Been put on consultant led due to previous third degree tear :(

[soandsosmum]

Had my booking in with my midwife today, second DC, last one was born 11 months ago with a 3rd degree tear. Because of this she has had to put me down as consultant led.

I'd really like a home birth, but of course cant have one if I'm consultant led so I'll have to discuss this with the consultant at my 12 week scan. Sigh. The MW has registered me under a consultant she says is laid back and more inclined than others for natural options. Does anyone have any links or ideas of how I can persuade him to let me be MW-led?

(Also, has anyone got ideas on why it's more risky having a homebirth if you have a higher than average likelihood of tearing? I will have to go in to be sewn up if I tear badly, but I dont think they'll be able to do anything differently in hospital will they?)

Are you sure? My MW said I could opt for a home birth and I'm consultant-led (but I'm only 15 weeks so plenty of time for them to go back on that!)

PS i didn't see a consultant at my scan, my first consultant appointment is at 16 weeks - so don't be surprised if it's just a scan iyswim.

Hi, yes, she was certain that I'll see a consultant at 12 week scan. She said if he is happy to put me as MW led I can homebirth but not otherwise. Such different advise in different places!

I remember seeing consultant at 12 wk scan before as I'd had assisted conception. She signed me off for MW led which I was most thankful for. Simpler all round and saves their time for people who need them :)

I declined consultant led care and planned a homebirth. You do not have to see a consultant.

If you have had a bad tear, you are no more likely to tear again but if you do then it's likely to be another bad tear.

I had 3a tear, PPH and retained placenta first time round. DD was 8lb 2.

I was at home until 2nd stage was delayed, had forceps and no tear...and he was 11lb 7oz!

If its what you want, get on the Yahoo homebirth group for support and advice, but don't feel that you have to see anyone or do anything you don't agree with.

You can see the consultant, listen to what they've got to say. Then tell them you're planning a home birth and listen to what they've to say. Not all consultants are arses and besides if they are, your body your choice.

I had a 3rd degree tear with my ds (it was a home birth). After the birth I was transferred to hospital and had a epidural so I could be stitched by the surgeon.

I then went consultant led for my 2nd birth. The consultant was happy for me to have a home birth again but advised me to write in my birth plan that if there was any sign of any problem during labour that I should be transferred for a cs immediately. This was to ensure that there was minimal chance of an instrumental delivery. I had a successful home birth in the end, with a small tear. I went to hospital to be stitched, just to be on the safe side, but was home within the hour (I just had gas& air and it took the doctor 5 minutes).

I am now pg with dc3 and am consultant led again, basically with the same birth plan as before.

Where you give birth is up to you. Even if you are high risk you can choose to birth at home. Sometimes women have to fight for this, and may need to enlist the support of a local Supervisor of Midwives (SoM) or even the Head of Midwifery (HoM).

This site is fab.

In particular see this bit on previous tears.

Do you know what factors led to your tear last time, or was it just one of those things?

There are some tips here on booking a homebirth if you encounter resistance. Good luck making your decision .

I had a 3rd degree tear on my first. My second delivery was a home birth which again resulted in a 3rd degree tear. After delivering I had to go up to the hospital for an epidural to have the tear repaired.
For my third, i just went for an elective section. My poor perineum couldn't have coped with another mauling

Thanks ladies. Helpful food for thought there.

littleplasticpeople I like your perspective and attitude

pestopenguin great links, thanks

Id really like to find studies looking at probability of tearing again and tearing worse. Can only currently find 'more likely' kind of stats

I'm surprised you'd want a home birth after a thrid degree tear. I also had a third degree tear with my first baby and am pregnant now and was advised to have a c-section as the doctor warned that even if I didn't tear badly another vaginal birth would increase the likelihood of incontinence after menopause. I'm in my early thirties so that's a ways off but the doctor and the pelvic floor physios seemed to be very concerned with the future care of my perineum. Seeing that another person who responded had another third degree tear, I would exercise caution if I were you. Of course, best of luck with a home birth or whatever you choose! I hope it all goes wonderfully with no tears at all! :-)

Oh and I was told by the pelvic floor physio that it was 7 times more likely that I would tear again than the average person. However that still seems to only be around a 7 percent chance of having a third degree tear. But, she said that after a 3b tear it was also more likely to tear to a 4th degree, which just sounds incredibly awful.

I know someone who had 3 homebirths after a 3rd dgree tear with her second child. She had some tearing with each, but not serious and didn't have to transfer to hospital with any of her homebirths. She had at least 2 waterbirths.

I don't know what the evidence is about likelihood of another 3rd degree after the first one. However, the same sorts of measures for preventing any tearing are likely to help in trying to reduce the risk, so getting in good positions (not lying on back), trying to avoid an epidural or other interventions etc. Homebirth is a great way to create the right environment for many of these things , so I can totally see why some women choose it.

Equally, I can also understand why some women prefer not to take a risk with their perineum at all after such a serious injury, and choose to have an elective c-section. It gives greater control, and whilst guaranteeing a full-thickness wound to the abdomen in addition to any residual effects of the original perineal/anal trauma, it does at least avoid the risk of exaccerbating those problems.

Personally, I thankfully narrowly avoided a 3rd degree tear with my first child, although did require layers upon layers of stitches that took a good hour to do, after episiotomy and 2nd degree internal and external tears . I've since had 2 uneventful home waterbirths, with very minor tearing first time requiring no stitches and an unscathed perineum second time .

I was reading this thread with interest as I had a 2nd degree tear (internal only) with my DD & am now pg with DC#2 and considering a homebirth. I am down as MW led care at the mo, but as only 9+4 I've still got a hell of a long way to go.

I am not entirely sure why I tore - I wasn't in the most comfortable position for me (contractions forced me to an all-fours position, so feel it would have been better, but was in the delivery suite & kind of 'forced' into a reclining position - although I didn't think anything of it at the time iyswim) so perhaps that would help next time.

Think you for the information though - I will certainly look into homebirths in more detail. Good luck OP with your pg.