if you have a 3rd or 4rth degree tear can you tell me if you had a child later through caesaerean or vaginally?

[oranges]

And how you recovered, and what happened? I had a 4th degree tear and healed really well and am dithering now about whether to try again vaginally or go for a caesarean. and did it have any effect on breastfeeding?

Hi oranges, I had CS with DC1 (did have problems bfing but she was 4 weeks early so might explain that). Had 4th degree tear with DC2 (he had his elbow up by his cheek - ow!) . Sutured expertly in theatre and healed well. Now pregnant with DC3 and as healed so well from DC2I would expect to go for another VB despite having mild form of bowel disease which you might think would influence me to go for a CS.

I don't think I'd go for a CS over a VB unless it was strongly recommended by a professional . Good luck!

I had emcs with ds1 after he got distressed.

Had 3rd degree tear with ds2 - was very keen on vbac but nervous about the searing pain on pushing and when threatened with epidural before forceps and poss c/s, I pushed for england and he popped out too fast and I tore.

I had a lot of lack of sensation in the pelvic floor area and some stress incontinence after pooing.

Consultant was very keen I have cs for 3rd baby and I had investigations with bum dr before I got pg. She established that there was quite a bit of nerve damage which was why muscles so weak (hence stress incontinence) and agreed with consultant that I should go for cs.

I reluctantly agreed (dh also v keen in the circs that I didn't risk further damage down there). In my opinion, if bum dr hadn't found so much damage and so clearly recommended cs, I'd have taken the risk and gone for vb. But it is a very personal decision to take that risk!

I established bf pretty well with ds1 and ds2 but took ages for milk to come in with ds3 which was a bit distressing (he was starving poor might). Having said that, was only a few days (!) and my undercarriage is not doing too badly at the mo.

Hope that helps?

can i ask a really wimpish question? for those of you who had both a bad tear and a c-section,
Which was more painful and which took longer to heal? I know the labour was painful last time, and I was sore afterwards but I don't recall anything feeling totally unbearable.

and i really really don't want incontinence problems - i travel for work a lot and "having" to rush to the loo could prove really difficult. i keep thinking that maybe a c-section is better as there's six weeks of pain and then you do heal, whereas things going wrong with a vb can leave lifelong problems. spookycharlotte - were ongoing your problems caused by the first or second tear?

I really, really appreciate your stories. thank you.

Hi,
Am really interested in this thread, am in a similar position.

3rd degree tear with DS who was 9lbs 1. Now 26 weeks with DS 2, I have cholestasis and, after they suspect diabetes after a scan this week showed my fluid levels to be very high. Baby is measuring very big.

Had no huge problems after ds, some problems with stress incontinence but not too bad but I was horrified when my consultant pointed out that I had a prolapsed bladder on my scan.

She suggests CS. I am undecided but scared of another vbac after seeing the damage.

I had a 3rd degeee tear with DS1 - his arm was in the wrong position. Head delivered fine! Repaired in theatre - healed well and no problems since.

I didn't get the option of a CS. I really felt scared about doing it again. Had lots of support from my midwives and consultant and sort of came to terms with the idea.

DS2 delivered vaginally - had a fantastic water birth - got a 2nd degree tear but hardly knew about it afterwards.

Good luck with it all.

I've had a 3rd degree tear with both DD1 and DD2 - second tear was not as bad as the first apparently but still 3rd degree.

DD1 ended up being a forceps delivery and DD2 was a very fast labour and delivery - she popped out 15 minutes after I got to hospital. Both times I have been taken to theatre for repair which I think has helped as they have the right lighting, kit, staffing, etc rather than in the delivery room. Thankfully I seem to have healed well.

I have been told that if I am ever pregnant again (and we would like another), then I will need to see a specialist consultant who will see how well I have healed before they would advise whether I could have a vaginal birth again or if I would need a CS.

Personally, I would prefer a vaginal birth as long as I got repaired again in theatre if another 3rd degree tear happened.

oranges, in answer to your latest question, IMO the healing of a cs is more painful and much longer. However, I was ill after mine as I had a bad haemoragh (sp?!) and had to have a blood transfusion. However, being left with incontinence issues is probably a life-long thing and probably not something you need if you do a lot of travelling. That said a good midwife/doula who understands your concerns I am sure would help you with relaxed and controlled pushing stage! and could assist with necessary cutting in the most appropriate place. Sorry not feeling very technical with words today (in fact feeling bloody awful with early pregnancy, excuse me). And of course, this delivery may be totally problem/tear free!
hope this helps a bit, good luck!

That is just not true. I felt FINE on Day 3 of my elCS.

oranges - re "or those of you who had both a bad tear and a c-section, Which was more painful and which took longer to heal?"

I didn't have a bad tear but a big episiotomy. Horrendous pain for three weeks, pain to the touch for 6 months, and it took about a year for the pain to stop.

ElCS for second baby 7 months ago. Painful the first day (but well managed with painkillers so not a big deal) but I got up and walked a bit that first night. Second day difficult but manageable. And on third day I felt totally fine. Of course, I had to be careful while getting in and out of bed, but I took a shower, picked baby up, nursed him and started badgering consultant to be discharged.

There is no comparison. ElCS was by far the less painful and took much less time to heal (i.e. be pain-free)

well oddly I rang my midwife, who'd been carefully neutral, and if anything, pro vb till now, and said I'd like a c-section. She said straight away - "oh yes, I'd recommend that for you too" and made an appointment for me to see the consultant at 34 weeks to discuss and book in dates. I'll still keep thinking about it till then though.

Hi Oranges, if you are still thinking about a VB til then it might be worth stating in your birth plan your prefernces re:suturing should you need it. Mine stated absolutely NO midwives or SHOs to suture me, SpR or consultant only.

that'a very good idea littlesilver. i'd been fretting about that - never occured to me to put in in a birth plan!

Just stumbled across this mail and I'm in exactly the same predicament. Had a 3rd degree tear, perfectly healed with no fall out, pardon the pun, so counting my blessing. Have friends who had lesser tears and have continued problems. I rec'd fab after care and am due to see Consultant at 20 week scan - currently 14 wks, MW has imtimated that it will be my decisionn ultimately, and as someone has said previous is it 6 weeks of healing or a possible life of incontinence! It's so difficult I want to be out of hospital asap to be with my DS who will be less than 2 when the baby comes. Ohhh, the dilemma - if only crystal balls worked!

Good luck all in the same situ - keep us updated with the decisions.

Regarding differences in healing, I found it less painful after the cs. If I had received the painkillers and after treatment that I got for the cs with the tear, maybe things would have been a bit different. I was just so worried all the time with the tear but knew what to expect with the cs and to take it easy. Not all smooth and lovely though. Cs not taken lightly. Go with your gut.

Don't know if it is the severity of the tear that necessarily always determines whether you have continence issues? If you have nerve damage related to prolonged nerve compression during a slow 2nd stage, you might not have a severe tear but could have worse incontinence problems than someone who was expertly repaired after a more severe tear.
I think all these issues are hugely under-discussed ante-natally. I had no idea of the prevalence of continence issues in young women.
I owe a huge amount to the wonderful physio who helped me to recover sufficient pelvic floor function that I no longer leak just walking along. At my last appointment she told me she hoped to TTC again soon having had a still birth. She wasn't trivialising my problems by comparison but it did make me re-evaluate mine and ds1's birth outcomes.
In my case Ds2's arrival didn't worsen matters - am now TTC dc3 and am already apprehensive about what effect another pregancy may have.

No I didn't realise continence was such an issue among women either. And what shocked me more is that I think the medical profession often feel that a woman being left with a mild continence problems after a birth isn't that much of an issue, and don't feel the need to warn women of the risks.

I think my main concern about a natural birth is that I may be left incontinent. I spent 6 months after the birth of DS doing exercises etc to regain normal continence and now I am pg again I am struggling with the extra pressure on my pelvic floor.

I spoke to my Dr after having DS and she was pretty dismissive. Basically asked me what did I expect after a big baby? I never mentioned the othe problems which I found out last week were as a result of having a prolapsed bladder.

I can't even bring myself to tell DH.

I am very worried about having a CS but am equally worried about the possible consequences of a vaginal delivery.

At the mo I am leaning toward a CS. My thoughts being that may need surgery anyway if I risk a natural birth, so possibly having to suffer consequences anyway and still have surgery whereas with a CS I will have surgery but hopefully less side effects.

mybabywakesupsinging (top name, hope it's true) - that's very interesting (theory?) about long second stage causing nerve damage through compression.

I had v long second stage, mainly on my back (preferred position of MW I seem to recall ). I only managed to push ds2 out (and secure 3rd degree tear) after getting out of bed and getting onto all fours for a few mins, then getting back into bed so registrar could have a quick look prior to epidural - which turned out to be unnec. as ds2 shot out at her...

Have to say that the next day I felt like I'd done a marathon (think it was all that breathing!)

Also, think I healed v quickly from elcs - when off any serious painkillers, I was soon 'forgetting' to take the paracetemol they left me (I was ALWAYS trying to feed poor old ds3 and my milk only came in on the last day in hosp, day 3 I think)

Hi oranges, have only read your OP as I need to dash!

A friend of mine had a 3rd degree with DC1, then 2nd degree with DC2. Vaginal, obviously.

Another friend had 3rd degree with DC1 and then I think no more than 1st degree with DC2.

I had 3rd degree with DC1 and am planning a homebirth for DC2. Also a friend has given me access to midwives' medical papers (I need to search through the website first to find the relevant articles) so that I can do further research. If you like I'm more than happy to share the info with me - just CAT me and let me know when you're due so I don't leave it too late for you!

IMO the key is knowing why you tore the first time round - I believe there were specific, avoidable causes of my first tear (including giving birth sitting down - terrible, terrible position for mother and baby), which is why I have total confidence in my ability to have a homebirth.

Finally, don't let medics put you off having a vaginal birth - medically speaking, having had a major tear the first time around does not guarantee that you'll have a bad tear subsequently. Usually (I have this on good advice) when medics try to put you off things that are actually not a problem, it means that they just don't have experience in that area. So why the hell don't they refer you to someone that does ?? Patient's best interests and all that. Anyway I'm glad you have two different opinions from your mws.

You need to be allowed to give birth 'gently' - i.e. allowing your vaginal muscle reflexes to push the baby out spontaneously. Picture it - when you push/ bear down, you are straining the muscles and putting them under enormous pressure. If, while this is happening, your baby passes along this tensed-up birth canal, it is quite obvious why you'd be more likely to tear than if you are not straining but allowing your body to do what it knows best. This is why giving birth on your back/ bum is so awful - it massively limits your body's ability to push the baby out spontaneously.

Ultimately, if there are serious problems, you should obviously do whatever is necessary to protect you and your child. But bear in mind things like (in my case) the fact that being on your back cuts the blood supply to the womb, which can create distress in the infant. Then they tell you 'the baby's in distress, you need to push'. And hey, presto! Tear. What I should have said was: 'In distress, eh? Fine, let me get off my arse and labour properly, then check the baby's heart rate and see if it improves'.

Also IME if you end up having an OB in the room they will get the baby out, no question, but they will expedite a swift birth rather than doing things in a way that will benefit your body as well as the baby.

Oh, how I'd love to see my (male) OB and the (male) dickhead who stitched me up cope with 9 months of pain and 18 months of screwed-up insides following a 3rd degree tear. Might give them pause for thought next time they're in a birthing room.

Anyway, please excuse my bitter ramblings! Ignore the bile and read all the other stuff! Good luck - and do get in touch about those midwives' documents if you're interested.

Oh, and there's a fab mw on MN (but sorry, I've forgotten her name!) - you could start a thread asking for mws to give you advice.

(bitterness evaporated now)

Has a 3rd degree tear that tore further once home with some initial unpleasant incontinence issues.

Was offered an elective Cesarean but did lots and lots and lots of reading of mw and obstetric reports (having been put in the confusing position between obdurate mws and consultant who were in disagreement)

In the end, I chose to have a guaranteed epidural and vaginal delivery for no2 which was brilliant. If I hadn't been offered that I would have had the elective.

speedy, that would be great, thank you/ I'll cat you. See the problem i have is that last time I was at a hospital with an excellent reputation, but on the day I gave birth, I got overworked, harried agency midwives. And this time round I'm worried I'll put all sorts of things down as requests and that they will simply be ignored again and again I'll be left with no care.

There is no requirement that you must have a birthplan; didn't with the 2nd and they talked to me.

2nd births are traditionally easier and you are much less likely to tear again or tear to the same degree (75% don't). If you laboured fast and tore then an epidural can be beneficial to slow it down and allow you to concentrate on pushing; or look at the rabidmw site for how mw can help re positioning and support of baby's head.

If you do go the vb route, of the 25% of those who do require surgical repair, 75% achieve a good or better result. But if you have had fecal incontinence issues before you should be offered an elective - it's much less clear-cut with urinary incontinence.

A lot of mws only think about the immediate outcome, but you do need to give thought to future continence once post-menopause, as women who have had incontinence issues postnatally are more likely to have problems later - but haven't found a % stat on this.

I would also comment that, as Heated said, midwives seem woefully ignorant of long-term issues that can affect us who have had 3rd/4th degree tears; it seimply isn't within theior range of knowledge and I personally would prefer a colorectal surgeon to advise me and not a midwife, whom I don't believe is placed to do so.

Oranges - have you decided on what to do? I meet with my consultant on Wed and am still unsure.

CoteDAzur - if your retort "that is just not true" was in response to my reply to oranges I am rather bemused by your telling everyone that what I experienced wasn't true. How very rude. I even took the trouble to write In My Opinion and explain that my experience wasn't 'the norm'. I really don't think such remarks are helpful at all.