Experiences of labour after a 3rd Degree Tear??

[Gillyan]

Hi

I had a 3rd degree tear with my first baby and have had a 2hr appointment with MW today to dicsuss options this time round. I'm 24wks. I can have an Elective Section if I want. I think I am leaning towards a vaginal birth but MW explained that my last tear was about half a cm away from me needing a colostomoy bag. My idea so far with advice form lovely MW is to maybe have an elective episiotomy ( diagonally) to keep any further tearing away from bum area! I am keen on this as it seems better than a section. MW said that the over all trauma to your body after a section is wosre than giving birth. She also said more complications arise with sections than vaginal deliveries. I found the pain agonising last time but still I don't seem keen on a section. I must be mad...

Can I have any info from you guys on your second time round after a bad tear??? Thanks in advance

Hello Gillyan - I had the same choice to make as you do, in much the same circs (tho my third degree tear sounds not to have been quite as bad as yours). I was undecided right up to the last minute - had c-section booked - but went ahead with a vaginal birth and all was well. Good luck with everything!

Thanks sarimillie I just feel the choice is now between risking a worse tear or just giving up on all of it and having a section. Might just book one in like u did and I quite imagine I'll go into labour before the standard 39wks as had DD at 37wks, and then make my mind up on the day. Did you have any kind of tear at all? I keep thinking that if it's torn once whats to stop it going again??? My DD was only 7.5lbs and she came out normally and I breatheed her out so they don't know why I tore so badly.

Aarrggghhh!!! This sort of scaremongering from HCPs drives me potty! You are less likely to tear with a second baby than with your first even if you tore badly the first time. There is therefore not enough justification for a caesarean at all, nor even a prophylactic episiotomy. Have a look here.

ps. I had a 3rd degree tear first time round (home birth), stitched under spinal (in hospital). 2nd I had a 2nd deg tear stitched at home. 3rd a graze. 4th a small 1st deg tear left unstitched.

Gillyan, sorry to keep posting - don't forget you need to weigh up the risks of major abdominal surgery on your and your baby, as well as looking at the risks of a repeat tear.

Hi lindenlass I have seen that link before when I went searching for info on 3rd degree tears.

I am defo leaning towards a vaginal delivery anyway, don't really want a section - I have been offered one because of the tear last time but also cos I had a really bad hospital experience - no staff, or the ones that were there were horrible, Midwife pulled my notes and said she could tell I was fobbed off at every stage of my labour as they didn't believe I was as far on as I was. When they finally got round to examining me I was 10 cm dilated and baby was is in distress. So been offered it in case I have post traumatic stress...which I don't have and am not bothered about all that as I did it on my own last time so thats not what concerns me now. Just don't want to have a worse tear than last time, anything the same or less will be great. I reckon a well timed episotomy if needed should do the trick so think I'm just going to go for it and fingers crossed.

Glad to hear you had lesser tears 2nd and 3rd time round. I definatly don't see section as an easy option and just don't want to have one at all but just want to be able to poo normally for the rest of my life

Thanks for your advice

Get a Caesarean Section....seriously!

Ooh why?

Hello again Gillyan. With my second, I did have a small tear - it was stitched, but was apparently hardly worth stitching. Like yours, the first birth was traumatic, so I was a bit anxious about the second birth (and especially the worst-case repercussions), but it was a totally different experience.

Had a 3rd degree tear with ds1 and ds2. Ds1 was much worse though and took me a much longer time to recover. After ds2 though I started getting some "bottom" symptoms iykwim, so with dc3 I was advised to have a c section.
Like you I really didn't want one - both previous labours had been extremely fast and ds2 was a home birth. anyway in the end Idecided to have one as I was scared witless of doing any more damage down below.

I was shocked at how painful the recovery from the section was,but now 18 months down the line, Ifeel it was absolutley the right decision, and even wonder if I should have had one for ds2

Og God, totally not sure again what to do..Thanks for your replies. I keep wanting to go for a birth again and then just fretting about the bum thing! Just don't know hoe I am going to decide for certain, maybe I won't decide until the last minute.

I had a third degree tear with ds1 that was stitched under a spinal (missing the first 45 mins of his life is still something I regret :-() I was terrified with ds2 that the same would happen but decided I really didn't want a section. I was advised by my consultant and MW to go for a water birth and try to deliver very slowly. Ds2 decided that he was going to arrive too fast for me to get into the pool but my fab mw (I was in a me led unit) made sure that the delivery was very slow. In the end I got his head out fine but then he just caught me with his shoulder and I ended up having 2 stitches - they did didsucc not stitching it with me but told me that they could tidy up some of the scarring from last time if they did stitch! It wasn't until ds2 was born that I realised just how bad I felt having ds1, the recovery with ds2 was so much easier. Things look very different down there now than they did before I had ds1 but I'm glad I managed a normal delivery.

Thanks bert2e That is kind of what I'm hoping for, midwife said they could press on my perenium to slow everything down. Glad to hear your positive experience. The seperation is awful isn't it! I was in theatre 2 n half hours! Although about 45mins was spent trying to get epidural in - it failed 9 times!!!!

Gillyan, I am vehemently pro natural birth and I too had a 3rd degree tear - having had an active labour I ended up having to stay on my arse and tore 20 mins later. I believe that my bad birth position plus pushing hard were key factors.

After the trauma of a long and arduous recovery I swore that I would rather have a C-section than risk another similar tear. However, 2 years on I have changed my mind. Now that I know the reasons for my tear and what I can do about it, I will take better control of the birth next time around - as suggested in the radmid website, I will stay on all fours no matter what, and make the medics work around me rather than place myself in a position that's convenient for them.

That said, I had a diagonal episiotomy and so the colostomy bag threat was nothing like yours. That is a real problem and so I understand your worry. Perhaps the thing to do would be to have an elective episiotomy and then labour gently on all fours, letting the baby slip out rather than pushing him/her out?

Can you recall what happened in your labour/ birth that might have led to your tear? It's important that you think this through to help you as your decision has to benefit you and you alone.

Also try to find specialists (such as a doula and a midwife) who have different perspectives. Get as much information from them as you can. Marslady is a MNer, a doula and a wonderful woman (who's had 5 babies of her own!), so I'm sure she'd be more than happy to advise you, and help you in the birthing room if you can afford it.

Best of luck.

By the way I've also had an op which was not unlike a C-section - very arduous recovery; would be a flippin nightmare with 2 kids under your feet as well.

How could recovery from a CS be any worse than recovering from a potential 3rd degree tear?

YES a CS is major abdominal surgery BUT it's very well controlled. The sphincter thread on here shows the other side of the story for vaginal birth problems.

When your MW says "the over all trauma to your body after a section is worse than giving birth" and "more complications arise with sections than vaginal deliveries" is she speaking IN GENERAL or tailoring this opinion to your particular medical history? It sounds like the specific trauma to your body is worse than, or at least the same as, the trauma from a CS, without the benefit of it being as controlled as a CS is.

I had an EMCS and it was fine. My tummy area felt bruised but I personally was not in agonies. It just felt sore which I expect those with very bad tears do to (or even those who haven't torn). If I'd have wanted or needed to drive I certainly felt up to it even a week after the CS for example (although I accept the internal mending would still be taking place, I felt fine enough to have done it.

You need a consultant's opinion rather than relying on the MW's opinion.

Although I take MrsMerryHenry's point that CS recovery would be difficult (not impossible) with DC/s to look after.

Then again if you were sofa & rubber ring-bound after the birth due to tearing, tis probably the same difference.

Rubber rings are a bad idea after a tear as they cut off blood supply.

Isn't it still worth it for the relief though?

If it was me i would have a section, i tore badly with dd1 which took 6 months to recover (i may have recovered quicker from a c-section?), i also tore with dd2, not such a bad tear and had it repared under an epidural but my stitches got infected after 2 days and ended up with a huge blood clot under my stitches, couldn't sit down for a week and had to take 3 courses of antibiotics. I did recover within 3 weeks after having dd2. Both my tears were 2nd degree.

Umm...I have the feeling you've said something naughty, but I don't get it! How innocent I am...!

I had a third degree tear just as yours sounds. MW advised vaginal delivery, consultant on balance suggested an elective having had to give 2 women colostomy bags.

In the end I had a vaginal birth, with an epidural to have a very controlled delivery, had a minor tear, no problems. In fact it was brilliant.

However, I am now starting to wonder if made the right choice and if I had a third I would definitely have an elective. What I did not give enough weight to was incontinence in old age. Two years on I am having concerns about the elastisticity of the tissue between vaginal/anal wall and I am about to see my gp.

Jmo, but mws in my experience do not give sufficient though to this issue (just the baby outcome) whilst consultants perhaps see the longer term?

Good point, heated. I have a neighbour who's 96 and has used incontinence pads for years. Chilling thought, and it always makes me keep up my pelvic lifts.

No, nothing naughty MrsMerry, I just did the to show I meant it with humour otherwise it looked a bit confrontational!

Okay, phew! Bless you for considering my feelings!!

You're right about it providing relief, but I used cushions after I was told about the blood supply thing (carried a fat cushion everywhere I went) and it helped a great deal. I also made my own cool pad by putting frozen sweetcorn in a sandwich bag. It's also eco-friendly as you can obviously use the sweetcorn in a salad afterwards.

only kidding!