natural birth after 3c degree tear

[kamath]

Hi. I am expecting my second child but am a bit worried about another natural birth as I tore so badly the first time. I was told at first that I would need a c- section but have now been told I can have a natural birth and even a home one if I like.

Just wondered if anyone had a similar experience and was okay second time round? Not sure what to do for the best .

[Saffron]

A friend of mine had this too. Her 2nd birth was fine.

I would also suggest you start doing labial stretches immediately and continue throughout your pregnancy. If you're around month 7 or 8, consider a course of antenatal acupuncture. (I had mine from Ella Keepax, but Giles Davies is equally good). I did these two things plus raspberry leaf tea late in pregnancy. I was the only one from my NCT group with no intervention and no stitches. Staying active late in pregnancy probably also helps.

Happy birthing! xx

[kamath]

Thank you for the tips. I think the fact I labored in 3 hours, stood up and had a rather large baby didn't help the situation . Not sure what Labial stretches are but will find out.

Just a bit nervous as 3c degree tear was not at all nice

Thanks again

[mrs f]

An epi-no could help.... I'll let you search it rather than describe it on here!

[Saffron]

kamath Wrote:

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Not sure what Labial

> stretches are but will find out.

>

>

>

do a search on "perineal massage"

[Yak]

Second the recommendation for epi-no. All I can say is that it's German & very, um, efficient!

[Lochie]

I'm currently with the Brierley midwives and they handed me a leaflet on the epi-no - so now it is officially endorsed by Kings or seems to be.

http://www.epi-no.co.uk/

Though my MW did say that you are less likely to need it second time around which suggests things are a bit easier (you'd hope so wouldn't you!)

[telemum]

Hi

I had a natural homebirth after a third degree tear. First child at Kings, second under the Lewisham midwives ( I live in SE23). It was one of the best decisions I ever made. Happy to talk to you about it if it helps. Good luck

[Saffron]

Quick glance at epi-no website looks like it's designed to help with perineal stretching exercises and also toning after the birth. It recommends starting around week 37. I would start gentle stretching manually much earlier than this. If you have a surprise delivery at 35 weeks, starting your perineal massage at 37 weeks would have been pointless!!

[theratprincess]

I will be watching this thread with interest. I had a 3b tear and am contemplating whether to have a second child. My tear was caused by a variety of factors: ventouse delivery so no opportunity for things to stretch; baby was large (9lb 4) relative to me and was not optimally positioned - initially ROP and born with his hand under his shoulder. I refused an episiotimy as I had read that tears heal better than cuts and even if they cut you, you can still tear on top of the cut.

I've been doing a bit of research for myself and have the following info:

If you've had a 3rd degree tear, the chances of another 3rd degree tear are increased. 3% of women for first delivery and 5% (also seen 10% somewhere) for 2nd child where first was a 3rd degree tear.

The main issue with giving birth vaginally after a 3rd degree tear is the risk of incontinence in later life. Royal College of Obstetricians advises that if you have had a previous third degree tear you have between a 17% and 24% chance of developing some degree of bowel problems eg incontinence/urgency following a second VB even if you don't tear. http://www.rcog.org.uk/womens-health/clinical-guidance/management-third-and-fourth-degree-perineal-tears-green-top-29 This is the real clincher for me re: opting for an elective section.

Both being pregnant and giving birth vaginally have an impact on existing damage and continence in later life. Things also get worse post menopause when you lose pelvic tone due to hormonal changes.

A gyanae physio that I saw at Kings said that you can have a scan done to assess the extent of the 'deficit' in your perineum. However, what is evident on the physiology does not always reflect reality. People with little damage on the scan can have lots of problems and vice versa.

The physio told me that when pregnant you can ask for a referral to the perineal clinic/gynaecology for advice on birth options, ask for the above scan of the perineum and ask for late scan of the baby to check birth weight. She also said if giving birth vaginally, to focus on perineal massage and on pelvic floor exercises before and after the birth and to ask for a prescription for the hormonal cream to apply asap after the birth to help plump up the tissue and speed up recovery.

Sorry this sounds so negative. Good luck with your decision! It's very hard to know what is the best option.

[Trish]

I had a third degree tear with my first child - she wasn't big (6lb) but needed fast forceps delivery. It was a pretty traumatic experience.

Second time round was as different as it could possibly be - a really positive experience. I was 9cm when the midwives arrived and so comfortable at home decided to try and stay for the birth. Felt totally in control all the time and relaxed. Ended up being transferred to hospital at the eleventh hour because needed a bit of help getting him out. They used a ventouse but I still only suffered a first degree tear, which felt like a scratch confirmed to first time round!!!! Incidentally, I didn't do perineal massage - a few half hearted attempts but quite frankly I couldn't reach!!!!

[Fidgetsmum]

Yes - it IS possible. VERY happy to discuss in more detail with you via PM (I've posted more info in the past on the forum too) but basics of my situation are thus:

First baby - 9lb 2, (I'm 5'2"). Laboured at home for 20hrs - decided to transfer to Kings as baby just not moving (wasn't in distress, but I got to 9cm and no further). Episiotomy, and eventual failed ventouse so subsequent forceps delivery with messy 3rd degree tear. Infected stitches, residual pain on walking, sitting down, lying down, bending over for 12 months, PND.

Second baby - delivered by Brierley. 9lb 14 - delivered with hand up by his head. At home Christmas Eve, labour 3 hours total from first contraction to him landing on the bedroom floor. NO damage. No PND. Back in bed with cup of tea and a bowl of porridge straight after.

I credit my lovely second birth to the following in no particular order:

1) Use of Epi-No - I think it was the main cause of my physical relaxation in labour and birthing

2) Three sessions with Christine Neillands who gave me recordings to listen to - she was EXCELLENT at tailoring hypnobirthing techniques to my specific personality type (I'm not a hippy by any stretch of the imagination (although I probably wish I was!!))

3) the fantastic Brierley midwives who just 'understood' my paralysing fears of childbirth and guided me through.

4) Notes for ALL people due to be present at the birth about what they should and shouldn't precisely say so that it fitted in with my hypnobirthing language (I know that makes me sound like a controlling old hag - but it REALLY made a difference and helped me refocus when I lost my way in transition)

5) Acceptance that I couldn't be 100% sure that it would be ok - but that as long as I did everything possible to make it so, I would be happy accepting whatever was given to me in birthing. And, I thought I would be VERY unlucky to have such a sh*t time again!

Hope that helps - VERY happy to discuss any aspects with you on PM. Particularly the Epi-no which I think is essential both physically and psychologically if you've torn badly before.

(Sorry for use of SHOUTING capital letters - just very passionate that good births can happen after bad)

x

[kamath]

Thank you so much to everyone. Really helpful and will start doing some serious research. I think I just felt very left alone during the labor of my son and as he was 3 weeks early and came so quickly and I was sat on a birthing stool made the whole experience very scary. Then the fact I was off to surgery for 2 hours was rather distressing. I do have a gorgeous 2 year old now though.

Just wont to avoid this happening again . I am with Lanes midwifes and they seem good so far. My last experience was at st Thomas's and not only bad labor but awful after care.

Anyway I do understand how busy the NHS is and a midwife job is very hard. Don't want to be all negative just feel best advice is from those who it has happened to so Thank you again for all your help x x

[Saffron]

kamath Wrote:

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> Anyway I do understand how busy the NHS is and a

> midwife job is very hard.

That's very true indeed. Many midwives are working long hours with a heavy patient load. Have you considered hiring a doula who has experience with ladies in your situation? You can get some very good recommendations off this forum I'm sure! A doula will be at your side throughout, and she could help you feel the most comfortable and secure (physically or emotionally), whichever birth options you choose. xx

[kamath]

I have . Will look into and how expensive it is!! Thank you x

[mrs f]

To be honest if you are with the lanes I wouldn't bother with a doula as they are so amazing!

[kamath]

Really please to hear that. So far so good .

[chrism]

Hi - I had a 3rd degree tear with first baby - a whopping 10 and a half pounds, with ventouse (failed) then forceps delivery. Amazingly I never experienced any vaginal pain afterwards. I did religiously sit in a bowl of warm water with healing herbs that a hippy friends gave me - I have no idea whether this was any help. Second child I had at home, naturally, and tore again in the same place. That said, it was a fantastic birth with baby very calm, and the midwives I had were brilliant - totally reassuring (from Albany, which I don't think is independent any more). I did have to go hospital afterwards but my fab midwife stayed with me throughout and the overall experience was fine. Maybe I'm lucky, but I didn't have any pain, and no incontinence issues so far (I did do lots of pelvic floor exercises afterwards and still do when I remember). Second babe was also 10 and half pounds and I am 5 foot 3 in!!

[Sol]

I had two vaginal births and didn't have any tearing, I did lots of squatting and knealing when I was pregnant and when I was giving birth and used the following cream from Neals yard

http://www.nealsyardremedies.com/Mothers-Balm

I put it in my breast and belly all the pregnancy and in the vagina from week 32

[jollybaby]

This thread is making me cross my legs!

[Ruth_Baldock]

And me! I thought a c/s scar and stitches was bad enough! Really feeling for lots of the ladies posting on here!

[theratprincess]

There has been a a bit of discussion above of various lotions and potions and gadgets that might help prevent a tear. I wouldn't rule any of them out altogether, but I am doubtful if they would have made any difference for me. Even for perineal massage, there is no conclusive evidence that it will prevent a tear but it's still worth doing, just in case (this is what my Lanes midwife told me).

The risk factors for a 3rd/4th degree tear identified by the Royal College are:

birth weight over 4 kg

persistent occipitoposterior position

nulliparity

induction of labour

epidural

second stage longer than 1 hour

shoulder dystocia

midline episiotomy

forceps delivery

I say all of this because one source of anguish for me has been the question of why did it happen to me and what could I have done differently. The reality is that most of the above factors are well beyond your control.

The good news is that for second timers two of the above factors can either be dismissed (nulliparity) or have a very reduced risk (assisted delivery). Re: assisted delivery, the consultant I saw in the perineal clinic the chances of an assisted delivery second time around are very small.

I also wanted to add, in case anyone is reading this who is recovering from a 3rd degree tear, that although I spent a while in surgery after my son's birth and lost a fair bit of blood, my physical recovery was quick, painless and straightforward. I am completely asymptomatic.

[Saffron]

I read an article stating that raspberry leaf tea or tablet was associated with a decreased likelihood of assissted delivery. I will look for the article if anyone is interested. I think one reason that many of the approaches mentioned don't have much research support behind them is simply due to the fact that studies have not been done and/or the treatments are new so not a wealth of data available yet.

[eliza]

I know several women who had 3c tears and then went on to suffer equivalent trauma in a second birth. You need to think about your health and that or your baby. You can't ensure that you will have a good natural birth second time around just because a few women say that this was their experience. Plenty of women will say that this was not their experience. If you find out that you're going to have another big baby then do consider an elective caesarian. I've had 2 elective caesarians - quite different from emergency ones - and both were great experiences, really calm and stress free. I recovered from both very swiftly and with negligible pain due to good painkillers (much less pain than a vaginal delivery). In the end what matters is having a healthy baby and not having major recovery problems yourself. This holy grail of natural childbirth turns having a baby into a competitive sport. I have a friend who ended up doubly incontinent in precisely the situation you are in now. She rejected having a caesarian the second time round as her friends 'disapproved'. She wasn't able to have sex for 2 years due to the physical and psychological trauma. You may be lucky if you go for a vaginal delivery - like a few of the posters here - but you may not. You can't ensure the outcome you desire however much you follow all the advice about squats, perineal massage and raspberry tea. Good luck with whatever decision you make.

[Saffron]

eliza Wrote:

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> ..... You

> can't ensure the outcome you desire however much

> you follow all the advice about squats, perineal

> massage and raspberry tea.

Incidentally the same is true for elective caesarian. So preparing yourself mentally to accept that some things are always going to be beyond your control is one of the most helpful tactics you can have for having a safe birth and quick postpartum recovery. xx