WWYD after a third degree tear?

[Anonymous]

I had a complicated delivery w/ my first baby and ended up having a third degree tear. I'm now pregnant w/ my second and wondering whether I should have a C-section to avoid further damage. (I healed nicely and feel quite lucky that I don't have any incontinence issues.) My Dr. said he'd support me either way, but couldn't tell me what my chances of tearing like that (or worse) this time around would be. He did mention that when they polled a group of urologist/gynecologists (board certified in both areas), hands down they said they'd opt for the c-section. I'd prefer another vaginal delivery but am not opposed to a c-section since I learned w/ my first that, for me, the end result is far more important than the process. I'm not looking to earn any medals for a "perfect birth" if it means that I spend the rest of my life wearing adult diapers. Any advice is appreciated!

[Anonymous]

I had forceps and a 3rd degree tear with #2 and delivered #3 vaginally, with an only marginally working epidural. She just popped right out in one push. No episiotomy, no tear, nothing. I was up and about and ready to care for all 3 by the time I was discharged.

[Anonymous]

I opted for a c-section for my second after bad tearing during my first -- and I'm glad I did. I felt like I had enough trauma down there with #1 and didn't want to risk it with #2. Good thing I opted for a c -- since each subsequent baby tends to be larger than the first, and my second happened to be fullterm and nearly nine and a half pounds (and there's no way he would have popped right out like the PP said).

[Anonymous]

I am in the same boat at you, OP. I had fourth degree tearing and am pregnant with baby 2. My doctors offered a c-section, but I think I am still going to try for vaginal. I am hoping to have a better experience this time (like one of the PPs).

[Anonymous]

If you want to birth vaginally, I'd go with a midwife or another care provider who knows how to support the peritoneum and help it stretch. I'd also insist on pushing on your own timetable and not to a forced-march count of 10 -- again, to give that tender skin a chance to slide out of the way.

[Anonymous]

I know people who have had c-sections with their first and vaginal deliveries with their second. Some of the women have had third or fourth degree tears....they'd each prefer the tearing to a c-section.

Also, don't listen to the poster who said each baby tends to be bigger than the first. My first was 9lbs, 3 ounces - born a day before his due date. My second was 9lbs, 2 ounces...but she was 13 days LATE. Had she been born on-time, she would have been closer to 8 lbs.

[Anonymous]

Anonymous wrote:I know people who have had c-sections with their first and vaginal deliveries with their second. Some of the women have had third or fourth degree tears....they'd each prefer the tearing to a c-section.

Also, don't listen to the poster who said each baby tends to be bigger than the first. My first was 9lbs, 3 ounces - born a day before his due date. My second was 9lbs, 2 ounces...but she was 13 days LATE. Had she been born on-time, she would have been closer to 8 lbs.

I had a fourth-degree tear and would never risk repeating that experience. Everyone's different, but I would rather heal from a cut in my stomach that from a tear in my vagina. While I know there's a good chance that my second labor will go better than my first, it's not a chance I'm willing to take, especially having endured a bout of post-partum depression and PTSD that resulted from my dreadful "birth experience." I am not saying everyone should get a C-section - I am only saying that in my circumstances, it's the right choice for me.

[Anonymous]

I had a 3rd degree tear with my first, who was a week late and came out at 8 lbs 13 oz. It was weeks before I could sit down without pain, forget about rolling over in bed. I actually asked my doctor about doing an episiotomy with the second, but she said that I was much less likely to tear at all the second time and she thought I could get away without anything. We did induce DD two days before her due date to avoid another large baby (as it was, she came out at 8 lbs, 2 oz!). It was an extremely easy delivery -- ten pushes and nothing but "skid marks" that required two stitches. I was up walking around later that night and actually showered by myself the next morning.

Good luck with your decision and I hope this delivery is easier!

[Anonymous]

IF you tore bc of the size of the baby, is induction a week or 2 early a viable option? Our OB thought I was going to have a very large baby (10+ lbs) and suggested early induction as an alternative to a c-section. A planned c-section would likely be before your delivery date anyway, so it wouldnt be that different in terms of timing.

[Anonymous]

I had a third degree tear with my first baby--a 9 lbs 5 oz, 95th percentile head baby.
Second baby was 9 lbs 15 oz and also 95th percentile head. That baby slid right out.
OB said the first baby often "paves the way" for subsequent births.
The only tearing I had with my second baby was a first degree tear along where the original third degree tear was.
Just my experience.

[jb112]

I had a 3rd-degree tear with my first baby (8 lb 12 oz) and delivered my second vaginally also (9 lb 7 oz), with a 2nd-degree tear. I healed much faster the second time around than the first. From what I can tell, the situation down there now is no different than it was after baby #1; as in, it's not worse.

[Anonymous]

You just add further damage to your body by cutting into even MORE skin, ligaments, and muscle tissue. You add an entirely new set of trauma to the trauma that has already happened. Unfortunately some doctors, despite all the current medical research, think that cesarean is "just as safe" (or some will even say safer!) than a vaginal delivery. Doctors also do not have any special skills in preventing tears in the first place. Though your doctor *should* have been able to tell you that second babies, almost in every case, come out much more easily and with less tearing than first babies - even if the second baby is larger than the first.

If you are truly serious about determining your risks and your options, you need to seek out the opinion of a care provider who knows how to help you not tear. Go interview a midwife. See what experience she has with second babies and extensive tearing. See what techniques she uses to help prevent a tear. See what the rates are of women she works with tearing the first time and tearing the second time. One midwife you could interview would be Whitney Pinger at Washington Hospital Center. My guess is that if you were to enlist the care of a midwife for your next delivery, there would be little to no tearing the second time around.

As a side note - what caused the tearing the first time? Was it an instrumental delivery? Did the doctor cut an episiotomy (which often extend into bigger tears)? Were you in a position where your legs were stretched WIDE open? Did anyone use warm compresses or warm oil to help you skin stretch? All these things play into how much you tore and how likely a tear is the next time around.

[Anonymous]

Anonymous wrote:
As a side note - what caused the tearing the first time? Was it an instrumental delivery? Did the doctor cut an episiotomy (which often extend into bigger tears)? Were you in a position where your legs were stretched WIDE open? Did anyone use warm compresses or warm oil to help you skin stretch? All these things play into how much you tore and how likely a tear is the next time around.

I just wanted to note that the things listed do not always prevent a tear. I had a 1st degree tear with my first (epi, stirrups, vacuum) and had an identical tear with my second (natural, side lying, not pushing while the head emerged, etc). The trauma was less severe down there, but I think that had to do with pushing an hour the first time and only 5 minutes the second time.

[Anonymous]

OP here-- thanks for all the advice! I'm so thankful to hear other people's experiences. Frankly, it's just nice knowing I'm not the only who tore herself silly down there. For me, it was a little humiliating (or should I say humbling) that it happened despite my and my Dr.'s best efforts to avoid it. The first delivery was a induction that ended up being vacuum-assisted after a very long time pushing w/ little progress. Yes, I took Lamaze so I understood everything there is to know about interventions. Yes, I even saw a midwife who was affiliated with the practice. Yes, the baby still came blazing through w/ the little suction cup on top her head. She's healthy, I'm healthy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:
As a side note - what caused the tearing the first time? Was it an instrumental delivery? Did the doctor cut an episiotomy (which often extend into bigger tears)? Were you in a position where your legs were stretched WIDE open? Did anyone use warm compresses or warm oil to help you skin stretch? All these things play into how much you tore and how likely a tear is the next time around.

I just wanted to note that the things listed do not always prevent a tear. I had a 1st degree tear with my first (epi, stirrups, vacuum) and had an identical tear with my second (natural, side lying, not pushing while the head emerged, etc). The trauma was less severe down there, but I think that had to do with pushing an hour the first time and only 5 minutes the second time.

But, a first degree tear is a small tear. And it sounds like your experience is very normal with regards to first vs. second deliveries - meaning that the first was hard to push out while the second came out quite easily. Congratulations on the good birth!