern seems to be if the previous problems have cause incontinence, as it makes continence problems after the next delivery more likely. That's been backed up by everything that I've read on MN too. So as you (and I) haven't had problems in that area, it looks hopeful that we'll be OK for the next delivery.

I've also kicked up a bit of a fuss about my scar this time around. Partly because I'm still having problems with it (). So I'm seeing the gynae who deals with all the nasty repair jobs to get her opinion on whether the scar will stand up to another vaginal delivery. I'm also planning to see the OB consultant at the delivery suite, and if they both agree that it should be OK then I'll talk to the senior midwife about getting the most natural birth possible and doing everything we can to reduce tearing.

For what it's worth, my birth plan this time around is to have a completely natural birth, or (if things go wrong) a CS. I am not having another instrumental delivery, and am willing to have a CS earlier than strictly necessary to avoid a situation where one might be essential for the health of the baby.

I had 3rd degree tear with dd1, after long labour, hours of pushing, gas and air, episiotomy and ventouse.

With dd2 (who was born only 14 months later)
I was induced, had an epidural, a 6 hour labour, 5 minutes of pushing and a tiny tear.

The best thing I did was find a MW (at the birth centre of our local hospital) who went through my notes with me and made me feel much more confident in my decision to have another vaginal birth (most of the consultants/doctors I saw tried to push me towards a caesarian.)She recommended a water birth, but unfortunately because they found meconium in my waters I couldn't have one.

The most important thing, I think, is that you feel confident in your decision, a close friend who had a similar 1st birth, opted to have a CS, because she had such a fear of tearing again, and I think for her it was definately the best decision.For me I had a bigger fear of CS, so to have a vaginal birth felt right. ( I hope that makes sense)

Good luck

Hi Fidgetsmum, I had a third degree tear with DS1 (ventouse and epesiotomy after very long labour and stalled contractions),and lots of pain for ages afterwards. When I had my second baby, the consultant couldn't work out why I was positively cheerful about my second degree tear until I said I'd had a third degree tear before. Much, much less painful I found, and the stitching seemed to correct some of the discomfort that I had stupidly put up with since DS1 was born. For DD, I gave birth in a different hospital so there wasn't any real medical follow up on what had happened the first time, but I did do some stuff to help when the next pregnancy brought all the memories back more vividly than I'd expected--at about 6 months in the second time, I got a natal hypnotherapy CD to help me feel more in charge of the whole thing and while it was a bit airy-fairy I felt it really helped a lot. The second birth was really a magical experience which in turn helped me to get over the first time. The midwives the second time round were really sensitive to how things had gone before and kept stressing throughout the birth that this would be different and that helped too. Sorry to ramble. I think getting your notes and going through them would be a real help in the whole process of reaching the medical and personal decisions on how best to go forward. Good luck.

I had a third degree tear down to bum too, with ds1 too - ventuse delivery and baby with a huge head. The stitching took hours, though I must admit I was lucky and didn't experience the pain or infections afterwards that you had.

I never considered CS and second time was certainly very different. DS2 was smaller, but everything felt so much stretchier in giving birth - it really was a totally different experience.

I did drink gallons of raspberry leaf tea in the last few weeks, up to the advised quantities, as I read that that softens you up for delivery too.

Best of luck

you need to have a scan of your bottom. They will assess how well the muscles are working by the insertion of a finger for you to squeeze on! They will also assess how well the scar has healed and how weakened your sphincter muscle is at the site of the tear. They will ask you about any incontinence problems. I had all of this after ds and two consultants who carried out the procedure advised me to have a cs. Even though I was asymptomatic-the muscle was weaker at the area of the tear and so was advised that if it tore again-would be a risk of double incontinence. I had a cs with dd and it was great. But I was not prepared to even chance incontinence so it was a no brainer for me.

MrsTittleMouse I am with you on that on that one! Think we have discussed before and on the Oct due thread. I am hoping natural and c-sect if baby not coming No Instruments. It was a cut and tear and a wwrong use of forceps that led me to having my 3rd degree tear

Fidgetsmum I am under a consultant this time around so you will prob be to due to a 3rd degree tear. When you get pregnant your m/w should refer you anyway and they will look at all the factors. Got my appt next week.

meant 'so you will prob be too due to the 3rd degree tear. Sorry my eyes are stinging from hayfever and I cant see much

meant 'so you will prob be too due to the 3rd degree tear. Sorry my eyes are stinging from hayfever and I cant see much

I had a 3rd degree tear too, with DD1 after a failed ventouse and then forceps delivery. I didn't have an episiotomy though. Anyway, I found myself pregnant when DD1 was 4.5 months old. The second birth was lovely, and I didn't tear or need any sort of intervention although DD2 was 4 weeks early so they didn't allow me a waterbirth which I really wanted.

I was never offered a C section at any stage - I'm not sure why as I did/do suffer a bit from 'urgency', nor was I offered a bum scan.

Anyway, DD2s birth was a billion times better than DD1 and I didn't tear of need forceps again.

My 3rd degree tear was from a completely normal, birth, no instruments, in fact the birth was fine apart from the terrible tear, smallish baby too, just over 7lbs, I did all the perineal massage malarkey before hand (as ironically, my biggest fear was tearing, more than the fear of the uncontrollable pain of childbirth, drank the raspberry leaf tea and still tore so I am not risking it again!

Shame as othewise I seem to be very efficient at giving birth, but not very elastic....

Sorry jenwa - didn't mean to repeat myself.
I do find it rather comforting to have someone else with the same plan though. DH is still secretly hankering for me to have a CS I think (as he was so upset seeing me in pain afterwards, and is scared that the perineal problems could be even worse - they're bad enough now ).

Had similar birth with DS1 - delayed 2nd stage (at home), transfer to hospital where they tried (and failed) with ventouse. Spinal & episiotomy for a (successful) forceps delivery (under threat of CS), leaving me with 3rd degree tear too. Some faecal incontinence for first couple of weeks, some pain for following 8-9 months, altogether a horrible experience (but a beautiful 10lb 2oz baby!)

DS2 - consultant had said the baby would be likely to be bigger, I could have an elective CS, should deliver in hospital etc.

I opted for another homebirth, fairly confident that as the first stage of the first labour had been fairly swift and I had managed the pain well. Figured that it would all be a bit looser down there, IFYSWIM. And yes, DS2 (8lbs) born after 2 hours' labour, at home, with no pain relief, and a 2nd degree tear - which was repaired at home by the MW and healed with no probs.

I hope this helps - second natural births are often quicker and easier. The vast majority of complications are with first-timers, so with any luck you will have a less traumatic second time and almost enjoy the experience (if that is the right word!) Good luck.

MrsTittleMouse sorry did not mean it to sound like you were at all just meant i remember you from when we discussed it before. Its good to know that there are a few of us with the same probs and people to discuss it with. Can imagine how your DH feels as think mine the same but I think that if they see the M/W or consultant with you they also get some reassurance from it. It is awful for them as they get to see it all happening.

I just heard from a trainee MW to use wheatgerm on your perinum (sorry cant spell it) to help prevent tears. Will get some tomorrow.

I am planning to do everything this time around - massaging (did it last time ), evening primrose oil, wheatgerm, eating essential oils, labour in water, compress on the perineum, and anything else that anyone suggests may increase my chances of coming out intact.
I certainly can't discuss this with anyone in RL, as I would hate for them to know about my problems with penetrative sex. So thank goodness for MN.

hi,

I had 4th degree tear with my 1st and have had two natural deliveries with no stitches and no tears! Do all that you say and if you possibly can try and make sure you have a supportive and experienced midwife to deliver you - made all the difference to me and I had my second at home - it was a joy! That was after being told by a dr to just have a section and not consider trying any other way.

Bumping for any more opinions. But thank you thank you thank you to all these positive stories, opinions and thoughts. It opened the floodgates a bit, so I think I have some work to do on my emotions, as well as my body. But many of your approaches feel 'right' if that makes sense and I have also really welcomed those of you that chose or are choosing CS as that has also made me feel less worried if I make that choice.

Oh, and Gigglegirl, do you (or they) know why you tore so badly with DC1? And then not with the others? Can they work that out?