Natural birth after 3rd degree tear

[lumpybits]

Hello.

There have probably been loads of threads about this, but I just wondered what people's experiences were having a natural birth after a 3rd degree tear?

Saw the consultant this morning and he was advising me to go with a natural delivery as the problems I had in labour last time shouldn't happen again. I agreed but have the option to change my mind nearer the time. Does anyone have any experience with this? I really want to be told it will be fine and that I'll sail through it second time round

I had a home birth after a 3rd degree tear first time around. There was a recent thread on this where plenty of people told very positive stories of second births.

Good luck

Thanks. I'll see if I can track down that thread, along with my endless googling!

I had a 3rd degree tear with DS due purely to the speed of his arrival and the fact that he was "upside down" when he came out as he was back-to-back. 17 months later I was induced with DD and was extremely worried about tearing again but although her birth had its own complications (PPH) I didnt tear at all at least not enough to need stitching anyway.

It will all be fine and you will sail through it

Thanks. I had no problems at all with healing so hopefully even if I do tear it will be OK. It seems that quite a few women with 3rd degree tears aren't even offered a c-section so I guess it's not "standard practice" which is what I had been lead to believe.

I had a 3rd degree tear with DS 2 years ago, which IMO didn't heal very well. DD was born in Jan this year & I had an 'extended 2nd degree' tear. The MW wasn't sure if it was 2nd or 3rd, so a doctor was called & he wasn't sure either, but it was decided that I'd be stitched up in my room because I'd be facing a long wait to go into theatre. Apparently the doctor did an amazing job, my MW said the was always in awe of his work, so all in all not too bad.
Can't say for sure whether the tear with DD was because I tore with DS or because I had a 2 hour labour and a 9lb7oz baby!
I'm all healed now though, and because the doc. decided it infact was 2nd degree I've not had to have physio etc again.

I had emergency forceps with DD due to her position (head stuck side on). Episiotomy tore beyond the cut and I had many internal and external tears. Bladder has never completely recovered and v.weak pelvic floor.

I am going for elcs this time with DC2 so not your happy secondtime story - for me the risks of a vb bad tear when I already have some bladder incontinence are not worth it (do not want to have to deal with bowel incontinence too). I'm concerned I am just someone who is prone to tearing badly and recovering slowly.

All I'd say is make sure you look at longterm outcomes for the different scenarios. Some people have no issues shortterm but then post menopause find their weaknesses exaggerated as the hormonal changes affect them. Push the medics for the whole picture not just the immediate weeks and months post birth.

Good luck weighing the pros and cons!

I've had 2 very positive post 3rd deg tear VBs, BUT I would echo Lovethesea and say, look at the longterm picture, ie, the post-menopausal picture. Ask a colorectal surgeon, not a midwife, they do not deal with the long term sequelae of that kind of damage. Your consultant should be able to refer you. Good luck!

Had a 3rd degree tear 1st time around and generally not a great time, second baby, wonderful delivery, natural, quickish and much less traumatic. I did tear but after last time it felt fine. I was told I just had a small tear and felt quite comfortable so to speak. It was only afterwards that I found out that it had been 2nd degree, I decided that the benefit of a bad time 1st time around meant that anything better this time would feel great, and it did.
Good luck with the second time around, it should be much better for you?

I was told by my very good doctor (who sadly is abroad) that no self respecting doctor would opt for a normal delivery if the baby weighs more than 7.2 pounds and the mother had previous 3rd degree tear. Apparently, the operation that might be needed to sort out the mess afterwards would be more painful and would take much longer to recover from vs c-section.

I think if you where to consider the longterm picture as some has sugested then you would never consdier getting pregant for a seconed time. Just carrying a baby to term will weaken your pelivic flour espicaly if you'd had damage there before. Also if your looking at the piture post menopausal you don't have to have had babies to have problems. My anutie who has never had chirldren has been experancing problems in her late 60's with blader inconternaces,it just seems to be a problem for women regardless of carring children.

I can understand people who've have had bowel incontinence optioning for a section seconed time round. But I'm not prepared to risk a C-section seconed time round just because of my 3ed dgree tear from 1st labour which was probably coused by a forcets delivery. It healed well and I've had no major problems because of it. I think I would be willing to speculate that is was either an unasited birth or a c-section though. As I think the forceps couse the damage 1st time round.

And I can't belive a doctor would recomed a c-section for a baby so small as 7lb 2oz just to avoid tearing seconed time round. You can't tell the size of a baby before it's born sizing scans seem to be very unacurate and the chance of treaing again is actualy quit small when looking at other risk factors.

I think it is important though to realise that women can hit menopause and the huge hormone changes quite early on - I am likely to by the time I am 40 as my mum and nan did. That means I will be dealing with the worsening incontinence in my early 40's (I am 35 now) not some far off future. It is true that many women who have not had children also have issues with this but childbirth does add strains that can make the problem worse/earlier to deal with.

I do not want a third pregnancy or child for a few reasons but actually worsening my health is one of them - so I agree, it did make me consider whether to have a second child. For me the pros of two children outweigh my health risks but I took a planned c-section into account with that decision too.

I can understand people choosing either way forward but I do think the longterm picture is important.

The Royal College of Obstetricians recommends that:

1. All women who sustained an obstetric anal sphincter injury in a previous pregnancy should be counselled about the risk of developing anal incontinence or worsening symptoms with subsequent vaginal delivery.

1. All women who sustained an obstetric anal sphincter injury in a previous pregnancy should be advised that there is no evidence to support the role of prophylactic episiotomy in subsequent pregnancies.

1. All women who have sustained an obstetric anal sphincter injury in a previous pregnancy and who are symptomatic or have abnormal endoanal ultrasonography and/or manometry should have the option of

elective caesarean birth.

Rest of www.rcog.org.uk/files/rcog-corp/uploaded-files/GT29ManagementThirdFourthDegreeTears2007.pdf article here.

If you healed well, have no symptoms etc then it is still important to consider whether it is worth pushing for a scan to check the muscle strength before making a choice on delivery. I can absolutely understand why someone would choose a vb rather than major abdominal surgery, but I would hate for someone to be blindly told it will be fine and then end up dealing with incontinence having never been warned of it's possible occurence.

I have bladder incontinence and it goes up and down in severity. It's only when you are dealing with it day in and day out that you realise how much it affects you - basic life, relationship with partner, ability to do things like drinking water or going out without considering where the toilet will be etc. I know for others with bowel issues too it can be far worse with people unable to continue their jobs, huge strains on relationships and a major hit to self-image and quality of life. There is a thread in general health - ragged bits - for those managing this and the treatments that can be tried.

I recently posted something similar on the Pregnancy board.

I had a 3rd degree tear with DD1, saw a consultant when pregnant with DD2 who told me it wouldn't happen again. I had another 3rd degree tear with DD2.

I am now in early pregnancy with DC3 and MW is going to refer me to a consultant to discuss my options.

Although I have healed ok both times, I am very concerned about the long term impacts.

Not entirely keen on ELCS but am going to keep an open mind and would like the muscle checked before deciding on whether or not to have another VB and risk a third 3rd degree tear yet again.........

I had a 3rd degree tear with DS (2) then had a natural delivery with DD (4months). DD's birth resulted in a 2nd degree tear, BUT she was 9lb 7oz, and my entire labour from start to finish was just under 2 hours - she came VERY quickly, I hardly remember pushing so my tear was probably due to that.
I've healed well this time, and while I was still experiencing pain when emptying my bowles for around 10-11 months after having ds, I was completely back to normal after a couple of months with dd. HTH.