Vaginal birth after 3rd degree tear

[NeuroticFox1]

Hello I had a third degree tear with my first baby nearly 7 years ago. My second child is due in October and I'd like to have a vaginal birth ideally at home. Has anyone else done this and avoided tearing a second time. I'm very scared of tearing again! My first tear healed really well and haven't really noticed any issues since.

Thanks!

I can't help, but I was going to post this myself so I'm commenting to bump amd follow. My baby will be 28 months when I give birth, I'm due in October as well. I still have occasional pain though, even just standing or sitting hurts sometimes. I really dont want to tear again and have the pain made worse or end up incontinent. I'm really interested in seeing what others opted for.

3rd degree with first. Vaginal
birth and tiny tear with second (13 months later). Same for third ( 23 months after second) same for fourth ( 7 years after third) few stitches each time, healed well, no problems! Was in hospital each time though, not at home ( induced)

I didn’t have a third degree tear (ouch!!!) but I had a second degree tear from my first birth that took 7 months to heal (and my first was a tiny, 10th percentile baby).

I’ve since had 2 more, much larger DCs, and had ZERO tearing at all with them - not even mild grazing. I think partly the body is just less overwhelmed by a second or third birth… not sure if there’s scientific evidence for that, but at least anecdotally virtually everyone I know has found their second labour easier.

Another thing that helped was the midwives doing frequent perineal massages with warm compresses in between contractions… I felt like it really relieved some discomfort in that area, and they said it helps to stretch things out gradually, avoiding tearing. Then, when I started pushing, they applied a lot of olive oil while doing the perineal massage, to provide a bit more lubrication.

My last baby was a giant (9.5lbs with a 95 percentile head). As soon as the midwives realized that, they coached me to do smaller, lighter, gentler pushes. They helped me get him out in a slow, controlled and gradual way, and completely avoided any tearing. Honestly, those midwives were absolute legends.

Congratulations on your pregnancy OP!

I work in this field and so will provide some figures and insight, but only you can decide for yourself whether the risk of another OASI (obstetric anal sphincter injury, i.e. 3rd or 4th degree tear) is outweighed by the benefits of another vaginal delivery instead of a C section. It also depends on how many children you plan on having. It’s fantastic that you’ve not had any issues and healed up well!

As a starting point - The chances of having an OASI is about 6-7%, or 1 in 16 to think of it another way. Older literature gives lower figures which are likely to be inaccurate, as now OASI is better diagnosed as a lot of trusts now actively look much more closely for it and have an “OASI care bundle” in place for every patient to mitigate the risks of OASI and the risks of complications if you do have one.

Midwives etc will tell you that if you tore badly with your first then you probably won’t tear as much with your second. This is sort of true but I think it also obscured the truth. IF you have an OASI with your first vaginal delivery then you are MORE likely to tear severely with your second child than anyone is likely to tear severely with their first. i.e. If you had a severe tear with your first then the risk of a severe tear with you second goes up to about 1 in 10. Yes that means that 9 times out of 10 someone in your position wouldn’t tear, but that’s a risk/benefit only you can weigh up. The bad news about tearing severely a second time is that the outcome (ie pain, incontinence of flatus/urine/faeces) are all likely to be worse the second time. If you have been doing your pelvic floor exercises every day for the last 7 years then this is less likely in the short term. Sadly these issues often don’t come to light (or get significantly worse) until the menopause.

The other option is a delivery in hospital or a C section. The recovery from a planned CS is very very different from an emergency CS, and generally much wiser. Unfortunately the figures are often mixed together… If you deliver in a labour ward then the obstetrician can shine a bright light on all your bits afterward, carefully assess whether any fibres of the anal sphincter are showing (to indicate another OASI) and then carefully oppose them to suture them together for hopefully another good cosmetic and functional outcome.

I hope that some of this helps you to come to a decision that’s right for you. I think that the antenatal consent process for vaginal deliveries is appalling and often minimises the discussion around women’s well founded fears or worries. You will make the right decision for you and your body is powerful and amazing!

I didn’t have a third degree but I had a massive episiotomy that extended into my bottom. Recused to heal, got infected… second birth I just had a small graze on my labia.

The final thing to consider is if you do tear (including “only” a second degree tear, which as others have pointed out can still have severe consequences) would you rather have it repaired in hospital or at home? A poorly repaired second degree tear or episiotomy can have worse consequences than an obstetric anal sphincter injury.

I had an episiotomy with my second and had a successful vaginal delivery 2 years later. I opted for a home birth.

I had a third degree with my first. I went into my second (2 years later) assuming I'd tear again. I was very surprised when I didn't. Not a scratch. The midwife was very impressed at her own sewing skills (I had the same one both times) my second baby was bigger as well at 9lbs3 compared to 9lbs 1

For my second I had a water birth and gave birth on all fours. Both things I've been told reduce your chances of tears.

I al probably not the best person to ask but I had a third degree with my first baby then had DC2 3.5 years later and I’m afraid she came so fast at home without time to get to hospital, that I had another third degree tear…. I haven’t risked a DC3!

However, I did heal very quickly the second time round and have not had any issues 8 years on (fingers crossed).

They told me if I wanted about her baby I’d need a caesarean because of the risk of it again.

*another not ‘about her’

Thanks everyone it's really helpful to hear of your personal experiences, it gives me good hope, especially after healing well from second time around @Onelittlepiglet

@ItsAnOvaryAction can I ask what you do within the field? Interesting to hear your thoughts. I'm interested to know what injury wouldn't be checked with bright lights at a home birth or why you think a repair done at home would likely be done less well than in hospital? I can see why it may not compare to being in surgery but would you say it would be worse to have stitches at home?.I guess they may transfer me anyway? Thanks everyone! Thanks also for tips on compresses and position tbh I think it was the awful position I was asked to be in last time that caused the tear, but who knows!?

I didn’t say in any of the above that it would be worse to have stitches at home. It’s just one of many scenarios that I considered myself when planning whether I wanted to try for a home birth and the answer is different for every woman.

Third degree tear first time . Planned episiotomy second time .

I got myself in a knot trying to decide what to do second time. I kind of wish they just said "because of your previous tear you have to have a c section" rather than gave me the decision because when it's such an unknown. I healed pretty well first time and actually had a really good experience, analgesia was well managed and I got the golden hour with the baby before they took me down. But I'm on a fb support group and some of the mums there are dealing with painful sex and incontinence years on.

In the end I had a vaginal birth with an episiotomy but mostly because I was an expat at the time and A. It cost a lot more to have a c section and B. I had no support from family so was worried about healing from a major abdominal surgery with a toddler and no support. I had so much more pain this time, couldn't sit without a cushion for 2 weeks and went for a bath about 6 times a day to ease my stitches but 2.5 years on everything has healed well and I have very little ongoing problems (except a weak pelvic floor but I can access support when I have time).

I think in the end you have to listen to the advice (have you been offered a consultant appt to discuss?) And then decide what works for your family.

This is a tough call. I’m in the same position (first delivery was a rotational forceps with a giant epis which then tore to the third degree) but my first is only 22 months old. Also a lot of internal lacerations from the rotation. I had a lot of physio to help heal and densensitise the scar tissue and will be having a vaginal birth in hospital any day now! Since you say your tear has healed well and you have no lingering issues (amazing!) I can see why you would want to try for a low-intervention birth.

I think the PP who works in the field raises a valid point about post-partum stitching. A midwife with a torch and some local anaesthetic doesn’t really compare to a surgeon in a theatre with a full range of anaesthesia and equipment. As you say, maybe they would transfer you if they could see that any repair was beyond their expertise but a good stitch job is worth its weight in gold in my opinion. Well worth considering a hospital birth/MLU attached to a hospital for this reason alone!

Can’t get past this post. You still have pain all this time later?? That is awful! Surely there is something that can be done? Please ask your dr.

I had a 3a tear with my first that healed really well. I decided to go for a vaginal birth for my second and had close monitoring during the second stage so that the midwife could advise me when to push and when to pause, I had no tears at all. If you birth in the pool your midwife won’t be able to monitor it as well so I laboured in the pool but got out to push which might be worth thinking about if you were planning on using a pool for a home birth

I had a third degree tear with my first healed well and didn’t tear in subsequent births.

Following this thread with interest!
Also due in October and my DC will be 18 months old by then. Suffered a third degree tear during labour and terrified of it happening again. DC was back to back, and a bloody whopper of a baby at over 10lb, and due to a dodgy epidural I ended up with completely dead and heavy legs so I could only labour on my back. I'm hoping this is the main cause of the tear and if I was in a better position it might not be so bad a second time.
Interesting what a PP said about the midwives not being able to keep an eye on it in the birthing pool, that hadn't even occurred to me, so something worth thinking about.

I had a 3rd degree tear and had my second baby 2 years later . They numbed me and cut me . It was brilliant . I didn't feel her crowning or anything . They stitched me back up and I it was so much more comfortable to heal then the first time round .

Following with interest. I had a 3c tear with my first baby. He was 7lb 4 so not exactly big. I was induced. Labour went well but contractions slowed and was given drip at end and he sort of shot out! I did do perineal massage and pelvic floors religiously.

I have had problems since his birth. The shocking after care thanks to covid didn't help I don't think and have been like with prolapse type symptoms.

I am expecting our second in September and still undecided on mode of delivery. If they could guarantee a second degree or less I would 100% go vaginal again. But unfortunately nothing is guaranteed is it.

Honestly thank my midwife I didn't tear with my second

My midwife was able to monitor me in the pool. She had a mirror and a torch and was looking down there a lot.

My niece had 3rd degree year with first took over 10 months to heal after nasty infection. Baby was 10 lb 2 Oz. With second child she opted for section as worried she would tear again as told it would be large baby again. Baby was 11 lb. No problems after section. She just had third child vaginal delivery 10 days ago, episiotomy but baby smaller 8 lb 1.

I had a 3b tear with my first, rubbish midwife.

Second was born two years later without any problems, but I'd insisted I wanted a more senior midwife this time round given the risk of tearing is higher if you've previously had a serious one. Having the right midwife made all the difference for me- she had the experience and knowledge to get me through the birth safely unlike the first time round.