Still obsessing over/need to talk about 3rd degree tears...

[weebigmamma]

Here is my story with the nitty gritty TMI detail. My hospital are digging their heels in after I requested a section this time round. They keep saying there is no increased risk of having another 3rd degree tear and listing the risks of a section. They have made me feel so confused. So I'm trying to sort out what I really want in order to be clear, once again, the next time I have an appointment. Trying for a section might be worth one last push (so to speak!)

I had my DD 9 year ago. I had a 3rd degree tear and I don't know what grade (a,b or c) and I'm having problems getting my notes from the other hospital to find out. My memory of it is that although I tore badly and had to be taken to theatre for stitches, I repaired very well. I cannot remember having any pain 'down there' afterwards. At all! But I also had other things on my mind as I had major blood pressure problems and breastfeeding was a total disaster and I was on very strong BP meds etc. I had to have 2 anal scans and everyone was satisfied that I healed well. I didn't have any incontinence except I do sometimes now wear Tena Ladys for stress incontinence, but I imagined that this was normal for loads of people who have had a baby.

My consultant now says since I healed well and had no incontinence that a vaginal birth will be completely safe for me. But I really don't another 3rd degree tear and especially not a worse one. I have heard that the risk of another is slightly increased (although the hospital haven't told me this!). I am also a lot older than I was then and although everyone keeps saying that labour is easier the second time around I don't feel like it will be for me. My vagina is not at all stretched (maybe because of the stitches? I don't know, but I know that it's no different to the way it was before I had my DD! Lucky me, but does this not mean that another tear is more likely?) I also had BP problems last time and was induced and my BP has been up and down this pregnancy too.

I know it's not possible to guess what will happen but I'll be so angry if I'm pushed into a vaginal birth and have another tear. I have also heard that pelvic floor probs after 3rd degree tears might not manifest themselves until after menopause! I just don't think I want to risk it, despite the apparent lack of problems I had with the tear the last time. Does anyone know if lack of pain definitely indicates that I wasn't that badly damaged? Surely I must have been if they called me back for 2 anal scans??

I had a 3a tear 3.5years ago. No urinary or faecal incontinence. But consultant agreed to a section very early on in my pregnancy. I'll be having it in April.

Can you ask to see another consultant?

hum. I would say that having to wear Tena ladys is a very good reason to not want a second vaginal birth. I was told no one should have to put up with leakage and endless pelvic floor exercises should sort. if not then you might need intervention. you certainly don't need additional physical trauma.

I'm not a medical expert and this is just my opinion but I would be pushing for a section or at the very least a full exam of the area to assess any damage from last time.

weebigmama I'm here to make you feel better and to reassure you that I know completely how you feel. I had a 3a which was repaired in theatre followed by lots of physio including the physio checking that I could, ahem, squeeze her finger.

DD2 is now 4mo and I spent the entirety of that pregnancy terrified about it happening again. I also thought I didn't feel very stretched afterwards which I put down to stitches and scar tissue.

Your medics are right - there is no greater incidence in people who have had them before and there is no evidence that episiotomies are useful either. That said, in my case the consultant did want to do an episiotomy as the previous tear had been into my sphincter and if that happened again unguarded, it could cause damage that would cause problems much later on. I wasn't keen on a section as I didn't want to have to get over it while running around after DD1.

I had a long conversation with the midwifery team and agreed that I wouldn't necessarily have an episiotomy but that they would be ready to do it and would do it quickly, and without discussion, if they thought it was needed.

So, I went into labour naturally at 40+3. Once my waters broke, the midwife said she would get the kit in case she needed to do the episiotomy. While she was getting it out of the cupboard, I delivered DD2's head, unaided, while lying on my side. With the next push, for which the midwife had managed to get to the end if the bed, she was born. My second stage had lasted four minutes.

I had torn, but only a second degree and they only classed it as that as I'd torn around a little cyst, which I didn't even know was there, which is probably a result of the previous tear. Recovery from the birth was a breeze in comparison to recovering from DD1. Honestly - no comparison.

That's long, but thought a positive story would help.

I had a 4th degree tear with DC1.

I too healed well and anal scans revealed no incontinence but unsurprisingly, the muscles are much weaker than before.

There was absolutely no doubt when speaking to midwives early on in my second pregnancy that I should have a section second time around. The consultant didn't even need convincing. (I had a letter from the birth injuries specialist about future births but didn't even need to show it.)

If you feel reassured that second time round will be different (and my SIL had a third degree tear and had no trouble with her second vaginal birth - done in 15 mins with no stitches!) then that is great. If you are still anxious, I'd ask to speak to the hospital again.

I found the section harder to recover from than the tear, by the way. I hated it and would never lightly recommend a section. But I also think a birth which doesn't end in incontinence is a good thing. So if this is making you anxious, I would ask to talk again to the hospital. Do you have any notes/paperwork/previous doctors who could help you state your case?

I had a third degree tear with my first birth.

I was cut with dc 2 as she was back to back.

Dc 3,4 &5 were vb & no stitches.

Dc6 is 5 days late... I'm worried even after 3 dc with no stitches! I would seek a second opinion. Ultimately this is your pregnancy, baby and body.

Thanks all. I am a bit scared about getting a second opinion. I feel like the hospital probably has an agenda to reduce the no of sections and they'll all say the same thing. yes, Rubyroo, they're treating me like I think a section would be a lovely day out or something. I have no desire to have major abdominal surgery either but I just can't help worrying about possible pelvic floor damage and how that could affect the rest of my life, whereas at least a section wound eventually heals.

Have you asked about an episiotomy? That was going to be done to prevent further pelvic floor damage in my case. Recovery would certainly be easier than from a section. I liked knowing it was there as an option if I needed it. While my second stage was fast, there still would have been time I think.

I cried after I delivered as I was so relieved I hadn't torn - honestly, it is scary but I think it is important to remember that there is no greater chance of it happening this time than the last time and that it only happens in what 2% of cases.

That said, of course, choice in childbirth is so important and therefore you should push (excuse the pun) for what you feel is right for you.

I am confused about statistics. People here are saying there is no increased risk, but this document suggests otherwise:

www.rcog.org.uk/files/rcog-corp/GTG2911022011.pdf

'The risks of a subsequent vaginal delivery after
third-degree tear were examined in four studies,5,49,53,54 which showed between 17% and 24% of
women developed worsening faecal symptoms after a second vaginal delivery.'

Hard not to believe the source!

Having said that, I would really welcome seeing other sources of research/stats that contradict this. It occurred to me following my last appointment that I hadn't asked to see their sources for that information and I am finding them hard to find online.

I'm pretty certain I read there was no increased risk in the NICE guidelines but a very bad night has fuzzed my brain. I certainly read it somewhere as it made me feel better. I'll look tonight if that's ok - currently wrangling non settling DD2 while trying to keep and exuberant 21mo DD1 entertained!

I had a 3rd degree tear 9 years ago. Ds was born 2 years later. Like you, I had concerns. The consultant suggested that a section was not the best option and that in his opinion, I should opt for an episiotomy. I was not really happy about an episiotomy and discussed it with the midwife when I went into labour. We agreed that I would try and go without intervention but at the first sign of a problem, then I would be cut. Ds was born with a 50 minute active labour with no problems.

I had a third degree tear with my ds 3.5 years ago. I had an episiotomy as I was having a ventouse delivery after ds became distressed but the cut tore further and became a third degree tear. I had no incontinence and healed well, but did have several scans and an anal ultrasound in the first year after the birth to check the damage. The specialist (whose entire job was focused on birth injuries) said he'd recommend a caesarean next time as there was a somewhat increased risk of another tear, but more importantly there was a higher risk of incontinence later on after a second vaginal delivery following a severe tear, even if I didn't actually have a bad tear the second time around. He did say that they could always repeat the scans during a second pregnancy to see how my sphincter function was doing after practising my pelvic floor exercises for a few years if I really wanted a vaginal delivery. We're ttc now and I'm pretty sure I'll go for a caesarean (live abroad now so have choice) as I am terrified of being incontinent!

Thanks all. The incontinence is also the thing I am most worried about. I made a complaint about my hospital care last week as it has been crap so far, and tomorrow I have to go and have a meeting with my consultant and the head midwife (who agrees my care has been crap). I'm absolutely bricking it. I have no idea what I want to do and I really don't want to face these people who I made a formal complaint about. But hey ho, just another crappy day! Thank god pregnancy is only 9 months. Never, ever, doing this again. really appreciate all your stories. Thanks.