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.

Bumpity bump bump -any more?

Fidgetsmum - just wanted to say say good luck with the birth whichever option you choose, it is such a hard choice to make!

hi fidgetsmum,

tore with DD1 because I was induced and then failed ventouse and finally forceps (had episiotomy as well though) but she was back to back (didn't find out til after delivery) and IMO was induced before she was ready but was first time mum and didn't know anyone else who had kids at that time (and wasn't a mumsnetter!) so just agreed with whatever the dr.s suggested!

Other two were natural labours and the right way round.

That's interesting as DD wasn't back to back, but her back was down my right side so I had front and back labour. They think she flipped to the other side mid labour, but then went back again to the other side. But never to optimal or back to back. So they delivered her sideways, which was why she couldn't get out (38cm head!) In fact, I was told I might have an 'android' shaped pelvis. In fact I think I'll do another thread on that one as I haven't been able to find out much about that. My MW thinks that may have contributed to DD getting stuck. Big head and pelvis shaped like a rectangle with round ends, as opposed to a circle.
And thanks Minnethemoocher - I can't believe I only discovered MN a few weeks ago. It's so helpful to be able to speak to other mums!

I had my 1st baby at the age of 22......most traumatic thing i have ever been through!failed ventous twice and 3rd attempt with forceps came my beautiful daughter weighing just 5lb 8oz! i suffered a 3rd degree tear which scarred so bad that i had to have re-constuctive surgery to repair the damage. I was hospiatlized for 2 weeks in which i had two operations to repair my vagina.
two and half years later i had my 2nd baby by caesarean section, which was my only option or i would be undoing all the work they had done 4 me and it was impossible for me to have normal vaginal delivery due to the extent of the damage i suffer to date with pain and all sorts but i still feel it was a small price to pay 4 my 2 beautiful girls!

Very similar experience to chipkid.

I had a scan and my wonderful consultant (who is very pro natural birth - even for breech babies) recommended a c section. I had big hissy fit having had previous homebirths and being somewhat evangelical about them. However the words colostemy (sp?) bag had a sobering effect! Rang the birth centre in Tooting and they agreed with consultant.

Had a truly wonderful c section, calm, relaxed, gentle, and now fully understand why some people choose them. (Don't flame me don't flame me I have at least had home births so can compare - and it is only a personal view......phew!)

Anyway - find out all you can - knowledge os power and make your own decision.

Good luck

Thanks cheesychips. My GP checked me out, and said that until I'm pregnant again, they won't do much, but they will go through all the options again with me then, and then also do a lot more exploratory work to find out about the state of my perineum and bum. I wanted to know all this before I was pregnant, so there wouldn't be all the extra hormones rushing around skewing my take on things, but it seems I will just have to wait.

I laboured very happily at home for 20 hours until it was decided DD was stuck and I was too tired to carry on. I wouldn't hesitate to aim for a home birth again though but it was precisely the incontinence issue that still makes me worried. Not surprisingly.

Sorry - should explain that I am one and same as Fidgetsmum.

I read so many posts about new MNrs having Mumsie type names that to my shame, I bowed to the general concencus and changed my name!

Gosh - I'm such a sheep following a herd!

MrsTittleMouse - I am worried about tearing too after a 3rd degree tear last time and pain/bleeding for months afterwards. It sounds like you know about lots of things to do to prevent tearing, I knew about perineal massage but not evening primrose oil and wheatgerm - what do those do?

According to the senior midwife that I spoke to, the most important thing to stop tearing (apart from not having an instrumental delivery) are to:
Not have coached pushing (like the awful american shows where they scream PUSH at you)
Like the above, to use slow panting and breathing techniques so that you can fight the urge to push at the end and allow the perineum to stretch slowly
She also thinks that a water birth can help prevent perineal damage.

I have been advised to do perineal massage as it can't hurt and could help, but I think that the evidence isn't so good for second births. The evening primrose thing I think is better for ripening the cervix than helping the scar tissue, got the wrong end of the stick there.

Thank you, anything that can help me prevent tearing again is very welcome
I saw the consultant the other day and she was totally unsympathetic to the problems I had arising from the tear, she just said they don't treat women who've had 3rd degree tears any differently to women who haven't and that was it.

Nellybell...that's awful to hear that your consultant was so unsymapthetic. And there is plenty of evidence to suggest that managing a second delivery well can make a big difference to the outcome of the birth. If I were you, I would seek a second opinion and I would also contact AIMS and RADMID:

www.aims.org.uk
www.radmid.demon.co.uk

Both websites are excellent sources of information by midwives, for midwives and mums to be, but I would try to actually contact them somehow and see what they say.

Good luck. Don't resign yourself to having no influence on your next birth. It's YOUR birth so you need to find people to be around you who will support you in the way YOU need supporting. Don't give up.

Oh, and not sure how to link you to a posting... so will try this:

www.mumsnet.com/Talk/1365/135734

It's from a while ago, but some people have some really interesting comments and help. I found it helpful when I was having 'a moment' about the birth of DD and being scared of the next one.

nellybell - that's awful! I had a very unsympathetic consultant too, and my GP was fine to get me a second opinion - you're well within your rights. At the very least there should have been a discussion about continence, as continence issues after the first birth are a good indicator of problems after subsequent births.
In terms of nasty tears/episiotomies and second births, I have now met (in real life and on Mumsnet) many women who had dreadful first births (including women who had to have repair operations) but who have gone on to have really good second deliveries. Hopefully in a couple of months, I will be one.