Vaginal birth after 3a tear

[Jimjams24]

I’m expecting my second child in March, and having to decide between a vaginal birth and a c-section. I don’t really know what to do.

When my DS1 was born I was induced on oxytocin. I had a fairly quick 3 hour labour with no pain relief except gas and air for the last 10minutes. However I ended up with a 3a tear. Thankfully I recovered well and haven’t had any ongoing issues.

all through my first pregnancy I was seriously considering an elective c-section over vaginal birth. It was partly because I was really scared of the pain of childbirth (I have a low pain threshold) and partly because I used to work in personal injury law specialising in birth injuries, and the cases I came across were almost always vaginal births. However when it came down to it, I was convinced against a c-section by the consultant in charge and ended up having a vaginal birth. In the end, even though I had a 3a tear and less than ideal birth, I remember feeling so amazed and proud of myself for having done it (which i know probably sounds a bit ridiculous). I can’t really explain it, but it felt like I was on a high afterwards.

however I now have to decide what to do about second pregnancy. Things that are worrying me about having a vaginal birth are

(1) that I had a 3a tear last time. Even though it healed well and no ongoing problems, I’m worried about another tear;
(2) I’m pretty sure I have a small prolapse (right now just an uncomfortable bulge) which i don’t want to get worse. Doctors have said that a vaginal birth shouldn’t increase the risks, but i don’t see how it couldn’t?;
(3) I feel much less prepared than for my first pregnancy. First time round I was doing pelvic floor exercises more frequently, was doing gentle exercise, had been practicing breathing techniques etc from NCT. whereas this time round I feel like I haven’t prepared for giving birth at all, mainly due to working and running around after my toddler.

however i think I’m leaning slightly towards a vaginal birth because (1) this will be our last child, (2) i had problems bonding with my DS1 and in hindsight had PND. I really don’t want to have similar bonding issues again, and I think that’s making me lean towards a more natural way of giving birth, (3) I don’t feel as scared about childbirth this time round because I’ve done it before, but conscious that induction is probably a very different experience, and I was more prepared last time.

i just feel so confused and unsure. It would be good to hear anyone’s views, especially those who had a 3rd degree tear first time round

I had a 3b tear with my first but no tear with my second and a 1st degree with my 3rd. Not guaranteed but my understanding is that tears are most likely in your first birth.

I had 3a and my consultant seems to think I can do a vaginal birth with no issues this time as birth canal is bigger so less likely to tear. Im terrified of being cut open and the recovery from a csection with a then 4 year old wouldn't be ideal as he won't be in nursery for all the 6 weeks (I'm due mid-June and he attends school nursery). I've no real advice just here for solidarity really. I have heard elective sections are very calm and you're not as tired at the end cos you've not had to go through labour but as it's elective your slot can be moved around a bit depending on what's on the list

I was in a similar situation and opted for a section after a 3a tear from a very fast first birth. Turned out to be a good decision as baby was over 10lb! I bonded immediately (much faster than first time), felt really present for the birth and recovery was fine.
I found pain manageable with a vaginal birth (with G&A) but I wasn’t prepared to take the risk of further damage. Discussed it with a couple of doctor friends at the time to help me feel comfortable about my decision.

Obviously be guided by your midwife but I would not be having a CS unless I absolutely needed one with a second child. Remember that the second you are home you will have two small children to care for, not just one. The older child will still be jumping on you and wanting to be carried and you will feel awful if you have to push him off, especially after him missing you while you have been away. You will have to bend and pick up toys, get down on the floor and play with him…all that is hard after major surgery.

Good luck with it all!

I had a 3b tear and ultimately opted for a home birth with my second. Had a minor 1st degree tear - no stitches required and I don’t even remember feeling any pain afterwards.

what helped me decide was really understanding why the tear happened. For me it was a combination of things - I was tired and had a prolonged pushing stage, as well as a forceps delivery and episiotomy. For me, most of this could be mitigated by having a better understanding of birth (I did sort of go into my first just hoping to go with the flow and really only understood the bare minimum) and having a home birth to limit the likelihood of needing an instrumental birth.

really happy I made the decision but it was well informed. and just the right decision for me. Good luck! :)

I’ve done both vaginal and c section. No tear on vaginal and c section was an emergency due to baby distress so quite traumatic.

My bonding experience was the same with both births. I’d say it took me a while to recover from the c sec, but I’d imagine a severe vaginal tear would be similar or harder in terms of recovery.

I'm in the same boat (sort of, 3b tear for the same reasons as @HangryHandful) also due March. It's so tricky but as others have said, and my midwife and consultant also said the same thing, a tear like that is much more likely to happen with your first birth. My midwife also said giving birth again can help with healing / elasticity of the original tear.. no idea if that's true.

No one has a crystal ball though, such a pain 😂

I went into my first birth with my eyes closed and definitely could prepare more this time.. @HangryHandful do you mind sharing how you prepared as it really sounds like it worked for baby 2!

I had a 3a tear with my first and was on the fence about whether to opt for a c section. Throughout most of my pregnancy I was planning to have a vaginal birth as I was worried about the c section recovery whilst also looking after my toddler. I had a scan at 36 weeks and baby was measuring big, plus with a lot of encouragement from others I changed my mind and opted for the c section as I felt like I needed some control.

In the end my waters broke in the evening at 39 weeks and baby came too quickly for the c section. I was completely unprepared (mentally) for a vaginal birth and so I actually found that birth more difficult than my first. I had a second degree tear and was back home within a few hours and had no problems recovering.

Of course!

I did sign up to the positive birth company online course - short modules you can complete any time. I really enjoyed this and they explained birth and what your body is doing really clearly. I found the way they explained the 2 muscle groups in your womb working together really helped me visualise what was happening during labour and why I was feeling what I was feeling.

I practiced pushing exercises and visualised pushing my breath down, rather than pushing a baby out.

I think some of the most useful prep I did was flooding myself with positive birth stories, whether they were vaginal, instrumental or sections. Sustaining a severe tear or a negative experience is unfortunately common but so is having no or very minor tears and really great birth experiences!

I also wrote a really detailed birth plan - not something I did with my first but just layout what I wanted to happen at each point - basically my preference was a home birth, if that couldn’t happen, a midwife unit, if that couldn’t happen labour ward.. I laid out each preference in order of how I’d want it so that if anything changed I felt really well informed of where things were headed next. I laid out preferences for location of labour, pain relief, and at which point I’d accept separation from my baby (I very much struggled being apart when getting stitched in theatre and wish I’d asked to take him with me). The above just really helped me feel prepared in a way I just didn’t first time :)

whilst in labour I really focussed on the fact that the pain had a purpose. And I counted! I paced up and down counting my steps - for some reason that really helped. I think just kept my mind busy and also being upright really helped baby descend down my pelvis too.

hope the rest of your pregnancy goes well & birth, however it happens, is enjoyable!

Thanks everyone, really interesting to hear people’s experiences. It’s reassuring that most people seemed to have less tearing on the second birth, although I suppose nothing is guaranteed.

for anyone who had a c section with a young child at home, how did you find it? Was the recovery ok? It’s strange, I really wanted a c section with my first but after having gone through a vaginal birth, I think I’m leaning toward a vaginal birth

also, interesting point about how understanding what wrong the first time can help to prepare for the second birth. In my case, the midwives didn’t listen to me when I was telling them I was contracting, so they kept increasing the drip resulting in an a shorter but very intense birth. Also, the midwife went out for a chat at the key time when baby was unhelpful, and then when I gave birth i was on my back on the bed. Hoping to avoid these issues the 2nd time round.

part of me is wondering about hiring a doula for the birth so i can guarantee I have support at all the way throughout. But I also just haven’t been as prepared mentally and physically, so maybe a doula can help with keeping me on track mentally when giving birth

Thank you @HangryHandful that is so useful!

@Jimjams24 a doula is a great idea - they can advocate for you if you go through your plan beforehand then you can concentrate on you! Especially if you weren't listened to at points last time.

Hi OP and everyone else :) If you decided to deliver vaginally what was the outcome? Currently in the same situation…

Hey @spicytuna06, I had my baby a few weeks ago and used a lot of the prep @HangryHandfulsuggested.. positive birth videos and mentioned the tear on my birth plan.

Not sure if they helped but also did yoga and the miles circuit a lot towards the end.

Had a vaginal birth and despite it being pretty speedy / chaotic the midwives were all over it and had a hot compress over where I tore before. They were going to do an elective episiotomy away from where the older tear was but there wasn’t time as baby’s head was coming out 😂

The compress did its job though pretty much and I had a second degree tear which healed fine.

Good luck!

So I’ve recently given birth to DS2 and weirdly it was almost an exact repeat of DS1’s birth.

my waters broke but no contractions after 24 hours so they offered either induction with oxytocin or c-section. In the end I opted for induction with oxytocin because I was too worried about c-section recovery with a toddler and I didn’t want to be so unavailable for DS1. However I decided I would be more sensible this time around and ask for an epidural early on. I did that, but ultimately didn’t receive it because the anaesthetist got called into an emergency just before he was meant to do my epidural, and then didn’t turn up again until 7 hours later just as baby’s head was coming out!

They did switch the oxytocin drip off after I asked for an epidural to avoid the pain getting too bad until the epidural was in. However after a few hours I started to contract naturally so they never needed to switch it back on, and i gave birth with just gas and air. The breathing exercises and the Freya app really helped. I hadn’t done much birth preparation at all, but I managed to get through it.

my the last phase of delivery was quick (I think went from 6cm to baby’s head coming out in about 40minutes) so there was no time for a compress etc which they were planning to do. In fact I don’t think the midwife was in the room as baby’s head came out. I ended up with a second degree tear which got infected but now seems to be healing well and so far I haven’t had any other complications.

the birth didn’t go exactly as I was hoping it would, but ultimately I’m happy with the experience. It was incredibly painful, mainly towards the end, but I got through it, and even though things didn’t go to plan it all worked out well in the end. For me personally, I’m also glad I had the experience of a natural birth over a c-section, but that’s a totally personal thing to me and everyone will feel differently about it.

I do think a vaginal birth has more risks to it than a planned c-section, so for me the deciding factors to weigh up were (1) the recovery period from a c-section, especially with a toddler, (2) how important the birth experience was to me, and (3) pain tolerance, just in case you can’t get an epidural (which admittedly is rare).

I think if I wasn’t so worried about the c-section recovery, and the pain aspect of childbirth did really concern me, I would have probably opted for a c-section.

good luck with whatever you decide, I don’t there is any right or wrong. Childbirth is so unpredictable, sometimes you just have to pick a choice and run with it!

I did elective c section because of fears about incontinence and prolapse and tears.

I would get a Physio to advice you on the state of things now and the risk of both. Most people say the second vaginal birth is easier and your muscles have memory of the last so in your shoes I might go for v again to avoid having to recover from c section.

I found the recovery really hard it was difficult to get myself out of bed, it would be so so so difficult to be in that state with a toddler who loves to jump on me!

Sorry just seen update - congrats on your baby !!